BOLO Health Law, LLC | November 6, 2026 | Employment and Healthcare Workforce Compliance
Part of BOLO Health Law’s November 6 legal-history series; see the BOLO Insights library for connected discussions of legal risk, regulation, and business operations.
November 6, 2026 marks forty years since President Ronald Reagan signed the Immigration Reform and Control Act of 1986 (IRCA). The statute changed employment practices across American industries by introducing employer sanctions for knowingly employing unauthorized workers and a system for verifying identity and employment authorization. For healthcare employers, the anniversary is a useful occasion to audit a deceptively routine administrative process: Form I-9.
Hospitals, home health agencies, hospices, medical offices, laboratories, staffing companies, and healthcare startups share an operational reality: rapid hiring, distributed worksites, turnover, temporary staff, and urgent scheduling. Those conditions can expose weaknesses in onboarding, even when nobody intended to evade the law. The answer is a consistently administered process—not demands for additional documentation based on a worker’s appearance, accent, citizenship, or name.
I-9 compliance begins with a consistent onboarding workflow
Employers generally must complete a Form I-9 for employees hired to work for pay in the United States. The employee completes Section 1 no later than the first day of employment; the employer generally completes Section 2 within three business days after employment begins. Special rules apply to very short-term engagements, and existing-employee or rehire situations require attention to the instructions for the current form. An offer may be contingent on lawful work authorization, but the employer should not use the I-9 process as an informal immigration screening test.
The threshold employment question also matters. BOLO’s reviews of New Jersey independent-contractor classification rules and why a 1099 file is not a classification defense address different legal regimes that can overlap in a hospital, lab, practice, or staffing arrangement. The contract title should not be mistaken for a legal determination.
The employer must follow the current USCIS form instructions, including acceptable document combinations and any applicable alternative remote document examination procedures. An employer cannot assume that a photo of a passport emailed to a practice manager satisfies all verification requirements. Likewise, a remote employee and an in-office employee should not be subjected to different document demands without a lawful basis.
More documents are not necessarily better
A common compliance error is asking a new hire who has presented acceptable documents to provide a different, supposedly ‘stronger,’ document. The I-9 rules give employees choices among permissible documents. Unfair documentary practices, citizenship-status discrimination, and national-origin discrimination can create separate liability under the Immigration and Nationality Act and other applicable laws.
The same risk-management discipline applies when evaluating equal-treatment obligations. BOLO’s companion November 6 analysis of healthcare nondiscrimination duties following the Section 1557 litigation addresses the separate task of identifying legally required protections without improvising requirements that may themselves be discriminatory.
For example, a clinic might regularly accept a List B identity document plus a List C employment authorization document from one applicant but insist that another applicant present a U.S. passport or permanent resident card. The latter request may be unlawful even if the clinic believes it is exercising extra caution. Consistency, reasonable training, and an escalation process for unusual documents are safer than improvising rules for individual workers.
Retention, corrections, and reverification require separate controls
Employers must generally keep an I-9 for as long as the person is employed and, after separation, until the later of three years after the date of hire or one year after employment ends. This is a minimum retention calculation, not permission to discard records relevant to pending litigation, an investigation, or a preservation notice. Employers should track both hire and termination dates and maintain a record-management protocol that protects personal information.
Employers should place I-9 recordkeeping alongside the broader employee handbook and workplace-policy controls. If a dispute or inquiry has begun, distinguish routine retention from a healthcare investigation evidence hold for messages and electronic records; the November 6 regulatory investigation response guide explains why preservation decisions should precede broad assertions to an agency.
Reverification is not required simply because a worker’s identity document expires. It is generally linked to certain temporary employment authorization documents or status. Incorrect reverification can cause an employer to interfere with lawful employment. For employees working under time-limited authorization, the organization needs a reliable reminder system that does not create unauthorized assumptions about other employees.
Errors discovered during an internal audit should be corrected transparently using the agency’s guidance, with the original entry preserved where appropriate. Backdating, replacing an old form to hide a problem, or asking employees to sign entries that falsely represent an earlier review can multiply exposure.
Healthcare staffing arrangements introduce additional questions
A hospice might use a staffing agency for nurses; a lab might engage couriers, phlebotomists, consultants, and traveling personnel. The label ‘1099’ or ‘contractor’ does not decide whether someone is an employee under immigration verification, wage, tax, or state-law standards. Businesses should separately determine which organization is the employer for I-9 purposes, whether the arrangement is genuinely independent, and what contractual assurances and audit rights are needed.
When staffing structures change through growth or acquisition, consult BOLO’s guide to healthcare acquisition compliance diligence and its analysis of physician recruitment agreements and regulatory risks. Employment verification is one component of a broader workforce and transaction review, not a substitute for those other legal tests.
In a transaction, buyer-side diligence should include workforce verification practices. An acquisition that combines several physician groups or laboratories may inherit disorganized records and different workflows. The legal analysis should distinguish new hires, continuing employees, qualifying successor-employer rules, and the integration plan; do not automatically require everyone to complete a fresh form without evaluating the applicable requirements.
A practical seven-step I-9 audit
- Identify the exact current Form I-9 version and train the people who use it.
- Sample recent hires for completion dates, missing fields, signatures, and authorized reviewers.
- Check that document choices have been respected consistently.
- Calculate retention deadlines and confirm secure storage, access, and disposal controls.
- Audit reverification dates, without demanding new documents where reverification is not required.
- Review remote-hire procedures, staffing arrangements, and supervisor escalation rules.
- Create a documented correction process and preserve records associated with any active dispute or government inquiry.
A written I-9 procedure protects employees and employers alike. Forty years after IRCA, the greatest value of an audit is not adding bureaucracy; it is removing inconsistent decisions from a compliance process that ought to be routine.
BOLO Health Law assists New Jersey employers and regulated healthcare businesses with compliance policies, workforce agreements, internal reviews, and outside general counsel matters. Explore outside general counsel services or contact the firm.
Continue the November 6 legal-history series
- Contracting and management authority before a business launches
- Healthcare civil rights and discrimination duties
- Regulatory investigations: records, facts, and communications
Primary sources and further reading
- USCIS — I-9 Central
- USCIS — Retention and Storage
- DOJ — Immigrant and Employee Rights Section
- Reagan Presidential Library — IRCA Signing Statement
General legal information as of November 6, 2026, not advice for a particular employer. Federal and state obligations depend on the facts and current agency instructions.