What Is E-Verify and Does Your Medical Practice Need to Use It?

Medical Answer

E-Verify is an internet-based system operated by USCIS within DHS in partnership with SSA. It electronically compares information from an employee’s Form I-9 against government records to help determine whether the employee is authorized to work in the United States.

For many medical practices, participation is voluntary. However, your practice may be required to use E-Verify because of:

State law → Federal contract requirements → Federal subcontract requirements → Other requirements applicable to your organization

So don’t simply ask: “Are medical practices required to use E-Verify?”

Ask: “Is our specific medical practice required to use E-Verify based on where we operate and the contracts we hold?”

What Is E-Verify?

Think of Form I-9 and E-Verify as two connected—but different—steps.

Form I-9 – You examine acceptable documentation and complete Form I-9 to document an employee’s identity and authorization to work.

E-Verify – You submit information from the completed Form I-9 electronically so it can be compared with government records.

E-Verify provides an automated connection to government records to help participating employers confirm employment eligibility.  E-Verify doesn’t replace Form I-9. That’s one of the most important points for your HR team to understand.

Is E-Verify Required for Every Medical Practice?

No.There isn’t a blanket federal rule saying every physician practice in the United States must participate in E-Verify simply because it employs people.

Federal E-Verify guidance states that participation is voluntary for most employers, while noting that some employers are required to participate under state law or federal regulation.

That means two physician practices providing exactly the same services could potentially have different E-Verify obligations.

Why? They may be located in different states or have different government contracts.

When Might Your Practice Be Required to Use E-Verify?

There are several important situations to investigate.

1. Your State Requires It

Some states have enacted E-Verify requirements that apply to particular categories of employers—and requirements vary significantly by state. Depending on the jurisdiction, rules may apply to private employers, government contractors, public employers, or employers meeting other criteria.

If your physician group has locations or employees in multiple states, don’t assume the rules at your headquarters answer the question for your entire organization. Review each applicable state’s current requirements.

2. You Have a Covered Federal Contract

E-Verify can also be mandatory for employers with qualifying federal contracts or subcontracts containing the Federal Acquisition Regulation (FAR) E-Verify clause. This deserves particular attention if your medical organization does business with the federal government.

Don’t assume: “We’re a private medical practice, so federal contractor rules don’t apply to us.”

Review the actual contracts.

3. Another Requirement Applies to Your Organization

Your organization’s structure, location, contracts, and workforce can affect its obligations. That’s why your HR team shouldn’t rely on what another physician practice down the street is doing.

Determine the requirements applicable to your legal entity and circumstances.

Why Would a Medical Practice Voluntarily Use E-Verify?

Even when participation isn’t mandatory, some practices choose to enroll voluntarily. E-Verify provides an additional electronic employment-eligibility verification process after Form I-9 completion.

USCIS describes E-Verify as a tool that helps employers electronically verify the employment eligibility of newly hired employees.

But voluntary enrollment shouldn’t be treated casually. Once you enroll, you’re agreeing to follow E-Verify’s requirements.

Think of the decision as: “Are we prepared to operate an E-Verify compliance process?”

not simply: “Wouldn’t another verification check be helpful?”

How Does the E-Verify Process Work?

The basic workflow looks like this:

Employee accepts job

↓

Employee and employer complete Form I-9

↓

Participating employer creates E-Verify case

↓

Form I-9 information is compared with government records

↓

E-Verify provides a case result

Many cases confirm employment authorization quickly. But not every case immediately returns an Employment Authorized result. Your HR staff must know what to do when another result occurs.

Can You Use E-Verify Before Hiring Someone?

No. E-Verify shouldn’t be used as an applicant screening tool.

Federal E-Verify guidance states that employers may check an individual’s information only after the person has been offered and accepted employment and completed Form I-9. Employers cannot use E-Verify to prescreen applicants.

For example, don’t tell applicants: “Before we schedule your interview, we’re going to run you through E-Verify.”

That’s not what the system is designed for.

Can You E-Verify Only Certain New Employees?

Participating employers generally cannot selectively run employees through E-Verify because someone:

• Has an accent
• Was born outside the United States
• Presents immigration documentation
• Has an unfamiliar name
• Appears to be a noncitizen

E-Verify guidance states that employers must use E-Verify for all new employees at participating hiring sites regardless of national origin or citizenship status. There can be specialized rules for certain federal contractors and other situations, but your general process should never be based on assumptions about an individual employee.

What Happens If E-Verify Finds a Mismatch?

A mismatch doesn’t automatically mean the employee isn’t authorized to work. E-Verify may initially return a Tentative Nonconfirmation, often abbreviated as TNC, when information doesn’t match available government records.

Employees must be given the appropriate opportunity to respond to and contest a mismatch. Employers cannot simply assume: “E-Verify didn’t confirm you immediately, so you’re fired.”

Federal guidance describes specific notification and employee-rights procedures for a Tentative Nonconfirmation.  Your HR staff needs to understand those procedures before it encounters its first mismatch.

Does E-Verify Change Which Documents Employees Can Present?

Employees still generally choose which acceptable Form I-9 documents they present. There is, however, an important E-Verify-specific requirement: if an employee presents a List B identity document to a participating E-Verify employer, that document must contain a photograph.

Don’t interpret E-Verify participation as permission to tell employees: “You need to show us a driver’s license.”

Employees retain their right to choose acceptable documentation subject to applicable Form I-9 and E-Verify requirements.

What Does E-Verify Have to Do With Remote Employees?

