{
  "study": {
    "slug": "nursing-home-fine-size-trend-2026",
    "title": "The rising size of nursing-home fines: a three-year trend, 2026",
    "standfirst": "Across three years of CMS nursing-home enforcement — 13,764 fines totaling $459.3M — the size of the typical penalty more than doubled. The median fine rose from $8,193 in 2023 to $22,315 so far in 2026 — up 21% across the two complete years. The whole distribution shifted up, not a few outliers.",
    "desk": "financial-distress",
    "article_type": "Original Research",
    "published": "2026-06-16",
    "issue": 82,
    "doi": "10.5072/fonteum/nursing-home-fine-size-trend-2026",
    "url": "https://fonteum.com/research/nursing-home-fine-size-trend-2026",
    "methodology_version": "cms-cmp/v1"
  },
  "data_as_of": "2026-06-16",
  "datasets": [
    {
      "slug": "cms-nursing-home-compare",
      "name": "CMS Nursing Home Compare",
      "publisher": "CMS — Nursing home quality (Care Compare)",
      "upstream_url": null
    }
  ],
  "key_findings": [
    {
      "number": "2.7×",
      "finding": "the median CMS nursing-home fine more than doubled, from $8,193 in 2023 to $22,315 in the partial 2026. Across the two complete calendar years the median rose 21% — from $16,055 in 2024 to $19,412 in 2025. Median is a per-action figure, unaffected by the partial first and last years",
      "dataset": "cms-nursing-home-compare"
    },
    {
      "number": "$4,587 → $15,185",
      "finding": "the bottom-quartile (25th-percentile) fine more than tripled across the window — the broadest sign that the entire schedule of amounts shifted up, rather than a few large penalties pulling the average. By the last complete year, 2025, the bottom-quartile fine had already reached $12,632",
      "dataset": "cms-nursing-home-compare"
    },
    {
      "number": "55.3% → 16.4%",
      "finding": "the share of fine actions under $10,000 collapsed — from 55.3% of all 2023 fines to 16.4% in 2025. The thick base of small fines thinned out as the typical amount climbed",
      "dataset": "cms-nursing-home-compare"
    },
    {
      "number": "~40%",
      "finding": "the share of fine dollars coming from fines of $100,000 or more held near 40% every year (39.4% in 2023, 40.4% in 2024, 42.4% in 2025). Because the outlier share is steady, the rise is the base moving up — not a thickening tail of very large penalties",
      "dataset": "cms-nursing-home-compare"
    },
    {
      "number": "$459.3M",
      "finding": "across 13,764 fine actions, plus 2,513 payment denials, fell on 6,884 Medicare/Medicaid-certified facilities in 53 states and territories, CMS release dated 2026-05-01. Every figure here is a count, sum, or percentile over published records — no individual facility is named, ranked, or scored",
      "dataset": "cms-nursing-home-compare"
    }
  ],
  "faqs": [
    {
      "q": "What is a CMS civil money penalty against a nursing home?",
      "a": "A civil money penalty (CMP) is a fine CMS imposes on a Medicare/Medicaid-certified nursing facility found out of compliance with federal Conditions of Participation. CMS can levy a per-day amount for an ongoing deficiency or a per-instance amount for a specific event. The penalty is a CMS enforcement determination; this study counts and sizes the published actions and does not assess any facility's compliance."
    },
    {
      "q": "Has the size of nursing-home fines changed over time?",
      "a": "Yes. The median fine in CMS's Civil Money Penalties file more than doubled across the window, from $8,193 in 2023 to $22,315 in the partial 2026. Looking only at the two complete calendar years removes any partial-year effect: the median still rose 21%, from $16,055 in 2024 to $19,412 in 2025. Because the median is a per-action figure, the incomplete first and last years do not bias it."
    },
    {
      "q": "Is the increase just a few very large penalties?",
      "a": "No — it is the whole distribution moving up. The bottom-quartile (25th-percentile) fine more than tripled, from $4,587 in 2023 to $15,185 in 2026, and the share of fine actions under $10,000 fell from 55.3% to 16.4% by 2025. Meanwhile the share of dollars from fines of $100,000 or more held near 40% every year, so the rise is the base of small fines climbing, not the outlier tail thickening."
    },
    {
      "q": "Why are the 2025 and 2026 fine counts lower?",
      "a": "Mostly reporting lag, not a drop in enforcement. The file behind this study was released 2026-05-01, and recent enforcement actions report into the public file over time, so the most recent quarters are still filling in. That is why this study reads the trend off fine size — a per-action measure that does not depend on how complete the count is — and treats annual counts as understated at the tail."
