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AHLA's Speaking of Health Law
Regulators In the Waiting Room: What to Do When Health Care Investigations Begin
Miriam Swedlow, Associate, Davis Wright Tremaine LLP, Ryan Belton, Senior Counsel, PeaceHealth, and Kris Deyerle, General Counsel, Confluence Health, explore the tools the government uses to initiate and conduct potential enforcement actions and best practices for health care organizations to mitigate risk. They cover audits, subpoenas, civil investigative demands, and search warrants. Miriam, Ryan, and Kristie spoke about this topic at AHLA’s 2025 In-House Counsel Program in San Diego, CA.
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SPEAKER_01:Hi hi, and welcome to everyone out in AHLA podcast land. Today we're going to be exploring how healthcare organizations handle enforcement when it lands on their doorstep. My name is Miriam Swedlo. I'm an associate in the healthcare practice group at Dance Right from Maine. A large part of my practice involves advocating on behalf of hospitals, health systems, healthcare entities, and providers who are facing actual or threatening government enforcement actions. Joining me today is Ryan Belton and Chris Dyerley. The three of us had the pleasure of presenting on this topic at the recent AHLA in-house program that happened on June 29th in beautiful, lovely San Diego. Before we delve into our conversation about that presentation and points of that presentation, Chris, Ryan, why don't you share a little bit with the audience some of your background?
SPEAKER_02:I would be happy to. My name is Chris Dyerley. I'm the General Counsel of Confluence Health, a rural integrated health care delivery system in North Central Washington.
SPEAKER_03:Ryan? Yeah, thanks, Chris. I'm Ryan Belton. I'm senior counsel at Peace Health. It's a Catholic nonprofit health system. We're based in Vancouver, Washington, and have operations uh through Oregon, Washington, and Southeast Alaska. And uh to just succinctly describe my role here, I'll just say I'm operations counsel. I work closely with our compliance regulatory and risk departments among others. So with that out of the way, like Miriam said, we're talking about um uh government enforcement and and some of the tools they use. Uh in our uh June presentation, we focused on a handful of tools that regulators may employ. Um think audits, subpoenas, civil investigative demands, search warrants, and some of the best practices uh for how we respond to those. Um and that's what we'll be focusing on today. So uh we'll jump right in and start with with audits. Um, Chris and Miriam, as you know, there are several types of audits, including RAC, Mac, CERT, UPIC, uh you can have OIG audits, OCR audits. Uh I thought it might be helpful for our audience to give a quick, just kind of high-level overview of some of the common audit types you've encountered. And and Chris, maybe since you're in-house and and oftentimes audits are handled in-house, can you tell us some about uh about some of the audits you've dealt with and what distinguishes them one from another?
SPEAKER_02:Certainly. I think over my tenure I've received audits from almost every governmental agency that issues audits, um, starting with like CMS, the IRS audits, RAC audits, OIG audits, OCR audits. Um, generally, the audits I've received for the most part have been, thank goodness, uh, routine, non-targeted reviews by agencies, particularly CMS or the IRS. These those audits have been primarily administrative in nature. We have received RAC audits as well, which are also fairly targeted, but smaller in scale, not the huge RAC audits that we've seen. Um, unfortunately, I have been the recipient of some OIG audits. They've been a little more targeted with more of a federal regulatory slant to them. Um and I have received been the recipient of some OCR audits coming in to look at our practices with regards in particular to providing care to those who English is not their primary language. Um, in today's regulatory environment, I find that being the recipient of these kinds of audits a little more stressful than I ever used to because it's now that the government is extremely focused on fraud in healthcare, there's always the concern that one government agency will share the results of an audit or share what they receive in response to an audit with other governmental agencies.
SPEAKER_01:Yeah, I think that's an excellent um point, Chris, because we do know that there's you know, you know, more and more collaboration on the government side. So what kind of feels like it could be pretty benign could suddenly escalate quicker behind the scenes that you don't know about and and with the I think the fact that the government's really relying also so heavily on technology and like massive data sweeps and things like that. So yeah, that's an excellent point.
