44% of nursing homes were fined in three years: 16% in Alabama, 75% in South Dakota

CMS's nursing home files for September 2026 list 14,690 currently active nursing homes, and 6,510 of them, 44.3%, were fined at least once in the three years the files cover. By state, the share runs from 15.6% of homes in Alabama to 75.0% in South Dakota. In 20 of the 50 states and DC, more than half of the homes were fined.

CMS's Penalties file lists the fines and payment denials nursing homes received in the last three years. It dates each one by the inspection that triggered it, and in the September 2026 file those inspections run from September 17, 2023, to August 17, 2026.

How large were the fines?

Among the 6,510 fined homes, the median three-year total was $33,594. State by state, the median for fined homes runs from $12,404 in Mississippi to $120,167 in Vermont. Homes in Illinois were fined $73,934,986 in all, more than in any other state, and Texas came next at $51,954,195, although Texas has 1,177 active homes to Illinois's 666.

What does the chart leave out?

The chart counts fines only. CMS's Penalties file also lists 2,430 payment denials, in which Medicare and Medicaid payment for a home's new admissions is suspended for a time the file records in days, and a home with a payment denial but no fine is not counted as fined.

It also counts only homes CMS listed as active when it built the September 2026 file, because the Provider Information file covers currently active nursing homes. A home that is no longer active in CMS's records, such as one that closed, is in neither count.

The Penalties file lists each fine's amount in whole dollars. They do not say what each home paid, or why the share of homes fined differs from one state to the next. The map leaves out Guam, which has one home, and Puerto Rico, which has nine, and both are in the national figure.

What does it mean for a nursing home?

Every fine in the Penalties file is tied to an inspection, because CMS dates each one by the inspection that triggered it. CMS's data dictionary describes a Health Deficiencies file that lists each health citation from a home's last three inspection cycles, with its tag number and description. So a home can see which requirements surveyors cited in its own building, and in others in its state, before its next inspection.

Nursing Home Survey Readiness uses CMS's public inspection, fine and staffing files to compare a building with others in its state and rank the tags, the federal requirements surveyors cite by number, where it is most at risk.

Nursing home inspections and fines also appear among the healthcare problems AI tools can work on without patient data and on the post-acute and senior care cards in where AI tools fit in healthcare, by kind of organization.