Dear Hadi,
Assalamu aleykum wa rahmatullahi wa barakatuh,
Sorry for the long question. Here is the description of the situation:
A Muslim physiotherapist works as an employee in a hospital in Belgium. The duration of each treatment is determined by the government through specific nomenclature based on the patient’s condition. A session can be a minimum of 30 minutes (physiotherapy only) or a multidisciplinary session (physiotherapy, occupational therapy, and/or speech therapy) lasting a minimum of 60, 90, or 120 minutes. Patient reimbursement is around 90%.
However, patients often refuse to complete the full duration of therapy because of fatigue or other reasons, or sometimes colleagues do not provide a full session. For example, a patient whose treatment should last a minimum of 120 minutes might receive only 60 or 90 minutes. Despite this, the session is still registered as 120 minutes and sent to the hospital’s invoicing department.
When the Muslim physiotherapist treats patients, he registers the actual duration of each session and selects the correct nomenclature based on that duration before sending it to the invoicing department. But the head of the physiotherapy department reviews and may change the entries. He also tells the Muslim physiotherapist to register a session of less than 120 minutes (for example, 60 minutes) as 120 minutes. He claims that time spent on administrative tasks also counts as “treatment,” even though these tasks take very little time.
The Muslim physiotherapist does not benefit personally from this practice in any way.
This raises two questions:
1. Does this situation make the physiotherapist’s income haram?
2. Should he leave his current workplace?
Jazakallahu khairan,
Dear Reader,
Thank you for your question. Let us start by saying that we do not believe the physiotherapist’s income is haram or that he needs to harm his livelihood by leaving his current workplace, unless there is a readily available alternative that would be better for him and that he would prefer. The physiotherapist is not the one setting the rules or deciding on the billing practices, and therefore, should not bring harm upon himself for a situation that not only did he not initiate, but which he derives no ancillary benefit from at all.
In this regard, we quote the well-knowh hadith of the Prophet (pbuh):
"There should be neither harming (darar) nor reciprocating harm (dirar)" (Arabic: la darar wa la dirar).
It is considered an authentic (sahih or hasan) hadith, related in collections such as Sunan Ibn Majah and Muwatta Malik.
It is a fundamental maxim in Islamic law which means that one must neither inflict harm upon oneself nor inflict harm upon others, and that harm should not be reciprocated with similar or greater harm. It is used by scholars to derive rulings across various fields of life.
While we do not give fatwas, we feel that the harm that would come from quitting the job under these circumstances is significant, particularly since the hadith is also linked with the general maxim that necessity obviates prohibition, and so if this job is a necessary means of livelihood, and is in general not based on haram or prohibited practices, we see no obvious reason to take responsibility for a situation that is not of one’s making.
That being said, let’s take a closer look at the specific issue you raise.
If there are legitimate reasons for a billing greater than the time actually spent with the patient, then we see no problem with the practice. For example, if the physiotherapist set aside a 90 minute appointment for a patient, but the patient was only able to complete, let’s say 60 or 70 minutes, we don’t think it is problematic to bill for a 90 minute session because the physiotherapist had planned on a 90 minute appointment and in all likelihood would not be able to schedule a last minute 20 or 30 minute appointment with another patient.
Similarly, if preparatory or administrative tasks are legitimately part of the set-aside appointment time, we also don’t see a problem with this time being included in the invoicing, even if it is a bit less than the actual billed time. It can be considered as a general overhead or administrative cost.
However, if the situation goes beyond legitimate circumstances and becomes more a matter of “fraudulent” invoicing, then that is a problem that should be addressed. We are not familiar with the laws of Belgium, but we assume there are, as in the United States, “whistleblower” laws that provide anonymous avenues (as well as protections) for employees to raise such concerns. If you feel that this situation rises to the level of fraudulent business practices, we would encourage you to make use of available resources to raise your concern.
Clearly, you are very conscientiousness and keen on doing the right thing. May God bless you for your efforts.
In peace.