SPEAKER_03:Yeah, thank you both. Um Miriam, what what are maybe some best practices that that apply across the board? We talked about, you know, uh Chris just mentioned a lot of different types of audits, but across the board, what are some best ways to approach them?
SPEAKER_01:Yeah, I mean, I think you'll hear a lot of these same, you know, we know like these are a lot of the same themes across all of these, right? You know, you want to respond timely, you want to be professional when you're dealing with the government. So right away let them know that you've received it, acknowledge receipt, um, and then take a look at it, really carefully review what you have, who's what agency has issued it, what are they asking for. Um, then you want to involve legal counsel, whether that's internal, which is likely going to be the case, um, you know, right off the bat, and then your internal legal counsel can assess whether it makes more sense, makes sense to also collaborate with outside counsel given potential risk that might get that might arise from the um audit itself. You want to make sure that you're documenting everything. Like you want to make sure that if somebody comes back and asks you what you did, you can coherently be able to tell them what happened and and the steps that were taken. Um, and you know, from my perspective, I just think it's always very helpful and critical to just not be in free, uh not be hesitant to engage with the government and have it be a conversation and rather than just kind of reacting defensively.
SPEAKER_03:Yeah, that's great. Um, thanks for that. So um I thought we'd just run through one of the uh examples we used in our presentation as an illustration. So, Chris, allow me to set the table for a second. Um let's suppose that you're in house counsel for a nonprofit hospital with 300 beds, and you receive notice of an OIG target uh audit that's targeting some inpatient rehab claims for medical necessity, coding accuracy, physician certifications, discharge documentation and the request uh or the notice requests 40 random claims and gives you 30 days to respond. So with with the uh with all that information, what what's your first move as counsel?
SPEAKER_02:So initially I look at the audit request and I see what its scope is and and try to ascertain is this a targeted request of us or is this something that's a general request at this government agency that they're doing to more than one provider? If I feel it's a targeted request, I'm initially going to engage outside counsel to assist me with this audit. At the same time, I might be engaging outside counsel. I'm going to be working with my compliance team and potentially my risk management team to gather whatever documents are responsive to this request so that we can begin reviewing them internally to see if there's going to be any kind of issue with the documents that we're turning over. Even if I haven't engaged outside counsel in the first, you know, the first blush, if I see anything that may be concerning and what I'm going to ask to turn over, I'm going to engage outside counsel to help me frame whatever I'm sending out.
SPEAKER_03:So as as a follow-up to the first thing you said there and trying to ascertain whether whether you're being targeted, um what ways have been helpful for you to find out that information? Are you plugged into local um hospital associations? Are you calling council? Are you calling you know phone a friend at a different organization? What what's your approach there?
SPEAKER_02:From my perspective, I would probably reach out to the hospital association. At the same time, I'm reaching out to outside council. They generally, outside council have their ears open and they're they're hearing more than I'm hearing in North Central Washington. So I rely on them to have the relationships with the government officials, folks working in the government sphere, um, connecting with their other out, you know, council resources to know what's going on in the industry.
SPEAKER_01:I would imagine the the the type of audit and the requests that are being asked for also might give you some sense. You know, if it seems very, very, very targeted and specific to your organization or some events that have happened or whatnot, it's much more likely to be, you know, okay, this is they're looking for something or concerned about something as opposed to um, you know, there's been something published by the OIG of an area that they are looking, you know, that they're recommending focus. And then three months later you get hit with an audit and you're like, okay, that's you know, this sounds sounds quite routine.
SPEAKER_03:Yeah. So so Miriam, um, as outside counsel, assume you get that call from Chris, what what things are you focusing on?
SPEAKER_01:Uh well, I mean, I would, you know, like I like if you know, you definitely want to know and understand kind of what they're what they're asking for. Um, I, you know, I my first kind of engagement would be what is the inter what is my inside council, my in-house counsel concerned about? Um, they're that they have, you know, they know kind of, you know, much more information than I do. And if they have specific concerns, I need to be aware of those and kind of follow those down. Also, in-house counsel is going to be extremely helpful in in helping to understand the stakeholders on the other side and who's who's going to be easier to get information from and maybe where the roadblocks might arise in actually like gathering and responding to the audit requests. And really just collaborating to get a game plan. Do we need to ask for an extension? Do we, you know, has has has there already been engagement with the government, or do we need to make that as as quickly as possible? Things like that, kind of, you know, just really like setting it up as, you know, here's what we have, let's let's create a game plan and where we go from there. Um so okay.
