ICE enforcement shift puts focus on paperwork checks as practices weigh visa cost shock, attorney says

Federal immigration enforcement affecting medical practices has been less about dramatic workplace raids and more about quiet, employer-focused compliance checks, according to an immigration attorney who advises health care employers.

“The biggest shift we’ve seen is more toward employer-focused enforcement issues … less dramatic raids, and more scrutiny of compliance documentation,” said Katie P. Russell, J.D., a partner at Brown Immigration Law, in an interview with Physicians Practice. “It’s … compliance-driven, not operationally disruptive, but it’s still good to make sure you’re in a good position.”

For many practices, that means revisiting the basics such as I-9 employment eligibility forms, record retention and clear internal protocols for what to do if immigration officers arrive.

Russell said she continues to hear from employers who are unfamiliar with the I-9 process, a red flag because the form is required for every employee, including U.S. citizens. “Sometimes I’ll talk to employers and they’re like, ‘Oh, I’m not familiar with that.’ And I’m like, ‘Well, that might be an issue,’” she said.

While audits are “very rare,” Russell said she has received panicked calls from businesses that say they received notice and have “three days to turn in all my I-9s and supporting paperwork.” The better approach, she said, is to be proactive, including internal audits and training refreshers, so a practice is not scrambling under a short deadline.

“This might not be the most exciting thing: we do internal I-9 audits quarterly,” Russell said of her firm’s approach. “We’ve seen enough horror stories that we really encourage employers … just make sure you’re documenting the I-9 paperwork and supporting documentation.”

Training for surprise visits

Beyond paperwork, Russell said some practices are seeking “walkthrough” training to prepare staff for the possibility of a worksite visit, whether by Immigration and Customs Enforcement or other federal immigration officials.

“I’ve been hired by a number of employers recently just to come into offices, come into practices, and sit down and meet with everybody on staff: What happens if ICE shows up?” she said. In those trainings, she said, practices designate a point person and review what documentation can be provided and when legal counsel should be called.

Russell also emphasized that practices should not assume health care is insulated from enforcement. “One common misunderstanding is thinking health care, because it’s critical and essential, is somehow insulated from being held to account with these compliance standards,” she said. “That’s not the case.”

Warrants and patient areas

Russell said confusion persists about warrants, particularly the difference between judicial warrants and administrative warrants, and what access each allows. She described scenarios in which someone arrives with “a piece of paper that may or may not say what it’s supposed to” and asks for access beyond public areas.

Most practices have a publicly accessible portion and restricted spaces, she said, and staff should understand where that line is. In trainings, she said, teams will “literally walk it out: ‘This is open to the public … but beyond this point is the hard line. Don’t grant access unless you have something.’”

In a hypothetical scenario where staff are unsure what kind of warrant an officer is presenting, Russell said the first step is to verify the document and its scope, and to document the interaction.

“First: verify the warrant. Ask for it,” she said. “You need someone trained to look for specific language … look at the issuing authority: Is it … a judge? What’s the scope and what limitations are listed? That will be specified in the warrant.”

‘Insane amounts of money’

Russell also addressed a separate anxiety point for employers that rely on international clinicians, a $100,000 fee tied to some H-1B visa petitions.

“‘Insane amounts of money’ is basically a legal term of art here,” she said, describing the reaction from employers when the change was announced. Russell said her clients initially feared the fee meant “the end of H-1B,” but she said subsequent clarification suggested many employers will not be affected.

Russell described the fee as aimed primarily at cases involving consular processing, meaning workers applying for the visa abroad, while emphasizing that many of her firm’s H-1B cases involve people already in the United States moving from student status into H-1B status.

“The majority of the H-1B processes we do are for folks already in the United States,” she said, describing a common pathway from an F-1 student visa to Optional Practical Training and then H-1B. “That process hasn’t changed. There’s no $100,000 fee for that.”

But for employers bringing in workers from overseas, Russell said the price tag could reshape hiring decisions, particularly for smaller organizations and rural facilities.

Asked who would pay the fee, Russell said it must be paid by the sponsoring employer. “All fees need to be paid by the sponsoring employer,” she said. “That’s a hard pill to swallow.”

Alternatives beyond H-1B

Russell urged practices to avoid assuming H-1B is the only viable route for international hires, particularly if a specific case triggers the new fee or the lottery process.

“H-1B isn’t the only game in town,” she said. “There’s a visa for every letter in the alphabet.” In consultations, she said, her team will brainstorm alternatives that may be less expensive, faster or not subject to certain H-1B constraints.

“It really comes down to: what kind of relationship do you have with counsel?” Russell said, encouraging employers to review each situation rather than repeating the same approach “every year for every worker.”

A practical first step: Get clarity

For practice leaders feeling overwhelmed by enforcement headlines and visa costs, Russell’s advice was to start with information and a plan.

“Knowledge is power,” she said, describing many conversations as reassurance as much as legal guidance. “If you’ve got a problem, I’ll tell you. If you don’t have a problem, I’ll tell you.”

She recommended practices carve out time for a compliance check-in with HR or an administrator, confirm I-9 processes are current, and ensure staff know who to contact if an officer arrives.

“Be informed when you have a minute,” Russell said. “Fit a call in with someone, your counsel, someone you’ve worked with before, maybe someone new, just to get your bases covered and have a plan in place for staff.”