You’re in the middle of a busy clinic when federal agents walk through your front door. They flash their badges. “We’re from ICE,” one says. “We’re looking for someone.”
Do you let them in?
It’s a question that makes every physician and practice manager pause—not because anyone is hiding fugitives, but because we live in a world where immigration enforcement has gotten tangled up with healthcare, fear, and civil rights. So, what are your legal obligations? And what protections do you have if you say no?
First, Understand the Type of Warrant
Federal agents can’t just barge into private areas of your practice unless they have a judicial warrant signed by a judge. That’s very different from an administrative warrant issued by ICE itself.
- Judicial warrants (signed by a federal judge or magistrate) give them legal access to specific locations. If presented, you should comply.
- Administrative warrants (typically labeled I-200 or I-205) are not enough to enter non-public areas like exam rooms or staff-only areas. You can legally deny entry.
Unless ICE presents a judicial warrant, you are not required to let them beyond your waiting room. And you are not required to share patient information without a court order.
HIPAA Still Applies
ICE doesn’t override HIPAA. In fact, the HIPAA Privacy Rule specifically limits what information you can disclose without patient authorization, even to law enforcement. Unless you have a court order, warrant, or other HIPAA-permitted justification, you may not release protected health information.
But…
What about the HIPAA Law Enforcement Exception?
The HIPAA Privacy Rule contains an exception for law enforcement purposes that permits a covered entity to disclose PHI to law enforcement officials without patient authorization under the following circumstances:
- If there is a court order, court-ordered warrant, subpoena or administrative request (see above)
- To identify or locate a suspect, fugitive, material witness or missing person
- To answer a law enforcement official’s request for information about a victim or suspected victim of a crime
- To alert law enforcement of a person’s death if the organization suspects that criminal activity caused the death
- When an organization believes that Protected Health Information (PHI) is evidence of a crime that occurred on its premises
- In a medical emergency not occurring on its premises, when it’s necessary to inform law enforcement about the commission and nature of a crime, the location of the crime or crime victims and the perpetrator of the crime
For purposes of this exception, “law enforcement official” is defined broadly and means an officer or employee (state or federal) who investigates or conducts an official inquiry into a potential violation of law or prosecutes or otherwise conducts a criminal, civil or administrative proceeding arising from an alleged violation of law. Some examples of law enforcement officials include officers, investigators and detectives from a sheriff’s office, the FBI and state agencies.
Know Your Rights, and Train Your Staff
If your front-desk staff panics and waves agents through, it may be too late to undo the breach. That’s why preparation matters.
Have a written policy. Train your team. If law enforcement enters the practice:
- Stay calm and polite.
- Ask for identification and documentation.
- Request to see the warrant and verify if it’s judicial or administrative.
- Politely but firmly state that, without a judicial warrant, you cannot permit access to non-public areas.
- Contact legal counsel immediately.
What If You Refuse Entry?
You have the right to refuse entry to non-public areas without a judicial warrant. ICE cannot arrest you for that. You are not “harboring fugitives” simply by following the law.
Still, refusing entry could prompt scrutiny or follow-up visits. That’s why it helps to have legal guidance before you’re ever in that situation.
Bottom Line
You are not required to act as an immigration agent. Your duty is to your patients and the law. Protect patient privacy. Follow proper legal protocols. And make sure your staff knows the difference between a badge and a warrant.
What do you think?
As medical providers, we have a “Trump Card” obligation: to maintain patient privacy and conduct examinations in a non-intrusive environment. I appreciate the suggestions regarding the order that should be presented. How would you like your loved one to be in a lithotomy position, only to have a 220-pound agent burst into a room? A male can be getting a prostate exam, which rarely has paper draping. HIPAA was introduced for a reason, and HCP should not have to be responsible for all of the nuances that ICE introduces as new laws concerning invasion of privacy are passed into law.
From what I recall, even federal prison officers, are not allowed in the operating room with a prisoner.
But they can be in the OR suite right outside the door, in gown, booties, and scrub cap.
They might have to be in the room before the procedure to unlock cuffs, when the prisoner is handcuffed to a stretcher.
They might be there until the patient is asleep.
But for procedure itself, they must be outside of the room.
If I recall correctly, they are allowed to have firearms in the hospital, as are all on duty police officers.
In the case described above, would it be worthwhile to be taking illegal aliens into your practice?
In a hospital employed situation where the hospital staff are the gate keepers, hospital policy would prevail. If the hospital permits access inside the office, for an officer showing a badge, the staff must comply and the physician does not have a say.
But then the next step is when the ICE agents start asking questions of the physician. What is the physician going to do? Should the physician refuse to answer questions until he has an attorney present?
Will the physician remember to ask if the search warrant is judicial or administrative?
Will the physician be able to reach legal counsel promptly while ICE agents are present? Probably not. Are all general attorneys versed in what to do in such situations? Probably not.
When I operated my own Medicare Certified Surgical Center, our inspections were done without prior notification. These were highly “invasive” experiences and the inspectors would arrive in the office and “take over” my private office to evaluate my medical charts, my accreditation manuals, open drawers and evaluate the condition of our shelves and status of sterile packs and instruments.
Ocassionally, they would request to witness a surgery I was doing in the OR. I did have scrubs available for them, masks and shoe covers. However, I first had to ask permission of the patient to sign a form allowing Government agents to witness their procedure.
I did not have any personal objections to Government witnessing my procedures. But that was me. The patient however, DID have permission to deny this request. And they had to sign a form permitting it. This was certainly an unusual scenario. But I DID have patients REFUSE to allow Government witnesses into the rooms they were in.
I would simply explain to the auditors that the “patient did not allow them in.” I never made any attempt to “encourage” a patient to allow this. It was entirely up to them. Not me.
Michael M. Rosenblatt, DPM