SPEAKER_03:And I wanted to maybe just explore one of the um the wrinkles that we had thrown into our presentation hypothetical. Um and in the interest of time, we probably can't get to all of them, but one was you know, in in responding to the audit, you know, the team discovers that that some of the records may not meet medical necessity. Um Mira, maybe you can talk a little bit about you know what what to do in that kind of a situation to mitigate any potential exposure.
SPEAKER_01:Yeah, I mean, I think that's always you know the the dread, right? You you're compiling documents to turn over, and suddenly in your review before pulling them out, you recognize, oh my gosh, there's been some errors or there's some bad facts here. Um and I mean I you know facts are what they are, you know, and and at least when you know, the helpful thing is if there are bad facts, we want to know them before those facts are turned over to the government. And so um so knowing about them is extremely helpful. And we'd much rather um have that said, we can then decide what steps need to be taking. Do we start resolving, do we start making internal changes? Uh is it a systemic thing or is it just inadvertent errors? And then of course, when you're turning over information to the government, you want to be able to have a narrative and an explanation. Okay, here's here's what we discovered, here's what's been done, here's what we don't think that it's a problem that the government needs to be concerned about, right? Um and so you know, the key is as you, you know, if we can control that narrative as best as we can, that's going to be much more helpful than being on the back foot and just responding to to kind of peppered questions from the government. Plus, you're offering up goodwill, you know, you're showing the government we're not, you know, we're not trying to hide anything here. We're wanting to work with the government, we want to make sure that there's no concerns.
SPEAKER_03:Yeah, all really, really helpful advice. Um in interest of time, uh Miriam, maybe you can walk us through some of the the additional fun tools that uh right.
SPEAKER_01:Like the what we what we want, we do not want an audit to lead to next.
SPEAKER_03:Right, right, right. Yeah, so what comes next?
SPEAKER_01:So so one of the you know big areas that that um we talked about in our presentation, and of course, unfortunately, healthcare entities have to kind of contend with in dealing with government threatened actual um investigation tools, are of course the subpoena or the civil investigative demand or CID, which are very, very similar, but of course there are key differences um between the two. Um, Ryan, why don't you describe some examples of CIDs and subpoenas that are typically seen within the um healthcare space?
SPEAKER_03:Sure. Um so you know the one that I think everybody dreads is you know, if you're under investigation for uh uh an alleged false claims act violation, um then I think you can expect to see a CID issued by uh the Department of Justice. Um also, you know, state attorneys general offices may issue either a subpoena or a CID, just depending on on you know what stage uh you may be in in litigation. Um courts as well can issue uh some civil subpoenas as part of uh litigation that you might be a party to. And then uh even if you're not a party, uh you may receive third-party subpoenas maybe from a regulatory agency that uh perhaps they're um investigating uh an entity that you've done business with and they want to understand more about what uh what transpired as part of those transactions. So those are those are a few.
SPEAKER_01:Yeah, yeah. I mean, and especially I would imagine for hospitals that uh that license professionals, then there's all the professional licensing bodies that that when they're investigating an individual, then they might come to the to the employer or hospital to seeking records as part of uh through a third-party subpoena if necessary, um, you know, things like that. So Chris, um in your experience, what are best practices you have employed when responding to a subpoena or a CID?