    },
    {
      "q": "Why did the amounts rise?",
      "a": "The file does not say. It records the amount CMS set for each action under the agency's published enforcement criteria, but not the reason behind it. Penalty amounts follow CMS's own methodology, which this study reports as recorded rather than replicating or auditing. We describe the movement in the amounts and draw no conclusion about its cause."
    },
    {
      "q": "Does a larger fine mean a nursing home is less safe?",
      "a": "Not on its own. A fine records that CMS cited a facility for a deficiency on a past survey and set an amount; a larger amount reflects CMS's enforcement criteria for that citation, not a Fonteum measure of safety. Many facilities correct deficiencies promptly, and the file does not show current condition. This study works only at the year, percentile, and distribution level and names no facility."
    },
    {
      "q": "Is Fonteum issuing or assessing these penalties?",
      "a": "No. Every penalty in this study is a CMS enforcement action published by CMS. Fonteum does not impose fines, assess facility compliance, or make enforcement determinations. The study aggregates the published records — by year, fine size, and distribution — and reports the counts, sums, and percentiles."
    },
    {
      "q": "Can I reproduce these figures?",
      "a": "Yes. Every number is a direct count, sum, or percentile over the public cms_civil_money_penalties table — CMS's Civil Money Penalties file, source release 2026-05-01 — with no modeling. The exact SQL for the median-by-year trend, the percentile shift, the small-fine and outlier shares, and the quarterly check is published in the reproducibility block below."
    }
  ],
  "citation": {
    "apa": "Fonteum Research. (2026, June 16). The rising size of nursing-home fines: a three-year trend, 2026. Fonteum Research, Issue 82. https://doi.org/10.5072/fonteum/nursing-home-fine-size-trend-2026",
    "url": "https://fonteum.com/research/nursing-home-fine-size-trend-2026"
  },
  "reproducible_sql": "-- HOW the size of CMS nursing-home civil money penalties has moved over three\n-- years. Fully reproducible query.\n--\n-- Question: across the civil money penalties (CMPs) CMS has imposed on\n-- Medicare/Medicaid-certified nursing facilities, has the SIZE of the typical\n-- fine changed over time? The lead figure: the median fine more than doubled,\n-- from $8,193 in 2023 to $22,315 in the partial 2026, and rose 21% between the\n-- two complete calendar years ($16,055 in 2024 to $19,412 in 2025). The climb is\n-- broad-based — the bottom-quartile fine more than tripled and the share of\n-- fines under $10,000 collapsed — not a few large outliers pulling the average.\n-- A penalty is a CMS enforcement action, NOT a Fonteum judgment, fraud signal,\n-- or assessment of current facility quality. The file records the AMOUNTS CMS\n-- set; it does not record why they moved, and this query infers no cause.\n--\n-- Source:\n--   public.cms_civil_money_penalties — CMS \"Civil Money Penalties\" public-use\n--     file, published quarterly via the CMS data catalog (data.cms.gov, dataset\n--     g6vv-u9sr). 16,277 enforcement actions; source release 2026-05-01.\n--     Public, read-only. License: US-Government-Works (17 U.S.C. Sec. 105).\n--     methodology_version = 'cms-cmp/v1'.\n--\n-- Universe: this study reads the published file AS A WHOLE — every row is one\n--   enforcement action CMS records against a certified facility, keyed to the\n--   facility CMS Certification Number (CCN). The file carries NO provider NPI;\n--   penalties join to facilities, never to a named clinician. The window runs\n--   from a partial 2023 (actions dated from 2023-05-17) through a partial 2026\n--   (to 2026-04-17), so the first and last calendar years are incomplete.\n--\n-- Counting note: two penalty types appear. A \"Fine\" carries a fine_amount; a\n--   \"Payment Denial\" suspends Medicare/Medicaid payment for new admissions and\n--   carries no dollar amount. Every size figure below is over fine actions only.\n--   Per-action statistics (median, percentiles) are unaffected by the partial\n--   first/last years; annual COUNTS are not, because recent actions report into\n--   the file with a lag (see query 6). No individual facility is named.\n\n-- ============================================================================\n-- (1) Universe reconciliation — the published file at a glance.