7 ways to protect your practice if ICE shows up

Federal immigration enforcement has returned to the nation’s hospitals and clinics, raising new risks for medical practices that serve diverse communities. The Department of Homeland Security recently ended a Biden-era policy that treated hospitals, schools and churches as “sensitive locations” where Immigration and Customs Enforcement (ICE) could not easily operate, according to Axios.

With ICE once again allowed to make unannounced visits, immigration attorney Katie P. Russell, partner at Brown Immigration Law in Cleveland, Ohio, says preparation is key. “It’s usually unannounced,” she said. “You want to make sure you’re prepared so that element of surprise doesn’t throw you or your staff off.”

Here are seven ways to keep your practice calm, compliant and protected.

1. Designate a single point of contact

Every practice should identify one employee—often the administrator or HR lead—to handle any interaction with law enforcement. “That person should be trained to review documents, communicate professionally, document the visit and contact legal counsel,” Russell said. Name a backup in case the primary contact is out of the office.

If a front-desk employee is approached first, they can politely defer. “It’s fine to say, ‘I’m not authorized to speak with law enforcement. Please give me a few minutes while I contact our compliance officer or attorney,’” she said.

2. Create a written plan

A written policy or checklist ensures staff know what to do and whom to call. Include steps for verifying documents, recording details of the visit and protecting patient areas. “Having a plan makes you look organized and keeps everyone calm,” Russell said.

Keep a printed version in the front-desk area and distribute digital copies to managers.

3. Learn to spot the right kind of warrant

Understanding the difference between an administrative warrant and a judicial warrant can prevent serious missteps.

“An administrative warrant, the kind ICE usually carries, does not authorize entry into private spaces,” Russell said. Those documents are often labeled with “I-” numbers or DHS and ICE seals. Only a judicial warrant—signed by a judge and featuring a court heading—authorizes entry into restricted areas.

Because the two can look similar, Russell recommends regular staff training with sample warrants. “We show practices what these documents look like so no one feels pressured to make a split-second call.”

4. Remember: HIPAA still applies

Even though the “sensitive location” policy was lifted, HIPAA privacy laws remain fully in effect. “HIPAA protects all patient health information, regardless of immigration status,” Russell said.

Agents cannot access treatment rooms or patient records unless they have a judicial warrant, explicit patient consent or a court order that meets HIPAA requirements. According to Axios, some emergency-department staff now cover whiteboards and restrict access to maintain privacy when ICE is nearby.

5. Audit your I-9 files

Every employer must verify the work authorization of each employee through Form I-9. “Doing internal I-9 audits helps you catch issues early,” Russell said. “If ICE does show up, you’ll already have everything organized and accurate.”

Keep all I-9s and supporting documents in one binder or secure digital file, separate from other HR records.

6. Involve your attorney early

Don’t wait for a knock on the door. “Meet with immigration counsel now,” Russell said. “We can review your I-9s, train staff, and map which parts of your office are public versus private.”

If ICE arrives unexpectedly, contact your attorney immediately and request to see any documentation the agents have. “Just hearing that a lawyer is coming by can change the tone of the encounter,” she said.

7. Document everything afterward

Once ICE leaves, write down the details: names and badge numbers of agents, time of visit, what was requested, and copies or photos of any documents shown. “It’s your insurance policy against misunderstanding,” Russell said.

That record will help legal counsel verify that the agents acted within their authority and prepare any needed response.

Bonus tip: Support international physicians proactively

If your practice employs international medical graduates or visa-sponsored physicians, make immigration compliance part of your retention plan. “Know each person’s visa status, renewal dates and options for permanent residency,” Russell said. “If they’re doing great work, look at how to keep them here long-term.”

ICE visits can be intimidating, but preparation keeps them manageable. “Just being prepared—knowing what you can and cannot do—takes a lot of the heat off,” Russell said. “Even if you never use the plan, it’s peace of mind for everyone in the office.”

Listen and learn more

For a deeper dive into how medical practices can prepare for an unexpected ICE visit, listen to Katie P. Russell’s full interview on the Off the Chart podcast. She explains real-world scenarios, common legal pitfalls and how to train staff to stay calm when enforcement agents arrive.