What to do if an ICE Agent Enters Your Medical Practice

Developing a written policy now will help your practice prepare and meet its legal obligations if an ICE agent conducts an enforcement action at your medical office. This article informs practices of their responsibilities before and during an ICE enforcement action, and it provides considerations for practices who develop a policy for interacting with law enforcement.

ICE Agents Can Now Conduct Enforcement Actions at Medical Practices

The United States Department of Homeland Security (DHS) issued policies in 2011 and 2021 generally prohibiting Immigration and Customs Enforcement (ICE) agents from conducting enforcement actions at health care facilities, including at medical offices and practices. However, on January 21, 2025, DHS issued a directive rescinding these policies. As a result, medical practices might now wonder how to prepare for an ICE enforcement action and how to manage any tension between protecting patient privacy and complying with law enforcement requests.

Responsibilities Before an ICE Enforcement Action

ICE agents might arrive at a medical practice unannounced to conduct an enforcement action. To prepare, medical practices should know their responsibilities pertaining to patients’ immigration status.

• • Patients’ immigration status can be considered protected health information (PHI).
    
    
  • In most states, physicians and other health care providers are not required to document patients’ immigration status.
    
    
  • Physicians and other health care providers generally are not required to report immigration violations to law enforcement.
    
    
  • HIPAA permits covered entities to disclose PHI to law enforcement if the entity believes the PHI is evidence of criminal conduct that occurred on its premises.¹ Such disclosure is discretionary and not mandatory,² and not all immigration violations are criminal.

Responsibilities During an ICE Enforcement Action

Medical practices should also understand their responsibilities during an enforcement action. Practices should know the two types of warrants and subpoenas an agent might present. A judicial warrant or subpoena is signed by a state or federal judge or magistrate, and it should include the name of the practice, the time for executing the warrant, and the scope of the search. Meanwhile, an administrative warrant is signed by a government agency (like ICE or U.S. Customs and Border Protection) or by an immigration judge. An administrative warrant might appear on Form I-200 or Form I-205.

Practices’ responsibilities during an enforcement action will depend upon the type of warrant or subpoena presented by the agent. If the agent has a judicial warrant or subpoena, the practice must produce the documents listed in the warrant or subpoena. Agents with a judicial warrant or subpoena can also enter private areas of the medical practice, if those areas are listed in the warrant or subpoena.

Meanwhile, if the agent has an administrative warrant or subpoena, the practice is not required to produce the documents listed in the warrant or subpoena. Similarly, agents with an administrative warrant or subpoena cannot enter private areas of the practice without the practice’s consent. However, agents with an administrative warrant are allowed in public spaces without consent, including the practice’s parking lot and waiting areas.

Last, ICE agents might ask questions during an enforcement action. Patients and staff have the right to remain silent if questioned by agents. Patients and staff who wish to remain silent can say, “I’m exercising my right to remain silent.”

Policy Considerations

Practices should develop a policy ahead of time that not only governs staff interactions with ICE agents, but also with law enforcement agents in general. Practices can consider the following when developing their policy.

Practices can physically designate private areas of their building. This might include locking doors and hanging signs to mark areas as private.

Practices can appoint an internal representative who is responsible for speaking with any law enforcement agents who arrive at the practice. This person should be familiar with the practice’s policy for interacting with law enforcement. This person should also be able to review any warrant or subpoena to determine whether it is judicial or administrative, and whether all required elements are present.

Practices can also consider appointing an external representative who can provide additional support if agents arrive. The external representative might be legal counsel. As soon as agents arrive at the practice, the internal and external representatives can be notified. The practice staff can direct agents to a room, office, or an area away from patients. One or both representatives should accompany the agents around the practice. The representatives should document the name of anyone interviewed by the agents and anything seized by the agents.

Practices should train staff members to protect patients’ PHI as required by HIPAA, even during an ICE enforcement action. HIPAA protections apply even if the request for disclosure of PHI comes from law enforcement agents. Practices should caution staff to avoid leaving patient PHI visible from public areas—like the public side of the reception desk—because PHI in plain view can be observed by law enforcement without a warrant. Staff should also refrain from discussing confidential information within earshot of anyone not authorized to receive that information.

Checklist for Practices to Include in their Law Enforcement Policy

The following is a checklist of steps that practices can consider incorporating into their policy for interacting with law enforcement agents.

1. Agents arrive at the practice, possibly unannounced.
   
   
2. Front desk staff:
   
   • Notifies the internal representative (and external representative, if one exists) of the agents’ arrival.
     
     
   • Escorts the agents into a room away from patients while waiting for the representatives to assist the agents.
     
     
3. The internal and external representatives:
   
   • Arrive in the room where the agents are waiting.
     
     
   • Review any warrant or subpoena and confirm all required information is included.
     
     • Judicial warrant or subpoena = signed by a state or federal judge or magistrate, describes the name of the practice, the time for executing the warrant, and the scope of the search.
       
       
     • Administrative warrant or subpoena = signed by a government agency or by an immigration judge.
4. If the agents have an administrative warrant or subpoena:
   
   • The agents cannot enter private areas of the practice without the practice’s consent.
     
     
   • The practice is not required to produce the documents requested.
     
     
5. If the agents have a judicial warrant or subpoena:
   
   • The practice must provide the documents requested (unless advised otherwise by legal counsel).
     
     
   • If the agents search the practice, the internal and external representatives should escort the agents.
     
     
6. The internal and external representatives should document the following information:
   
   • The agents’ names and badge numbers,
     
     
   • What information the agents requested,
     
     
   • The name of anyone the agents spoke with,
     
     
   • A description of the agents’ behavior,
     
     
   • How long the agents were at the practice,
     
     
   • What areas of the practice were searched, and
     
     
   • A list of anything the agents seized.

Practices seeking more information on how to prepare for an ICE enforcement action can visit the National Immigration Law Center.

^{[1] See 45 C.F.R. § 164.512(f)(5).}

^{[2] See id.}