ICE at the Facility: How Healthcare Compliance Of...

Immigration compliance in healthcare has traditionally been associated with back‑office functions such as Form I‑9 completion and record retention. Recently, however, Immigration and Customs Enforcement (ICE) agents have entered hospital facilities seeking specific individuals, which underscores a more immediate reality for healthcare organizations: immigration enforcement can occur unannounced, on‑site, and in the midst of patient care.

In those incidents, healthcare staff reported uncertainty about where ICE agents were permitted without the facility’s consent, how to assess the authority presented, and how to balance enforcement activity with patient privacy and continuity of care. While the circumstances of any individual encounter will vary, the lesson for leadership and compliance officers is consistent—when ICE appears at a healthcare facility, the organization’s response must be deliberate, coordinated, and grounded in a clear understanding of legal boundaries.

Leaked ICE Memo Highlights Enforcement Uncertainty

That need for clarity has been reinforced by a recently leaked ICE memo. The memorandum suggests that agents can rely on arrest warrants or administrative documents to enter private residences and businesses without owner consent. This directive is contrary to longstanding Fourth Amendment case law. These leaked documents underscore why staff and leadership at healthcare facilities must be prepared to evaluate enforcement authority in real time and not assume that documentation presented—such as a removal warrant or administrative arrest form—confers lawful access to clinics. This context reinforces the importance of clear protocols for identification, verification of authority, and escalation to legal counsel when federal agents arrive on site.

In this environment, institutional protocols—not individual judgment—become the primary safeguard against unauthorized access to clinical spaces and improper disclosure of information. The compliance officer’s function serves as the buffer between evolving enforcement practices and the organization’s legal and ethical obligations.

Preparedness is not about anticipating enforcement. It is about ensuring that if it occurs, no one is left improvising in a clinical environment.

Why Healthcare Settings Require a Different Playbook

Hospitals, skilled‑nursing facilities, ambulatory surgical centers, clinics, and all other healthcare facilities operate under constraints unlike those of other employers. Patient care cannot be paused. Protected health information must remain secure. Clinical staff are focused on treatment, not law‑enforcement protocols. And facilities contain a mix of public and private spaces, each governed by different access rules.

When ICE seeks a specific individual at a healthcare facility, these factors collide in real time. Without preparation, well‑intentioned staff may grant access too quickly, disclose information unnecessarily, or escalate fear among patients and employees. Compliance programs exist to prevent exactly that outcome.

The First Rule: Slow Things Down

If ICE agents arrive at a healthcare facility, the most important initial step is to slow the interaction down. Organizations should have a clear protocol requiring front‑desk staff, security personnel, or site managers to immediately contact designated leadership and legal counsel. It is entirely appropriate—and often advisable—to inform agents that institutional policy requires notification of counsel before proceeding. No one needs to panic. No one needs to improvise.

And no one should feel compelled to “helpfully” answer questions on the fly. This approach protects patients, staff, and the organization while ensuring that responses remain consistent and lawful.

Ask for Identification—and Read the Paperwork

ICE agents should be asked to present official credentials. Compliance or legal representatives should also request and carefully review any warrant or documentation presented.

One of the most misunderstood points, including in healthcare settings, is the distinction between different types of warrants:

Administrative or deportation warrants do not authorize a workplace search.
Only a search warrant signed by a judge can permit ICE to enter the business—including lobbies and public areas—without consent.

If a Search Occurs, Know the Boundaries

If agents present a valid search warrant and conduct a search, organizations should respond in a structured manner:

Immediately contact legal counsel.
Designate a single organizational representative to accompany agents.
Do not interfere with lawful activity, but do not consent to actions beyond the scope of the warrant.
Document the encounter, including agent names, time of entry, areas accessed, and items reviewed or seized.
If attorney‑client privileged materials are implicated, identify them as such and request appropriate handling.

