A senior surgeon has gone on trial accused of fraud, forgery and sending a malicious letter falsely accusing a colleague of sexually abusing a patient.
Mohammed Suhaib Sait is said to have submitted inflated claims running into the thousands of pounds to insurance companies while working at the private Fawkham Manor Hospital.
When colleagues at the Longfield-based clinic became suspicious, it is alleged Sait produced two fake letters from AXA and Aviva proving his innocence.
But fellow orthopaedic surgeon Michael Thilagarajah remained suspicious and pursued the matter when bosses cleared the 61-year-old.
The jury, which is sitting at the Nightingale Court at Maidstone’s Mecure Hotel, was told the alleged offences go back more than a decade.
The Chislehurst resident faces two charges of fraud, two of forgery – namely the two letters – and one of sending a malicious communication.
Sait, who also worked at Darent Valley Hospital, Dartford, denies the charges against him, with the trial expected to take up to three weeks.
The court heard he is alleged to have defrauded AXA between February 2011 and April 2015, and Aviva, from February 2013 to May 2015.
This related to claims for knee surgeries he claimed were more complicated – and expensive – than they were.
Prosecutor Serena Gates told the jury of seven men and five women how in 2015 concerns were raised by a Fawkham Manor staff member about Sait’s billing procedures.
In particular which codes he had used for the insurance providers.
Ms Gates explained how a simpler and cheaper operation was given the code of W8200, while a more involved one to repair the joint was given W8230.
There was between a £100 to £150 difference in price for the procedures, depending on which insurer patients were with.
These concerns led to an investigation from BMI, which owned Fawkham Manor, where initially more than three months of Sait’s billing history was “discretely” compiled.
This was then reviewed by a senior theatre administrator, who found with several procedures the simpler code was originally listed before being changed later to the more complex one.
She also said theatre charge sheets, which included information about the procedure, would usually be with them in the recovery room.
But with Sait’s patients, this would usually be handed over to her the next morning.
The jury heard from the hospital’s executive director at the time, Valerie Power who’d ordered the audit.
The history for the previous business year was also checked and compared to other surgeons who completed similar procedures.
Ms Power said the compiled data showed how the codes for private patients “consistently” changed from W8200 to the more complicated – and expensive – W8230 code.
She wrote to Sait telling him: “We have noticed a number of inconsistencies of codes used where private patients are concerned.”
He replied, telling her that W8200 was a “generic code” used for booking and the procedure could often included “trimming” of the knee joint which could be closer to the W8230 code.
He added he had never had any challenges from medical insurers and always had a high level of satisfaction from his patients, but would change how he billed codes and requested a meeting.
At the meeting, Ms Power and Sait agreed he would contact the insurers and ask them for an email or letter explaining they had agreed to him changing the code.
Two letters were produced at a later date claiming to be from the companies confirming what he’d told BMI and around two months later, the investigation was ended.
Ms Gates alleged these letters were forged by Sait and were dishonestly handed over in an attempt to end the investigation into his conduct.
The matter did not sit well with Dr Thilagarajah, who “doggedly” raised concerns about how robust the investigation into the validity of the letters was.
AXA and Aviva were contacted and said the letters did not come from them as they contained the wrong fonts, signatures, wording and general information.
Dr Thilagarajah, who had replaced Sait as head of the BMI medical advisory committee, was then the centre of “malicious and completely false allegations”.
In 2015, around the same time of the investigation, a Fawkham Manor patient received an anonymous, typed letter from someone claiming to be a nurse.
This accused Dr Thilagarajah of conducting unnecessary operations, doing them badly and sexually assaulting the patient while she was operated on. Ms Gates said these claims were completely malicious and had no basis.
The police were called in and a forensic test on the envelope discovered some of Sait’s DNA.
The court also heard evidence from American-born medic Deborah Koberstein who moved to the UK in 2004 and began working at Fawkham Manor alongside Sait in 2005.
She was a scrubs nurse and would usually be in the theatre with Sait every Wednesday and Saturday along with seven other people including an anaesthetist, porter, runner, and assistants.
Ms Koberstein said scrub nurses were “treated well”, but Sait could be harsher with porters and “bullied them into going as quickly as they could”.
She told the court Sait would seem frustrated if he had to work on knees which were “more diseased and would take longer than usual”.
Ms Koberstein also claimed on multiple occasions when there were no beds for patients to be brought to the surgery room by porters that Sait himself would go to the wards to collect them and sit them outside in a chair.
“We have noticed a number of inconsistencies of codes used where private patients are concerned”
Defending, David Whittaker, suggested this was because there were some patients who were anxious about the procedures and Sait – who would know about their fears through consultations – would go to see them and transport them as a calming factor.
When questioned by Ms Gates, Ms Koberstein told the court she had never seen Sait perform a meniscal repair – the more complicated W8230 procedure.
She added: “It takes special equipment going into the knee to do the correct repair. I’ve never seen him do that.”
The accused, who disputes he was responsible for the note, started working at Darent Valley and Fawkham Manor in 2000.
Fawkham has since closed after it was “no longer commercially viable” to run.
The trial continues.