I recently attended a webinar hosted by Littler law firm, featuring immigration attorneys Joshua C. Vaughn and Bruce Buchanan. The topic was one most healthcare employers hope they’ll never need – ICE audits, raids, and employer obligations when immigration enforcement shows up at the door.
Let’s make two things abundantly clear. First, this is not intended to be political. It’s informational. And for healthcare practices, especially those with multi-location operations, staffing challenges, new ownership, or those who hire temps, this is not just a theoretical risk. And second, a disclaimer. I am not an attorney and do not provide legal advice. This is written for educational purposes only. You should absolutely consult with a qualified attorney regarding employment, HIPAA, I-9, and investigation matters.
With that out of the way… what do you do if ICE shows up at your practice?
There are two sides to consider as a practice leader: employer and healthcare provider. Whether ICE is there regarding an employee or a patient carries different obligations, but I specifically want to address the employer considerations (though there may be some overlap). If you’re interested in the HIPAA and patient privacy side, I invite you to review the companion article by Amy Wood of Copper Penny Consulting.
In either case, however planning ahead is more critical than you think. The moment ICE knocks on your door, what you do in the first 10 minutes matters.
First, Understand What “ICE Showing Up” Actually Means
According to Littler’s immigration team, there have been significant changes to the way ICE has operated in the past compared to how they’ve operated in 2025 (and are anticipating this direction to increase in 2026). There are three very different scenarios, and employers often confuse them:
1. ICE I-9 Audit (Notice of Inspection) or No Warrant “Knock and Talk”
This is the most common scenario. ICE delivers a Notice of Inspection (NOI) requiring you to produce I-9 forms and related records, typically within three business days.
This is not a raid. No one is being arrested on the spot. But it is a legal demand, often accompanied by a subpoena. In the past, this has looked like two agents coming out dressed in standard business attire and handing you a notice. Nowadays, there may be three or more agents in full tactical gear, even if it’s just to deliver a notice.
Key Points: Do not panic or waive the three-day window. Immediately contact qualified, immigration-specific legal counsel to understand your exposure.
2. Administrative Warrant
This is issued by the Department of Homeland Security – not a judge – and is typically used to locate a specific individual.
Key Points: An administrative warrant does not give ICE the right to enter non-public areas of your practice without consent (i.e., treatment rooms, private offices, or places where patient information is stored). You are allowed to say no. But you should decide – in advance – with legal counsel, how your practice will respond. You also need to make sure your administrative team members at the front desk are trained on this protocol. If you’re treating a patient when ICE shows up, they won’t just take a seat and wait for you to finish.
3. Judicial Search Warrant (An Actual Raid)
This is the scenario that typically makes the news. It is signed by a federal judge and allows ICE to enter specified areas, seize documents, and detain individuals.
If this happens:
- You do not have time to negotiate.
- You do not interfere.
- You do not coach employees on what to say – or not say – in the moment.
Comply, document everything, and contact counsel immediately.
Where Healthcare Practices Get This Wrong
Healthcare leaders often assume they’re “low risk.” That assumption is dangerous.
While industries like construction, manufacturing, food processing, and staffing companies are historically targeted for I-9 audits and investigations, Buchanan emphasized that home care agencies and other healthcare employers (even dental practices) are increasingly scrutinized, particularly when staffing models resemble labor subcontracting or decentralized hiring.
Most of the mistakes I see practice leaders making involve employment authorization documentation. Common mistakes include:
- Missing I-9s (yes, even one is a problem, and yes, they look at past employees who separated within the past one to two years; your payroll records will be requested)
- Improperly completed I-9 Section 2 certifications (or not filing out the employer portion at all)
- Accepting expired or invalid documents
- Confusing E-Verify participation with I-9 compliance (they are not the same thing) and
- Using electronic I-9 systems without a defensible audit trail (i.e., your payroll company or accounting firm’s system)
One comment from the webinar stuck with me: “If someone in your organization asks ‘What is an I-9?’ during an audit, you’re already in trouble.”
The “Temporary” Problem
This is one of the most frequently occurring issues I’ve seen. Practice leaders hire temps to cover an employee who is out on leave or a gap left when an employee separates. I’ve talked extensively about how this is both an IRS misclassification misstep, a Department of Labor wage and hour problem, and even carries general liability and HIPAA issues. But there can be a serious overlapping issue if the individual is wrongfully hired as an independent contractor and they aren’t authorized to work in the United States.
To be clear, employers aren’t required to have true independent contractors fill out a Form I-9 and verify authorization to work. However, if the individual isn’t authorized to work in the U.S. and it’s deemed that they were misclassified as a contractor to avoid the penalty of hiring an unauthorized individual as an employee – or continued to engage the contractor after the work authorization status was discovered – there can be significant financial penalties as well as the potential for jail time for more serious, intentional violations or patterns of violation.