\n-- ============================================================================\nSELECT\n  count(*)                                                          AS actions,\n  count(DISTINCT ccn)                                               AS distinct_ccn,\n  count(DISTINCT state)                                             AS states,\n  count(*) FILTER (WHERE penalty_type = 'Fine')                     AS fine_actions,\n  round(sum(fine_amount) FILTER (WHERE penalty_type = 'Fine'))      AS total_fine_usd,\n  count(*) FILTER (WHERE penalty_type = 'Payment Denial')           AS payment_denials,\n  round(percentile_cont(0.5) WITHIN GROUP (ORDER BY fine_amount)\n        FILTER (WHERE fine_amount > 0))                             AS median_fine_allyears,\n  max(fine_amount)                                                  AS max_fine,\n  min(penalty_date)                                                 AS earliest_action,\n  max(penalty_date)                                                 AS latest_action,\n  max(source_release_date)                                          AS source_release\nFROM public.cms_civil_money_penalties;\n--  actions 16,277 · distinct_ccn 6,884 · states 53 · fine_actions 13,764\n--  total_fine_usd 459,337,807 · payment_denials 2,513\n--  median_fine_allyears $14,576 · max_fine $713,795\n--  earliest 2023-05-17 · latest 2026-04-17 · source_release 2026-05-01\n\n-- ============================================================================\n-- (2) HEADLINE: the size of the typical fine by year. Median is the headline\n--     because it is a per-action statistic — unbiased by the partial 2023 and\n--     2026 years. The median fine more than doubled across the window; across\n--     the two COMPLETE years (2024, 2025) it rose 21%.\n-- ============================================================================\nSELECT\n  extract(year FROM penalty_date)::int                              AS action_year,\n  count(*) FILTER (WHERE penalty_type = 'Fine')                     AS fine_actions,\n  round(percentile_cont(0.5) WITHIN GROUP (ORDER BY fine_amount)\n        FILTER (WHERE fine_amount > 0))                             AS median_fine,\n  round(avg(fine_amount) FILTER (WHERE fine_amount > 0))            AS avg_fine,\n  round(sum(fine_amount) FILTER (WHERE penalty_type = 'Fine'))      AS fine_dollars\nFROM public.cms_civil_money_penalties\nGROUP BY action_year\nORDER BY action_year;\n--  2023 (partial)  4,876  median $ 8,193  avg $24,038  $117,210,368\n--  2024            5,098  median $16,055  avg $36,090  $183,989,128\n--  2025            3,423  median $19,412  avg $41,888  $143,381,741\n--  2026 (partial)    367  median $22,315  avg $40,209  $ 14,756,570\n--  median 2025/2024 = 1.21x (+21%) · median 2026/2023 = 2.72x\n\n-- ============================================================================\n-- (3) The climb is the whole distribution, not a few outliers. Read the 25th,\n--     50th, 75th and 90th percentiles of fine size per year: every percentile\n--     rises, and the BOTTOM quartile (p25) more than tripled — the clearest sign\n--     the entire schedule of amounts shifted up rather than a thin tail growing.\n-- ============================================================================\nSELECT\n  extract(year FROM penalty_date)::int                              AS action_year,\n  round(percentile_cont(0.25) WITHIN GROUP (ORDER BY fine_amount)\n        FILTER (WHERE fine_amount > 0))                             AS p25,\n  round(percentile_cont(0.50) WITHIN GROUP (ORDER BY fine_amount)\n        FILTER (WHERE fine_amount > 0))                             AS p50,\n  round(percentile_cont(0.75) WITHIN GROUP (ORDER BY fine_amount)\n        FILTER (WHERE fine_amount > 0))                             AS p75,\n  round(percentile_cont(0.90) WITHIN GROUP (ORDER BY fine_amount)\n        FILTER (WHERE fine_amount > 0))                             AS p90\nFROM public.cms_civil_money_penalties\nWHERE penalty_type = 'Fine'\nGROUP BY action_year\nORDER BY action_year;\n--  2023  p25 $ 4,587  p50 $ 8,193  p75 $20,124  p90 $ 65,546\n--  2024  p25 $ 8,824  p50 $16,055  p75 $43,220  p90 $ 92,167\n--  2025  p25 $12,632  p50 $19,412  p75 $49,959  p90 $104,650\n--  2026  p25 $15,185  p50 $22,315  p75 $37,410  p90 $ 91,022 (partial)\n--  p25 2026/2023 = 3.31x; p25 2025/2023 = 2.75x\n\n-- ============================================================================\n-- (4) Two views of the same shift. The small-fine base THINNED: fines under\n--     $10,000 fell from 55.3% of all fine actions in 2023 to 16.4% in 2025.