Understanding the record

Nursing Home Fines: How CMS Civil Money Penalties Work

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By Nursing Home Checker · Updated Oct 20, 2026 · How guides are checked · Share

What is a civil money penalty for a nursing home?

A civil money penalty (CMP) is a fine for not meeting federal nursing home requirements. Federal rules (42 CFR 488.406) list it among several remedies. Others include denial of payment, state monitoring, temporary management, a directed plan of correction, directed in-service training and transfer of residents. A home's Medicare or Medicaid agreement can also be ended.

CMS or the state may fine a home for each day it is out of compliance, for each instance of noncompliance, or both, whether or not the problem is immediate jeopardy. An "instance" is a specific event at a specific time. One cited deficiency may include several instances.

When can CMS fine a nursing home or deny payment?

Federal rules (42 CFR 488.408) group remedies into three categories by how serious and how widespread the noncompliance is. Fines appear in Categories 2 and 3, and denial of payment for new admissions in Category 2:

• Category 1 (isolated or patterned deficiencies with no actual harm but potential for more than minimal harm): directed plan of correction, state monitoring, directed in-service training.
• Category 2 (widespread with no actual harm, or actual harm that is not immediate jeopardy): denial of payment for new admissions, lower-range per-day fines and per-instance fines, among others.
• Category 3 (immediate jeopardy): temporary management, immediate termination, upper-range per-day fines and per-instance fines.

For what these severity terms mean on an inspection, see what inspection severity letters A to L mean.

How much can a nursing home be fined?

The current amounts come from HHS's yearly inflation adjustment in 45 CFR 102.3, published and effective January 28, 2026. They apply to penalties assessed on or after that date, for violations on or after November 2, 2015.

The regulation itself (42 CFR 488.438) still prints the original base ranges, such as $50 to $3,000 a day, followed by "as adjusted annually under 45 CFR part 102." Those base figures are not the amounts in use.

How does CMS decide the amount of a fine?

Federal rules say the amount is based on the home's history of noncompliance, including repeated deficiencies, its financial condition, the seriousness of the problems and its degree of culpability. Other rules also apply:

• Start and end. A per-day fine may start as early as the date the home was first out of compliance and runs until it is back in substantial compliance.
• Repeats. The per-day amount must be increased for a repeated deficiency (found at the last survey, corrected, and found again at the next survey) when a lower penalty was imposed for it before.
• Immediate jeopardy removed. If immediate jeopardy ends but noncompliance continues, the per-day amount shifts to the lower range.
• Earlier problems. A fine may cover noncompliance cited earlier, going back to the last three standard surveys.

CMS's FY 2025 payment rule, effective October 1, 2024, expanded its authority to impose several per-instance fines when the same type of noncompliance is found on more than one day, and to combine per-instance and per-day fines. CMS memo QSO-26-03-NH (revised April 3, 2026) updated its enforcement guidance to match and said per-instance fines would be displayed on Nursing Home Care Compare beginning June 24, 2026.

Can a nursing home fine be reduced or appealed?

Yes, in limited ways. A home may appeal the finding of noncompliance behind a remedy, but federal rules say it may not appeal the choice of remedy. The hearing request must be in writing within 60 days of receiving the notice.

• 35% reduction. Since October 1, 2023, a home that does not request a hearing within 60 days of the penalty notice is treated as having waived it, and the fine is reduced by 35%.
• 50% reduction. For a penalty imposed by CMS, a separate 50% reduction applies when the home reported the noncompliance itself before it was identified, corrected it promptly, waived its hearing and met other conditions (for example, the problem was not immediate jeopardy or widespread harm and did not cause a death). The two reductions cannot be combined.
• No zero. If a judge or hearing officer finds there was a basis for the penalty, they may not set it at zero or reduce it to zero.

For informal dispute resolution and escrow, see how to read a nursing home inspection report.

What is a denial of payment for new admissions?

It means Medicare and Medicaid stop paying the home for residents admitted on or after the denial's start date. CMS or the state may impose it whenever a home is out of compliance. Federal rules (42 CFR 488.417) make it required when:

• the home is still not in substantial compliance 3 months after the last day of the survey that found the problem; or
• the state cited the home for substandard quality of care on its last three standard surveys in a row.

Residents admitted before the effective date, including those on temporary leave, are not new admissions. Without repeated substandard quality of care, payment resumes from the date the home is back in compliance, with no payment for the time in between. If a home without immediate jeopardy is still out of compliance 6 months after the last day of the survey, CMS ends its provider agreement.

Where does nursing home fine money go?

Of the fine money CMS holds in escrow and still has after a final decision, federal rules send 10% to the U.S. Treasury. The other 90% must be used for CMS-approved activities that protect or improve residents' quality of care or life, such as supporting residents of a home that closes. It may not pay for survey and certification work or state expenses, except reasonable costs of administering, monitoring or evaluating the funded projects. CMS memo QSO-25-26-NH says that for penalties imposed by CMS, a portion of the final amount collected is returned to the state where the home is located.

What does CMS publish about nursing home penalties?

CMS publishes a Penalties file listing the fines and payment denials nursing homes received in the last three years. Medicare's booklet on choosing a nursing home says Care Compare shows any penalties the federal government has issued against a home. In the data as of Sep 1, 2026, the file holds 12,989 fine records and 2,430 payment denial records. Of the 14,690 homes in CMS's Provider Information file, 6,510 have at least one fine and 1,876 at least one payment denial.

CMS's September 2026 Five-Star guide builds the health inspection rating from citations, complaint and infection control surveys, and revisits; it does not list fines as an input. Medicare says homes in the Special Focus Facility program are subject to more frequent inspections and penalties. See what a Special Focus Facility is.

How do I find a nursing home's fines on this site?

Each home's page has a section called "Penalties, past three years". Tap "Fines" in the page menu to jump to it.

This site does not show the payment denial start date. When CMS lists nothing, the page says "CMS lists no fines or payment denials for this home in the past three years." A note under the section gives the state and national averages. For a concern about care, see how to file a complaint about a nursing home.

What is the average number of fines per nursing home in each state?

Nationally, CMS's averages show 0.9 fines and $30,972 in fines per home, counting homes with no fines as zero. States are listed in alphabetical order. Tap a state to see its homes.

A state average describes that state's homes as a group, not any one home. For other state figures, see the site's nursing home data reports.