SPEAKER_02:So in general, when I receive a subpoena or a CID, which I hopefully will never receive from the DOJ, although I can't count your chickens. Um I generally look at the subpoena and try to ascertain the scope and whether or not this again, like your audits, is it targeted or just general? Am I the target of this subpoena or am I a third party that the government's just seeking information from? Um so I look at the scope. Does it seem overly broad? Is it a narrowly focused subpoena? And then I'm trying to ascertain who within my organization do I have to reach out to to get that information. So I'm thinking about who's going to be on my team to help pull together the information that's being requested. Um, and then another thing I'm looking at is are they requesting PHI? Because oftentimes then that requires another level of scrutiny, not only on my end, but engaging outside council to try to narrow the scope, maybe, or ensure that this governmental request meets all the state and federal requirements under HIPAA for releasing medical records. Um that's generally first steps from my end. Um in general, if I'm getting a subpoena for documents from a federal agency, I of course am reaching out to outside counsel to help me with that request, particularly if it's an if it's a broad request. Um, because my hope is that they will be able to narrow it and streamline that request.
unknown:Yeah.
SPEAKER_03:Yeah, and I I I I'll just add one thing. I think you know, Chris hit it on the head, convening the right team, um, super important, uh, including you know who may be the custodian of the records that are being requested and making sure that we um we promptly get out some kind of a preservation document preservation notice or memo or or lid hold um so that you know we can we can keep those and and respond.
SPEAKER_02:Yeah, I find that government the government subpoenas that I have received seem to um the government has a different idea of my document infrastructure. Um they seem to assume that we have an integrated document management system, so I can just put out a litigation request hold request and you know I can pull all the relevant information quickly. And although that may be true in my organization with regards to say emails or you know, the text messages that are done through our team system, we don't have a document management system. So I need to identify individuals who I think may have responsive documents, reach out to them to see who they think may have responsive documents, and then kind of do a broad blast email explaining why I need you to preserve these documents. Um we were in receipt of a subpoena. This is what I need you to do, and then field all the questions that come back. Right.
SPEAKER_01:Right. I think it I think one of the things you put you you commented on, and like the government has these, has this like view of what uh an entity's capabilities are. And the other thing I think they forget is you know, they'll sometimes issue the its requests and it's just it's a massively long timeline. And they forget the user technology, like you have to call together. Sometimes you might have had like a whole new system, you might have a hospital might have been affiliated or acquired, people come and go. And so it's not just like easy to test you know, start the three. Everything's fine, you know, it's like you've got like so many hurdles that um then have to kind of be navigated through, but also then like communicated to the to the government and and explained of like you know, mitigating expectations, managing expectations on their side, you know. Um always a delicate delicate balance. Uh Ryan.
SPEAKER_02:I think that's particularly true when the subpoenas are broad and they're asking for information and your IT team is throwing out word searches and you're getting back, oh look, there are 10,000 emails that fit in that is, and it's you can't possibly search through them all.
SPEAKER_01:Yeah. So well, and then and then when you when there is that expectation of of a broad ESI, you know, kind of trying to try like it's just such an extraordinary cost burden for organizations and trying to you know really like show that to the government when they're you know, especially if it's a you know, just it just feels like an effort of utility sometimes. But um, that's one of the you know, it is it is a frustration in dealing with the government because in in this type of space where it it's very different than normal litigation, civil litigation where discovery is kind of an equal playing field. Um, you know, kind of there's a kind of exchange of information. Um in these types of scenarios, the posture is very different. The government knows what it's information it has, but as the responding entity, you don't know what they have. You don't know kind of what their you have a sense of, you don't really know what their concerns are, and they hold all the power. Um, and so it's just it's ext it's psychologically just very and and and operationally extremely frustrating in my in my experience. So um, Ryan, um you mentioned litigation holds and and Chris you did as well in our um in our scenario that we kind of walked through during our presentation, our healthcare, our exampler healthcare entity, Ritual Health, did make some, let's say, missteps in in issuing its litigation hold following the receipt of a subpoena from HHS ORC. Um can you both kind of weigh in on um you know like just factors that and things that you need to think through uh in approaching the organization with a litigation hold?
SPEAKER_03:Sure. I think um, you know, as Chris mentioned earlier, just the biggest one of the biggest things is just identifying who the uh audience is and who is gonna have responsive documents. Um you know, we don't want to be over-inclusive in notifying, you know, everybody in the organization that um that we have this investigation going on. Um I think also uh just trying to educate them a little bit on on how it works and and the need to preserve those um you know folks can get a little bit excited um when they uh get a notice like that. Um and you know, you want to be able to try to curb water cooler talk and and gossip and things like that. And so just helping them understand um, you know, that hey, this is part of business, but you know, we also need to just kind of keep you know um keep things confidential that need to be cut confidential and and uh proceed that way.
