1. Summary
- 13,256 fines worth $456,752,787 stand against U.S. nursing homes in the CMS Penalties file for August 2026, which covers penalties dated 19 August 2023 to 29 July 2026. 44.3% of the 14,690 certified facilities have at least one; the median fine is $15,593. There are also 2,440 denials of payment for new admissions.
- The dollars are concentrated. The most-fined 5% of facilities (735) account for 44.5% of all fine dollars, and 895 facilities account for half.
- For-profit facilities carry more per bed. $318 in fines per certified bed against $201 for non-profit facilities and $206 for government facilities; 47.0% of for-profit facilities have a fine against 35.4%. These comparisons control for nothing.
- A surge of small fines, then fewer and larger ones. Counted like for like, the files show 2,467 fines for 2018, 24,070 for 2021 (median $2,600) and 7,818 for 2025 (median $22,925). The 2025 count is 3.2 times the 2018 count.
- What the file cannot say. It has no field for per-instance versus per-day penalties, it does not describe appeals, reductions or payment, and a fine reaches it late: a median of 245 days for fines first seen in 2026. The latest two penalty years are always incomplete.
2. What the public file is, and its two limits
CMS publishes a Penalties file with its monthly Care Compare data. Each row is one civil money penalty (a fine) or one denial of payment for new admissions imposed on a certified nursing home, with a date and, for a fine, an amount. The file covers about three years. Provider Information carries the per-facility totals. This brief reads release v2026.08 for the current picture and the 88 monthly files in the CMS archive since January 2019 for the history.
Limit one: no penalty type. CMS can impose a fine per instance of noncompliance or per day. The file does not say which a fine was. 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 files from 24 June 2026 hold 13,710, 13,687, 13,256. The 24 June 2026 file added 806 distinct fines, against a typical 998 per file. The downloadable file therefore shows no added batch at that date, and because it has no type field it cannot show whether per-instance penalties were added, were already in it, or appear only on the website. 673 facility-dates in the current file carry more than one fine; that is a description of the file, not a proxy for penalty type.
Limit two: fines arrive late. A fine first seen in 2026 reached the file a median of 245 days after it was imposed; a quarter took more than 343 days and one in ten more than 442. A count of fines by the year they were imposed therefore keeps rising for about two years, and any comparison of a recent year with an older one is unfair unless both are counted at the same age. Section 6 does that.
3. How much, and how concentrated
The 13,256 fines come to $31,093 per certified facility and $291 per certified bed. The mean fine ($34,456) is 2.2 times the median ($15,593) because large fines carry most of the dollars: fines of $25,000 or more are 35.2% of fines and 79.3% of dollars.
Ranked by fine dollars, the top 1% of facilities (147) hold 14.8% of the dollars, the top 5% hold 44.5% and the top 10% hold 65.3%. 895 facilities, 6.1% of the total, account for half of all fine dollars. 55.7% of all facilities have no fine in the file.
| Fine amount | Fines | % of fines | Dollars | % of dollars |
|---|---|---|---|---|
| Under $5,000 | 1,852 | 14.0% | $7,291,123 | 1.6% |
| $5,000 to $9,999 | 2,242 | 16.9% | $17,979,328 | 3.9% |
| $10,000 to $24,999 | 4,494 | 33.9% | $69,531,711 | 15.2% |
| $25,000 to $99,999 | 3,536 | 26.7% | $178,392,065 | 39.1% |
| $100,000 to $499,999 | 1,130 | 8.5% | $182,280,020 | 39.9% |
| $500,000 or more | 2 | 0.0% | $1,278,540 | 0.3% |
4. Who is fined
By ownership type, 47.0% of for-profit facilities have at least one fine, against 35.4% of non-profit and 40.4% of government facilities. Per certified bed the figures are $318, $201 and $206. For-profit facilities also have lower average overall ratings (2.80 against 3.57), so ownership type and inspection results move together here and the table cannot separate them.
Facilities in a CMS-identified chain carry $304 per bed against $261 for facilities outside one.
