Nursing home fines and payment denials

The authority sits in sections 1819(h) and 1919(h) of the Social Security Act. The regulations that carry it out are in 42 CFR Part 488, Subpart F. Section 488.406 lists the remedies CMS and the state may use. They include termination, temporary management, denial of payment for new admissions, civil money penalties, state monitoring, transfer or closure, a directed plan of correction, and directed in-service training. The public Penalties file does not try to be that whole list. CMS describes it as the fines and payment denials received by nursing homes in the last three years.

That limit matters. An empty penalty table does not mean the home has never been cited, and it does not mean a survey agency never required a plan of correction. Citations live in the Health Deficiencies file and are explained in the deficiency-tag guide. A directed plan of correction, state monitoring, and temporary management are remedies too, and they do not become a "Fine" or a "Payment Denial" row. Read the penalty section for the remedies this file actually contains.

Civil money penalties

A civil money penalty is a fine. The data dictionary's penalty type for it is the word Fine. Each fine has a date, a Fine ID, and a fine amount in whole dollars. The dictionary defines the penalty date as the date of the inspection that triggered the penalty. The amount column is the dollar figure CMS published for that row. It is not a daily rate printed next to a day count, and the file does not show the arithmetic CMS used to reach it.

The regulation allows penalties per day and per instance. 42 CFR 488.408 and 42 CFR 488.430 set ranges that are adjusted each year under 45 CFR Part 102. Because those ranges move, the number to use for a particular home is the amount in the file, not a figure remembered from an older pamphlet. Section 488.408 sorts remedies by how serious the noncompliance is. Denial of payment for new admissions is one of the Category 2 remedies. A civil money penalty for immediate jeopardy has to be in the upper range, under section 488.438.

A home can waive a hearing. When it does, the regulations provide a reduction of the penalty. The Penalties file does not say whether a hearing was waived. It publishes the amount. If you need the notice CMS sent the home, that document is not this catalog. The catalog is the amount and the inspection date CMS later posted for the public.

Denial of payment for new admissions

The other penalty type in the file is Payment Denial. The dictionary defines two fields that belong to it. The payment denial start date is the date Medicare and Medicaid payment for new admissions was suspended. The payment denial length in days is the number of days that suspension lasted. 42 CFR 488.417 is titled denial of payment for all new admissions. People who already live in the home are not the group this remedy cuts off. New admissions are.

CMS or the state may impose that denial when the home is not in substantial compliance. They must impose it in two situations the regulation names. The first is when the home is still not in substantial compliance three months after the last day of the survey that found the noncompliance. The second is when the state survey agency has cited substandard quality of care on the last three consecutive standard surveys. Sections 1819(h)(2)(D) and 1919(h)(2)(C) of the Social Security Act are the matching statutory rules for the three-month denial. Payment generally resumes, prospectively, when the home is back in substantial compliance, as CMS or the state determines from a revisit or from written evidence it accepts. A repeated pattern of substandard quality of care has an extra condition in the same section before payment resumes.

The start date and the penalty date answer different questions. The penalty date is the inspection that triggered the action. The start date is the day the payment suspension began, which can fall after the inspection, once notice and the regulatory timing have run. The length in days is how long CMS says the suspension lasted. A short number of days can be a denial that was lifted after the home corrected. A long number can be a denial that ran for weeks. Neither number, by itself, tells you whether the home is turning away admissions on the day you call. Ask the home, and ask the state survey agency, whether a denial is in effect now.

What the facility page shows

Every facility page has a fines and penalties block. The sentences at the top come from the Provider Information file: the number of fines, the total amount of fines in dollars, and the number of payment denials. Under that, the page lists individual rows from the Penalties file for that certification number. The columns are the penalty date, the type, and either the dollar amount or the number of days. Fines show dollars. Payment denials show days. If the Penalties file has no rows for that home, the page says so, even when the summary counts above it are zeros.

The denial start date is in the Penalties file and is not a separate column on the table. The date you see is the penalty date, the inspection date. To know when the suspension of payment began, you need the start-date field in the catalog, or the notice the home received. The days column is the length CMS published.

Facility pages follow /nursing-homes/[state]/[city]/[slug]. Start from the state list, then the city, then the home. Compare shows a shorter version for homes you line up together: the fine count and the total fine dollars from Provider Information, in the row labeled fines in the file. It does not repeat each denial's dates. Open the facility page for the rows.

Why the totals and the rows can disagree

Provider Information and the Penalties file are two datasets in the same nursing home Provider Data Catalog. The dictionary describes the Penalties file as one row per fine or payment denial for the last three years, with the columns above. Provider Information carries summary columns: number of fines, total amount of fines in dollars, number of payment denials, and total number of penalties. State and national averages for the fine count count a zero for homes with no fines.

Those summaries and the rows are easy to mix up, and they do not always produce the same arithmetic on the page. A summary can be present when the row file has no lines for that certification number. A row file can list several dates whose dollars you could add by hand and still not match the total, because CMS defined the summary columns and the row file as separate publications. This site prints both and does not recompute one from the other. When they differ, the honest reading is that you are looking at two CMS fields, each with the window and the rules CMS used for that column. The processing date on the page is the vintage of both.

The star rating is a third thing. The September 2026 Technical Users' Guide builds the overall rating from health inspection points, staffing measures, and quality measures. The dollar total of fines is not an input in that method. A large fine and a one-star rating can show up together because both can follow serious citations. They are not the same calculation. The star-rating guide is the walk-through of the stars.

State licensure is a different record

States license nursing homes under state law, and state survey agencies also carry out the federal survey under CMS oversight. The CMS certification page describes that split. The state conducts the survey and certifies federal compliance or noncompliance, subject to CMS approval for Medicare. A state can also fine a home, limit admissions, appoint a monitor, or move against a license under its own statute. Those actions may never appear as a Fine or Payment Denial row in the federal file. A federal row may exist for a case the state also pursued, or it may be the only public penalty you can see here.

If the question is whether the home is allowed to operate this week, the federal file is not the whole answer. Call the state survey agency. CMS lists the agencies on its quality and safety oversight contact page. Ask about federal remedies and about state licensure actions, and ask whether a denial of payment for new admissions is in effect. The guide to choosing a home includes that call alongside the visit and the long-term care ombudsman.

How to read a penalty next to the citations

Start with the inspection date on the penalty row. Then find the survey of that date in the citation list on the same facility page. The tags and the scope and severity letters are the findings. The penalty is what CMS imposed. A J, K, or L on that survey is immediate jeopardy. A G, H, or I is actual harm. The deficiency-tag guide defines those letters. Homes in the Special Focus Facility program are under a separate instruction to escalate remedies, including fines and payment denials, which the Special Focus Facility guide covers.

Then read the type. A fine tells you CMS assessed money and published the dollars. A payment denial tells you CMS published a suspension of payment for new admissions, for the number of days in the row. Ask the administrator whether that denial changed who could be admitted, when it ended, and what correction the survey agency accepted. Take the posted survey results the home is required to make available, and compare the date on the wall with the date in the file. The file moves on CMS's release calendar. The building moves on the calendar of the people who live there.

Sources

• Provider Data Catalog, Penalties and Provider Information.
• Nursing Home Data Dictionary, penalty type, fine amount, payment denial start date, and length in days.
• 42 CFR 488.406, 488.408, 488.417, and 488.430.
• Social Security Act section 1819(h) and section 1919(h).
• September 2026 Technical Users' Guide, for what the star rating includes.
• CMS nursing home certification and state survey agency contacts.
• Medicare Care Compare.
• CMS Provider Data Catalog, nursing homes, processing date September 1, 2026.