SPEAKER_01:Yeah, it's like this this tightrope of like, I need to give you enough information so that you can make sure that we're holding on to what we need to, but I don't want to give you so much information to freak you out and cause complete chaos in the organization. Exactly. Um so another thing that we talked about in our breach well scenario was that in that scenario, OCR, as part of subpoena issued interview um subpoenas with some of the employees. Um, what are some considerations um that um you kind of have to keep in mind when you have the government wanting to speak to employees or other stakeholders during the course of an investigation?
SPEAKER_02:So, my general rule of thumb, if the government wants to interview my employees to quickly loop in outside counsel and be it outside counsel that is engaged to represent that individual employee specifically, and I, as the employer, just kind of paying the bill and they have that one-on-one relationship with the attorney or something more general. But I because employees, that's not what this is not what they do in their general course of business is get interviewed by government officials, and it they're very nervous, they want to do anything possible to avoid it. So engaging outside counsel to help walk them through the process, um, prep them for any interview and be with them during the interview, I think is integral. Um, it also gives me an ear to what's being said and what's being asked. So I find that very important. And since I'm not a litigator, I and I don't deal with government investigators on a regular basis, thank goodness it's I need outside counsel to do that for me. Yeah, Ryan, you just have do you have any other not really.
SPEAKER_03:I'll I'll echo everything that Chris just said. Yeah.
SPEAKER_01:Yeah, I you know, I think it's like, you know, it's so stressful to be interviewed, especially if it's if in a CID or for there's some, you know, you've got a court reporter, or if there's it's very formalized and and whatnot. Um and so there's it's helpful to have outside counsel, some counsel there with the employee to just be an advocate for them in the room. Like even if it's unnecessary, my experience, the government is you know, they're all decent people and they're not there to beat up on the employees and um behave pretty, you know, respectfully. Just knowing that there's somebody there on like to advocate for you is very helpful. Of course, it's very beneficial for the organization to know what questions were asked, kind of what the tone is, you know, kind of what do they focus on and things like that.
SPEAKER_03:Well, I I will jump in just to say, you know, in my experience, it has been helpful to have the outside attorney, and and I felt I've had maybe some value add in just being the the trusted, you know, I have the relationship with that client. And and so just uh I'm able at least to reiterate um some of what counsel's saying, and and you know, the the advice I give is general, um but it it's generally, you know. Um you want to be you don't want to be hostile to the regulator um coming in. You also don't need to be super helpful and and do their job for them. You don't need to offer them you know more than what they're asking for.
SPEAKER_01:Um I think my my two golden rules are be honest, right? Like I think it's you can never underestimate the power of telling somebody we want you to be honest, right? Um, but also letting them know your your only obligation is to answer the question asked. So answer the question asked honestly, and that's that's kind of like the fundamental kind of thing. But but yeah, you know, definitely very helpful um space to have outside counsel. And you definitely don't want to do like our dear client did in our um our example a case study and just have the employees interviewed without any engagement prior uh by um internal or external counsel. So um I think that let's like that's you know moving away from our you know kind of controlled and um you know intense but controlled enforcement actions. Uh the last uh tool that we talked about was search warrants. So I'm gonna turn that over to you, Chris.
SPEAKER_02:Yeah, so search warrants can be a little more stressful than the subpoenas or CIDs that you receive where you have time to actually formulate a response versus a search warrant. Um they the individuals show up in person and they want to do their searches at that time. So search warrants generally can be issued both by judicial or administrative agencies. Um they are supported by probable cause, but they are served during business hours usually and in person. So that and there's typically no notice that you're going to be served with a search warrant. Um the only benefit to a search warrant warrant, unlike a CID or a subpoena, is it is limited to in search to the person or place that's identified in the search warrant on the time of the search and the items to be searched. So, Ryan, with all that background, is in how Council, what are your key practices when you're faced with a search warrant?