Using the disclosure groups of the ownership study, the 65 facilities that disclose a private-equity owner to CMS carry $457 per bed and 61.5% of them have a fine, against $288 and 44.3% for facilities with no private-equity or REIT disclosure. The group is small, disclosure is incomplete, and the comparison is descriptive: it is not an estimate of the effect of private-equity ownership.
| Chain | Facilities | % fined | $ per facility | $ per bed | Avg overall rating |
|---|---|---|---|---|---|
| ARCADIA CARE | 25 | 84.0% | $188,782 | $1,550 | 1.35 |
| RELIANT CARE MANAGEMENT | 34 | 82.4% | $150,154 | $1,492 | 1.18 |
| TUTERA SENIOR LIVING & HEALTH CARE | 25 | 84.0% | $113,487 | $1,186 | 2.04 |
| EPHRAM LAHASKY | 22 | 68.2% | $105,882 | $1,103 | 1.75 |
| ALLAIRE HEALTH SERVICES | 20 | 70.0% | $98,010 | $574 | 2.56 |
| THE ALDEN NETWORK | 27 | 74.1% | $92,358 | $543 | 2.85 |
| APERION CARE | 33 | 60.6% | $74,443 | $585 | 1.94 |
| FOCUSED POST ACUTE CARE PARTNERS | 25 | 80.0% | $69,240 | $602 | 1.88 |
A chain average is often carried by a few of its homes. Each chain name links to its profile, which lists every facility.
5. Where
Among states with at least 10 facilities, fine dollars per certified bed are highest in Vermont ($1,008), Illinois ($884), Alaska ($786), Montana ($694), Delaware ($662) and lowest in Arizona ($76), New Hampshire ($80), Indiana ($85), Arkansas ($85), Maine ($99). Illinois has the most dollars in all, $75,126,367. State survey agencies carry out the inspections and certify their findings, and CMS imposes the federal penalties, so a state figure reflects how enforcement is practiced there as much as how facilities behave. The state map and table carry every measure for every state.
6. Since 2018, like for like
For each penalty year the table counts only the fines that were visible by August 31 of the following year, so every year is measured at the same age. On that basis there were 2,467 fines for 2018, a surge to 24,070 for 2021 made up largely of small fines (median $2,600), and 7,818 for 2025, 3.2 times the 2018 count. The 2025 median fine, $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, so this brief does not attribute it.
7. What each monthly file adds
The monthly 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 2021 to 2023 surge leaves the three-year window. A typical file adds about 998 distinct fines. Among files that added at least 500 fines, the one with the largest share of old fines is the 20 November 2025 file, the first to add any fines in 113 days (since the 30 July 2025 file): 3,649 distinct fines, 58.6% of them first seen more than a year after they were imposed. The file does not say why.
8. Payment denials
A denial of payment for new admissions withholds Medicare and Medicaid payment for residents admitted while it is in force. The State Operations Manual makes it mandatory when a facility is still out of substantial compliance three months after a survey, or has furnished substandard quality of care on three consecutive standard surveys (Chapter 7, citing 42 CFR 488.414). The current file lists 2,440, or 16.6 for every 100 facilities. Across every monthly file since January 2019, the year with the most denials imposed is 2022, with 1,394 and a median length of 22 days. The two latest years are incomplete for the same reason fines are.
9. The Special Focus Facility program
The latest file flags 84 Special Focus Facilities and 441 candidates. The number of Special Focus Facilities has stayed between 79 and 89 in every monthly file since January 2019. 456 facilities have carried the flag in at least one file. The typical stay is 15 monthly files, and 106 facilities were flagged in 24 or more. Of those ever flagged, 84 are still Special Focus Facilities, 24 are candidates, 266 are certified and no longer flagged, with an average overall rating of 2.18 today, and 82 are no longer in the file. A count of monthly files is not exactly a count of months, because the CMS archive re-published a few vintages.
10. Limitations
- Descriptive only. No comparison here adjusts for resident acuity, facility size, region or how often a facility is inspected. Differences between groups are not estimates of the effect of belonging to a group.
- Federal penalties only. State fines and licensure actions are not in the file.
- Amounts as published. The file gives one amount per fine and does not describe appeals, reductions, or whether a fine was paid.
- No penalty type. Nothing here separates per-instance from per-day penalties, because the public file does not.
- Late arrival. Recent penalty years are incomplete. Trends use the like-for-like count.
- Identity across files. The history identifies a fine by facility, date, type and amount, so two equal fines on one day count once in the tables that follow a fine across files. Counts of fine rows in a file are taken from the file itself.
11. Reproduce, cite, correct
Every figure is a value in a CSV table committed under analysis/enforcement/v2026.08 in the public repository, computed by tcr-open-data enforcement-study from release v2026.08 (archived at Zenodo) and the monthly CMS archive. Section 12 of the methodology defines each table. The live tables, the state map and the most-fined facilities are on the enforcement page.
Cite as: The Care Ratings Team (2026). Where the fines fall: federal penalties against U.S. nursing homes: Enforcement brief, first edition (version 1.0, release v2026.08). The Care Ratings. https://thecareratings.com/data/enforcement/brief-2026/ Data: https://doi.org/10.5281/zenodo.22780105
Prepared by the Care Ratings Team under the editorial standards. Text and tables are CC BY 4.0. Corrections go to the contact page and are logged on the corrections page.
