Nursing home fines and enforcement

How to read this page

• What the file is

  The CMS Penalties file lists each civil money penalty (a fine) and each denial of payment for new admissions imposed on a certified nursing home in a rolling three-year lookback, with its date and, for fines, its amount. Totals per facility come from Provider Information.

• No per-instance flag

  CMS can fine a facility per instance of noncompliance or per day. The public file does not say which a fine was, so nothing here separates them. 673 facility-dates carry more than one fine; that describes the file and is not a proxy for penalty type.

• Fines arrive late

  A fine first seen in 2026 reached the public file a median of 245 days after it was imposed, and one in ten took more than 442. The latest two years always look low, so the trend below is given like for like.

• The brief

  Where the fines fall: federal penalties against U.S. nursing homes: the written reading of these tables, pinned to release v2026.08.

• Descriptive, not causal

  Rates by state, ownership and chain control for nothing. State differences reflect how survey agencies and CMS regional offices enforce as much as how facilities behave.

The headline numbers

• Fines in the lookback13,25690.2 per 100 facilities
• Total fine dollars$456,752,787$31,093 per facility · $291 per bed
• Median fine$15,593mean $34,456
• Facilities fined44.3%6,514 of 14,690
• Payment denials2,44016.6 per 100 facilities
• Any penalty46.1%a fine or a payment denial
• Held by the most-fined 5%44.5%of all fine dollars · 735 facilities
• Half of all fine dollars895facilities account for it

A few facilities, most of the dollars

Facilities ranked by fine dollars in the lookback. The bars show the share of all fine dollars held by the most-fined 1, 5, 10 and 25 percent of the 14,690 certified nursing homes.

• Top 1% of facilities14.8% (147)
• Top 5% of facilities44.5% (735)
• Top 10% of facilities65.3% (1,469)
• Top 25% of facilities91.2% (3,673)

Fines by size

By ownership

For-profit facilities carry $318 in fines per certified bed against $201 for non-profit facilities, and 47.0% of them have at least one fine against 35.4%. The second table uses the disclosure groups of the ownership study; the private-equity group is small and the comparison is descriptive.

Ownership type

PECOS disclosure group

Chain status

By state

Pick a layer. State differences reflect survey and enforcement practice as much as facility conduct; the table under the map carries every layer for every state.

Chains and facilities with the most fines

CMS-identified chains with at least 20 facilities in the release, ranked by fine dollars per facility, and the 25 most-fined facilities. A chain's average is carried by a few of its homes as often as by all of them; open the chain to see each facility.

Most-fined facilities in the lookback

Since 2018: a surge of small fines, then fewer and larger ones

Because fines reach the file late, a fair trend counts, for each penalty year, only the fines that were visible by August 31 of the following year. On that basis the files show 2,467 fines for 2018, a surge to 24,070 for 2021 made up largely of small fines (the median fine that year was $2,600), and a fall in each year since to 7,818 for 2025. That is still 3.2 times the 2018 count, and the 2025 median fine of $22,925 is the highest of the series. The surge coincides with the COVID-19 period; the file does not record what a fine was for.

Fines in the public file, month by month

The monthly Penalties file held 37,082 fines at its peak in the 27 June 2023 file and holds 13,256 in the 26 August 2026 file, as the three-year lookback rolls off the 2021 to 2023 surge. CMS memo QSO-26-03-NH, revised April 3, 2026, says: "Per-Instance CMPs will be displayed on Nursing Home Care Compare beginning June 24, 2026." The 27 May 2026 file held 14,058 fines; the 3 files from 24 June 2026 hold 13,710, 13,687, 13,256. The count did not rise at that date, and the 24 June 2026 file added 806 distinct fines against a typical 998 per file. The public file has no field for the type of penalty, so it cannot show whether per-instance penalties were added, were already in it, or appear only on the website.

What the latest files added and dropped

Distinct fines first seen in each file and last seen in the file before it. A distinct fine is a facility, date and amount, so two equal fines on one day count once and these counts run slightly below the rows of the files. A file that adds many fines long after they were imposed is a fact about the file; the table cannot say why.

How long a fine takes to appear

Denials of payment for new admissions, by year imposed

Every denial seen in any monthly file since January 2019, by the year it was imposed. The two latest years are incomplete for the same reason fines are.

The Special Focus Facility program

The latest file flags 84 Special Focus Facilities and 441 candidates. The program is small and its size barely moves: between 79 and 89 Special Focus Facilities in every monthly file since January 2019, and between 440 and 446 candidates in every file that carries the candidate flag. The monthly files show who has passed through it.

• Ever flagged since 2019456facilities with the SFF flag in at least one monthly file
• Typical stay15 monthly filesmedian; one in ten 32 or more
• Flagged two years or more10624 or more monthly files
• Left the list, still certified266average overall rating today 2.18
• Still Special Focus8424 are now candidates
• No longer in the file82closed or left Medicare and Medicaid

A count of monthly files is not exactly a count of months, because the CMS archive re-published a few vintages. The Special Focus Facility lists back to 2012, recovered from archived CMS PDFs, are in the history store.

Sources and method