SPEAKER_03:Yeah, you know, preparation is really the name of the game. Um, we've we've done a lot of work at Peace Health with frontline employees and leadership, just educating them on how to respond. And we've got a bit of a playbook. Um and an important critical part of that playbook is you know contacting legal as as soon as possible. And we've gone so far as to uh set up actually a legal hotline in our organization that the legal department staffs uh 24-7.
SPEAKER_01:I think that's that's awesome. You go, you you you're not a clinician, so you don't have to be on call, but yet you you're on call anyhow.
SPEAKER_02:So, Miriam, for in-house counsel, what what do you think are should be our immediate actions upon receipt of a search warrant?
SPEAKER_01:Well, um, certainly you want to look at that warrant. So you want to get the credentials of the the enforcement agents that are there at the scene. So, you know, you you want to make sure you're professional, you don't want to be obstructionist, but you also like, you know, want to verify like let me see your credentials and that you I think I know that you are authorized to be here. Let me look at the search warrant. I want to see the issuing order that is giving the authority for you to be here unannounced. And then of course, because they're technically limited to the scope of what is in that search warrant, um, what is it? And and and how do you make sure to kind of pen them in so that they're not trying to push the boundaries of that? Um and then I think, you know, let's all be honest, like you're healthcare entities, you're providing care to patients. And so you're also wanting to make sure that you're working with the team to make sure that care is not disruptive and the and that the priority of your organization to be able to care for people is not severely interrupted by this kind of government um enforcement action.
SPEAKER_02:Ryan, so what kind of instructions do you give your employees regarding search warrants? I mean, in addition to their first call should be to the legal hotline, it's gonna take a while for that legal rep to show up there. So what kind of tools or tech tricks are you giving them to handle an impatient um law enforcement officer who's wanting to execute on his search warrant?
SPEAKER_03:Yeah, a lot of it uh is exactly what Miriam just said. You know, it's first and foremost remain calm and professional. Um ask for identification, verify who they are and ask for their documentation, look at what they're needing to get at, um, and and then getting that in front of counsel as as quickly as possible so we can assess, you know, is this an administrative subpoena or uh warrant? Is this a judicial search warrant? Um, you know, and then once it is being executed, uh assuming all that stuff kind of checks out, um then it's really you know, for our our leaders um more than our frontline staff to um be there and to follow the law enforcement official, um, you know, try to document as much as you can about what is being collected and obtained and uh making a log of of what they're taking and things like that. Um I will add, you know, uh I think Miriam touched on this as well. You know, maybe the case that law enforcement officer just isn't wanting to wait around um for legal to to verify what he's after and and um is perhaps you know aggressive. And and in those situations, our our recommendation is you know, we'll deal with the fallout later, but but don't be you know obstructionist, don't don't try to intervene and and preclude them from executing, um, because because that can have some pretty serious consequences as well.
SPEAKER_01:Yeah, and that's where that's where that that instruction to document is so helpful. Like you know, if you can, like actually assigning one person, like you're responsible for just writing down, tracking what was said, how is it responded, what if what, you know. So if you had that kind of pushy officer who, you know, was just gonna, you know, take care of business, that you're like documenting kind of the dialogue of that there was a request to wait for labeling or not, or if there is a an action that exceeds the scope, you know, there's some documentation of that they were alerted to the fact that they were exceeding the scope and why, and then the fact that they continue to take the process. But it's it's obvious it's not going to help help the organization to like get into you know a bull's match with um executing officers. As you said, it's better to kind of just make sure you document it and deal with it in the aftermath and just be the one who's who's being cooperative.
SPEAKER_02:So, in that case study we used at the AHLA conference, a billing supervisor directed agents to files that were not included in the warrant because she knew they were likely responsive to the concerns that were raised in the warrant itself. So, Ryan, give us your thoughts on what is the risk of when employees expand the scope of a search warrant.
SPEAKER_03:Yeah, I think whether it's you know expanding the scope of a warrant or you know, volunteering information during uh an interview as part of a CID or subpoena, uh it's really the risk is letting the proverbial camel's nose into the tent, right? Once once the camel's in there, um who knows what they're gonna want to see in in addition to what was in the warrant. So um I I think making sure staff know to um, you know, again, not be overly helpful um uh is is really important.