Healthcare organizations should also remember what not to do. Employers should never hide employees, assist individuals in leaving the facility to avoid enforcement, destroy records, or provide false information. Those actions create far greater legal exposure than the visit itself. Recent scrutiny of immigration enforcement training practices also underscores the importance of documentation. When enforcement authority is disputed or unclear, contemporaneous records—what documentation was presented, what access was requested, and how the organization responded—may become critical. Healthcare compliance programs should treat on‑site enforcement encounters as reviewable compliance events, subject to internal assessment and, if necessary, external scrutiny.

Protecting Employees and Their Rights

Compliance officers should ensure that employees understand their rights without directing their actions.

In general:

Employees may choose whether to speak with ICE agents.
Employees may request an attorney.
Employees are not required to answer questions about immigration status, country of birth, or how they entered the United States.
Employees are not required to produce documents showing nationality or citizenship.

At the same time, healthcare organizations retain the ability to manage workplace safety and operations. If appropriate, non‑essential staff may be sent home to reduce disruption while leadership manages the situation.

A Note on I‑9 Audits

While on‑site encounters draw the most attention, healthcare organizations should remember that most immigration enforcement still begins with Form I‑9 audits rather than physical visits. If an audit notice is presented, it should be directed immediately to HR leadership and legal counsel. Employees should not respond independently, and the audit should be managed centrally and deliberately.

Preparedness Is a Compliance Function

Recent hospital enforcement incidents did not reveal bad faith by healthcare staff; they revealed uncertainty. That uncertainty is precisely what compliance programs are designed to address.

Now is the time for healthcare organizations to review or create an ICE response protocol tailored to clinical environments; train front‑desk staff, security, managers, and HR on who to contact and what to do; ensure I‑9 records are organized and audit‑ready; and confirm that leadership understands the difference between administrative and judicial warrants. At the same time, organizations should remain attentive to how courts and regulators address these issues, as emerging decisions may materially affect enforcement parameters and compliance expectations.

Think of it like a fire drill. No one expects a fire—but everyone should know where the exits are.

Final Thoughts

Immigration enforcement in healthcare settings raises complex legal, ethical, and operational questions. With clear protocols, informed leadership, and a commitment to patient‑centered care, compliance officers can ensure that unexpected enforcement encounters are handled calmly, lawfully, and consistently.

Preparedness is not about enforcement. It is about protecting patients, supporting staff, and preserving institutional integrity when pressure is highest.

Author Bios

Sarah Bileti is a Partner and Chair of the Immigration Practice Group at Warner Norcross + Judd LLP. She advises U.S. and international companies on business immigration strategy, workforce compliance, and cross‑border talent mobility. Sarah has extensive experience guiding employers through complex visa processes, I‑9 audits, and U.S. market entry. She represents clients across a range of industries, including manufacturing, healthcare, pharmaceuticals, energy, and technology.

Jeff Segal is a Partner and Chair of the Healthcare Practice Group at Warner Norcross + Judd, LLP. He advises health‑care organizations, physicians, and group practices on complex regulatory, compliance, and transactional matters. He counsels clients on issues involving the Anti‑Kickback Statute, the Physician Self‑Referral Law (Stark Law), HIPAA, and state and federal False Claims Acts, providing guidance both in proactive compliance planning and in responding to investigations and alleged non‑compliance. Jeff also has extensive experience with Michigan health‑care licensing and regulatory matters, physician and health‑system contracting, and strategic negotiations. In addition, he advises tax‑exempt organizations on obtaining and maintaining exempt status and ensuring ongoing compliance.

Madelaine Lane is a Partner and Chair of the White‑Collar Criminal Defense Practice Group at Warner Norcross + Judd LLP. She advises organizations and individuals facing complex civil and criminal investigations, including matters involving search warrants, subpoenas, discovery demands, and internal investigations. Madelaine has extensive experience handling high‑stakes white‑collar matters across a range of industries, including healthcare, higher education, automotive, finance, and agriculture. A seasoned trial lawyer, she regularly represents clients in state and federal court and helps organizations prepare for and respond to enforcement actions, whistleblower claims, and regulatory scrutiny.