This is becoming increasingly important for physician practices. You may employ remote:

• Medical coders
• Billers
• Credentialing specialists
• Schedulers
• Revenue cycle employees
• Administrative staff

Qualifying employers participating in E-Verify and in good standing may be eligible to use DHS’s authorized alternative procedure for remote Form I-9 document examination. That can make E-Verify particularly relevant for practices building a remote workforce.

But don’t enroll solely because someone told you: “E-Verify lets you do I-9s over Zoom.”

The alternative procedure has its own eligibility and procedural requirements.

What If Your HR Vendor Handles E-Verify?

Your payroll company, PEO, or HR vendor may act as an E-Verify Employer Agent and submit cases on behalf of employer clients.

Federal E-Verify guidance explains that employer agents act as liaisons between E-Verify and employers that choose to outsource case submission. Employer clients still participate under the applicable E-Verify structure and requirements.

Ask your vendor:

• Are we actually enrolled in E-Verify?
• What is our E-Verify client number?
• Which locations are covered?
• Who creates cases?
• Who handles Tentative Nonconfirmations?
• Who monitors unresolved cases?
• Who trains our staff?

Don’t confuse: “Our payroll vendor offers E-Verify.” with: “Our medical practice is properly enrolled and following E-Verify requirements.”

What About Multi-Location Medical Groups?

This deserves special attention.

E-Verify allows employers to structure participation across multiple hiring sites in different ways. For example, one site may create cases for multiple locations, or individual sites may perform their own verification activity depending on the enrollment structure.

If you manage several physician offices, know exactly:

• Which locations participate.
• Which location creates cases.
• Who has system access.
• Which employees are covered.
• Who oversees compliance.

Don’t allow each office manager to create their own informal E-Verify procedure.

Real Practice Example

Imagine a multi-specialty physician group with locations in three states. The practice administrator assumes E-Verify is optional because the original office never used it. Then the organization acquires another practice in a different state and begins hiring remote billing employees.

Instead of continuing the old policy automatically, the administrator reviews:

1. E-Verify requirements in each applicable state.
2. Federal contracts and subcontracts.
3. Current company enrollment.
4. Participating hiring sites.
5. HR vendor responsibilities.
6. Remote employee verification procedures.

The administrator discovers that the answer isn’t simply: “Do we use E-Verify—yes or no?”

It’s: “Which requirements apply to our organization, and how should we structure a consistent process?”

Does E-Verify Replace Form I-9?

No. E-Verify uses information from Form I-9 to electronically compare an employee’s information with government records.

Think of the process this way: Form I-9 comes first. E-Verify adds an electronic verification step.

Your practice still needs a compliant Form I-9 process even if it participates in E-Verify.

Medical Practice E-Verify Checklist

Use this checklist to evaluate your current process:

☐ Determine whether state law requires participation

☐ Review applicable federal contracts and subcontracts

☐ Confirm whether your organization is currently enrolled

☐ Identify participating hiring sites

☐ Confirm who administers the account

☐ Review your E-Verify Memorandum of Understanding

☐ Determine whether an HR vendor acts as your E-Verify Employer Agent

☐ Confirm Form I-9 is completed before appropriate E-Verify processing

☐ Don’t use E-Verify to prescreen applicants

☐ Apply E-Verify consistently at participating hiring sites

☐ Train staff on case results

☐ Establish a Tentative Nonconfirmation procedure

☐ Protect employees from improper adverse action

☐ Follow applicable List B photograph requirements

☐ Review remote I-9 procedures

☐ Document responsibility for E-Verify oversight

☐ Periodically audit your process

Bottom Line

E-Verify is not the same as Form I-9, and it does not replace your I-9 responsibilities. It’s an electronic system that compares information from Form I-9 with government records to help confirm a newly hired employee’s employment eligibility.

For many medical practices, participation is voluntary. However, state laws and certain federal contracts or subcontracts can make E-Verify mandatory, so you need to evaluate the requirements that apply specifically to your organization.

Don’t enroll—or decide you don’t need to enroll—based on assumptions. Check your locations, state requirements, federal contracts, existing enrollment, and HR vendor arrangements first.

Key Takeaways

• E-Verify and Form I-9 are not the same thing.
• Form I-9 is required for employees subject to federal employment eligibility verification requirements.
• E-Verify electronically compares information from Form I-9 with government records.
• E-Verify participation is voluntary for many employers.
• State laws may require certain employers to participate.
• Certain federal contractors and subcontractors may be required to use E-Verify.
• Once enrolled, employers must follow E-Verify’s rules and procedures.
• Don’t use E-Verify to prescreen job applicants.
• Don’t selectively E-Verify employees based on citizenship, national origin, name, or appearance.
• E-Verify participation can also affect whether your practice qualifies to use DHS’s alternative procedure for remote Form I-9 document examination.

Continue Building Your Human Resources Expertise E-Verify is just one piece of the HR compliance responsibilities your physician practice must manage. Your team also needs to stay current on Form I-9 requirements, employee onboarding, remote verification, reverification, HR audits, employee documentation, and changing employment rules. Healthcare Training Leader’s All-Access Pass gives your entire team access to expert-led guidance covering human resources and the other critical operational challenges physician practices manage every day. Whether you’re evaluating E-Verify, onboarding employees, auditing I-9 files, or training managers, you’ll have practical expert guidance available when your practice needs it. Why Trust Healthcare Training Leader? Healthcare Training Leader has helped physician practices strengthen compliance, improve operations, train employees, and manage the changing responsibilities of medical practice management for more than 15 years. Our educational content reflects the combined expertise of more than 200 training programs led by experienced professionals in human resources, compliance, medical billing, coding, reimbursement, credentialing, and physician practice management. We focus on translating complicated requirements into practical guidance practice managers and their teams can put into action.