SPEAKER_01:Yeah, it's it's one of the it's like so against human nature, right? Like our nature is to like, we want especially in the healthcare world, right? You're there to help people, like you know, and so so just letting staff know, like, we're not asking you to be a jerk, we're not asking you to do this, but at the same time, don't do the government's job for them. They are asking you for specific things or asking you these questions, answer those questions, give them those documents. You don't have to do anything more than that. And it's and it I think it's really hard to do in practice, but it is I think it's always good to just remind people, you know, like you know, you don't your good intention might have some significant consequences, but just you know bring it in for those types of things. Dealing with challenges is what you guys do on a day-to-day basis, right? So um and you know, kind of thinking about search warrants, I think given the current administration's aggressive stance, uh, shall we stay on immigration? I'm curious about how um your organizations are kind of approaching um, you know, kind of being prepared for this heightened level of enforcement from the federal government.
SPEAKER_02:So my organization, like Ryan's, we've instituted a program where if if immigration enforcement officials show up, like any other legal enforcement official with a search warrant, they're to immediately call legal counsel. Um, unlike Ryan's organization, I am it. So it's either calling me or calling risk management, and staff have my cell phone number to call me 24-7. But we've also taken a lot of efforts to distinguish what is public space versus what is private space, um, so that we can kind of restrain where immigration enforcement officials may go. Um, we want to try to keep them out of the patient face, the patient spaces themselves. Um, we've also educated staff quite a bit on that they have the right to remain silent. They don't have to be answering questions posed by immigration enforcement officials or any legal officials. They can, you know, wait for legal counsel to arrive. Um, but they should not be obstructionists either. And that doesn't mean we have to actively help them, we just can't hinder a search. So, but then staff has also been cautioned not to interfere with what law enforcement chooses to do. So if they want to blow past, don't physically obstruct them from going into areas that we may have told them other that they should not be entering. Um, and it's a lot of training staff on what patient rights are, what legal rights are, what information we can disclose, what information we can't disclose. So it's been a lot of training. Um, we do encourage them to document all law enforcement interactions, clearly write down if they're taking things, what they're taking. We do have surveillance cameras in the non-patient areas, so they will be recording and we would keep those surveillance recordings.
SPEAKER_01:Yeah. Yeah, so you know, a lot of the same recommendations, um, but definitely very, very front and center unfortunately right now that uh so many organizations are kind of struggling with. So um, well, you know, I think we've discussed various enforcement tool tools and um and things. Um is there any kind of last minute kind of takeaways that you wanted to share with the audience?
SPEAKER_03:I'll say if I, you know, kind of boiling it down, I think I think you've heard some themes today, but I think you know, when you receive uh any kind of of notice, you know, from the government, um it's important to to acknowledge receipt in a timely manner, to really look and understand the scope of it, um, you know, get it an extension if you need and and you know really document uh everything and coordinate with the right the right team and the right stakeholders.
SPEAKER_02:Chris? Yeah, uh another key takeaway is make sure your staff know to get legal involved immediately when any of these actions occur, tools are used. And when warranted, engage outside counsel. They can be your best friends when these situations arise.
SPEAKER_01:Yeah, yeah. Um and and yeah, just kind of talking about these things before they happen. Um, you know, you can't control when you're going to receive an enforcement action, um, but you can control how prepared you are to respond. Um I want to thank both of you again for your time, for your expertise on these topics on like working with me on putting together that presentation. Um, and Chris at the very last minute being willing to jump in when we had a last-minute um panelist who couldn't come. Um absolutely am fully in gratitude uh to you for that. Being a co-presenter with both of you was um highlight for me this year at the in-house program, which was fantastic. And um, so we wanted to use this opportunity to remind the audience that next year's in-house program and the ADLA annual update is gonna be in New York City. So, excellent conference, exceptional city. I think it's gonna be epic. Um, so hopefully everyone will be able to um take advantage of it. And again, thank you both.
SPEAKER_03:Thank you, Miriam. It was a pleasure.
SPEAKER_01:Thank you. Thank you.
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