Why Internal I-9 Audits Matter More Than Ever
ICE audits under prior administrations peaked around 6,000 per year. According to Littler, a significant increase in enforcement is expected in 2026, with increased use of AI-driven reviews before human auditors ever get involved.
Internal I-9 audits – conducted with qualified counsel – are one of the few proactive steps employers can take to reduce risk. Not eliminate it. Reduce it.
Some of the most frequent discoveries I’ve made when discussing this topic with practice leaders are:
- Thinking their payroll company has it covered (they don’t)
- Using expired Form I-9s for new hires, because they’re using a New Hire Packet from an unreliable source
- Not requiring employees to complete a new I-9 immediately following a practice acquisition
Penalties for I-9 errors can range from warning notices to seven-figure fines, depending on patterns, volume, and whether the government believes violations were knowing or systemic. If you’re not 100% certain your onboarding system is compliant, the best time to verify this is yesterday.
What Your Front Desk Team and Office Managers Must Know
With the practice owner often involved in patient treatment or off-site at another location, an ICE agent would typically make first contact with a patient care coordinator, office manager, or other team member at the front desk.
Your team should be trained to – and I can’t stress this enough – calmly:
- Ask the purpose of the visit
- Request and copy any documentation presented
- Limit access to public areas only unless a judicial warrant says otherwise
- Escalate immediately to leadership and legal counsel
- Avoid answering casual or “friendly” questions
Keep in mind – a “knock and talk” is still an enforcement tactic. Even if the agents are polite, it doesn’t mean they’re harmless. Train your team to follow a script. They should be able to ask questions and make statements such as:
“What is the purpose of your visit today?”
“Our clinical areas are considered private. You cannot enter without a judicial warrant signed by a judge. Do you have a judicial warrant?”
“I can’t give you permission to enter. You must speak with my employer.”
Most importantly, your team should know who to contact. If the practice owner is on-site, that’s easy enough. But what if they’re out to lunch, on vacation, or it’s an admin-only day? Who should your team contact? Do they have the number for the immigration attorney? These are questions you want answered before ICE shows up.
A Reality Check for Practice Owners
If your practice…
- Has grown quickly
- Uses temp agencies or contractors
- Has multiple locations where centralized HR, multi-state compliance, or state‑specific rules on cooperation with or refusal of immigration enforcement come into play.
- Has inconsistent (or non-existent) onboarding practices
- Has never audited I-9s
…then conservatively, you should assume some level of exposure. Not from a place of panic, but for the purposes of preparation.
ICE enforcement is not random. It’s methodical, document-driven, and increasingly coordinated across agencies.
Final Thoughts
Immigration compliance decisions – especially around audits, warrants, and enforcement encounters – should be made in consultation with a qualified employment or immigration attorney who understands your specific structure, locations, and risk profile. Your general counsel, real estate attorney, healthcare attorney who drafted the associate contracts, etc. will not likely be helpful in this situation other than to refer you to another attorney. If you’re being audited, do not wait until the day the information is due to try and scrounge up the right type of counsel. Know who you’re going to call and do it immediately.
Preparation is not fear-based leadership. It’s responsible leadership.
If you don’t have a plan for an ICE encounter, now is the time to build one – before someone else builds it for you.
by Kara D. Kelley, CEO of Clinical HR | January 14, 2026 (edited on 01/29/2026 to include the Copper Penny Consulting companion article reference)
*Disclaimer*
This article is provided for general informational and educational purposes only and does not constitute legal advice, tax advice, or professional advice of any kind. No attorney‑client, consultant‑client, or other professional relationship is created by your access to or use of this content. Readers should not act or refrain from acting on the basis of any information contained in this article without seeking advice from qualified legal counsel licensed in the relevant jurisdiction who can consider the specific facts and circumstances of their situation. Any references to third‑party law firms, webinars, attorneys, or publications (including Littler Mendelson P.C. and its attorneys) are for context only and do not constitute sponsorship, endorsement, or approval of this article or its contents by those third parties. Kara D. Kelley, Clinical HR LLC, and any affiliated persons or entities expressly disclaim, to the fullest extent permitted by law, any and all liability for any loss, damage, or adverse consequences arising out of or in connection with the use of or reliance on the information contained in this article. By accessing or using this article, you agree to release, defend, indemnify, and hold harmless Kara D. Kelley, Clinical HR LLC, and their members, managers, employees, and agents from and against any and all claims, liabilities, damages, losses, or expenses (including reasonable attorneys’ fees) arising out of or related to your use of, or reliance on, this content.