\n--     Meanwhile the dollar SHARE from fines of $100k+ held near 40% every year,\n--     so the rise is the base moving up, not a thickening outlier tail.\n-- ============================================================================\nSELECT\n  extract(year FROM penalty_date)::int                              AS action_year,\n  count(*) FILTER (WHERE fine_amount > 0 AND fine_amount < 10000)   AS fines_under_10k,\n  round(100.0 * count(*) FILTER (WHERE fine_amount > 0 AND fine_amount < 10000)\n        / count(*) FILTER (WHERE fine_amount > 0), 1)               AS pct_under_10k,\n  count(*) FILTER (WHERE fine_amount >= 100000)                     AS fines_100k_plus,\n  round(100.0 * sum(fine_amount) FILTER (WHERE fine_amount >= 100000)\n        / sum(fine_amount) FILTER (WHERE fine_amount > 0), 1)       AS pct_dollars_100k_plus\nFROM public.cms_civil_money_penalties\nWHERE penalty_type = 'Fine'\nGROUP BY action_year\nORDER BY action_year;\n--  2023  under_10k 2,698  55.3%  ·  100k+ 280  dollars 39.4%\n--  2024  under_10k 1,482  29.1%  ·  100k+ 462  dollars 40.4%\n--  2025  under_10k   562  16.4%  ·  100k+ 362  dollars 42.4%\n--  2026  under_10k    11   3.0%  ·  100k+  34  dollars 39.4% (partial)\n\n-- ============================================================================\n-- (5) Quarter by quarter — the median fine rises near-monotonically, confirming\n--     the annual trend is not an artifact of how the partial years split. The\n--     step up is concentrated at the start of 2024. The final quarter (2026 Q2,\n--     18 fines) is the file's trailing edge and is shown for completeness only.\n-- ============================================================================\nSELECT\n  date_trunc('quarter', penalty_date)::date                         AS quarter,\n  count(*) FILTER (WHERE penalty_type = 'Fine')                     AS fine_actions,\n  round(percentile_cont(0.5) WITHIN GROUP (ORDER BY fine_amount)\n        FILTER (WHERE fine_amount > 0))                             AS median_fine\nFROM public.cms_civil_money_penalties\nGROUP BY quarter\nORDER BY quarter;\n--  2023Q2   998  $ 7,444   2024Q2 1,184 $16,830   2025Q2  951 $19,503\n--  2023Q3 1,991  $ 8,469   2024Q3 1,183 $17,108   2025Q3  787 $19,135\n--  2023Q4 1,887  $ 8,424   2024Q4 1,032 $16,801   2025Q4  550 $21,645\n--  2024Q1 1,699  $13,674   2025Q1 1,135 $18,351   2026Q1  349 $22,320\n--                                                  2026Q2   18 $21,568 (edge)\n\n-- ============================================================================\n-- (6) Counts decline at the tail — and why that is NOT a fall in enforcement.\n--     The file is released 2026-05-01; recent actions report in with a lag, so\n--     2025 and 2026 fine COUNTS are incomplete and understate true volume. This\n--     query is the caution behind the study: it reads the SIZE trend (queries\n--     2-5, all per-action) as robust, and treats annual counts as lag-affected.\n-- ============================================================================\nSELECT\n  extract(year FROM penalty_date)::int                              AS action_year,\n  count(*)                                                          AS actions,\n  count(*) FILTER (WHERE penalty_type = 'Fine')                     AS fine_actions,\n  count(*) FILTER (WHERE penalty_type = 'Payment Denial')           AS payment_denials,\n  count(DISTINCT ccn)                                               AS facilities\nFROM public.cms_civil_money_penalties\nGROUP BY action_year\nORDER BY action_year;\n--  2023 5,539  fines 4,876  denials   663  facilities 2,798 (partial, from 2023-05-17)\n--  2024 6,170  fines 5,098  denials 1,072  facilities 3,819\n--  2025 4,162  fines 3,423  denials   739  facilities 2,932 (lag-affected)\n--  2026   406  fines   367  denials    39  facilities   371 (partial, to 2026-04-17)",
  "license": "U.S. Government Works (federal sources; 17 U.S.C. §105)",
  "generated_by": "Fonteum — https://fonteum.com",
  "notes": "Aggregate, source-traced figures frozen to the snapshot above. Reproduce by running reproducible_sql against the cited federal dataset; no per-entity records are included."
}