Clean on paper
Most US nursing homes that CMS shows with no penalty were penalised before its three-year window began.
6,255 of 7,915
nursing homes with no penalty in CMS's current file had one in an earlier edition, 79%.
The Centers for Medicare & Medicaid Services (CMS) inspects about 14,690 nursing homes. It publishes the fines and payment denials it imposes on them as a rolling three-year window. When a penalty turns three, it leaves the current file.
That file is what families see. Care Compare, ProPublica's Nursing Home Inspect, LTCCC's NursingHome411 and The Care Ratings all show about three years. Of the 14,690 homes CMS inspects, 7,915 have no penalty in the current file. On each of those tools they read as penalty-free.
CMS has not deleted the older penalties. It keeps monthly archive copies of the whole nursing-home dataset back to January 2019, and the oldest reaches penalties dated 2016. Rebuilding every penalty from those 83 archived editions gives 83,164 penalties. Of those, 67,468 are no longer in the current file, including 60,468 fines totalling $1.26 billion.
Joining that history back to the homes CMS inspects today:
| Homes CMS inspects today | Count |
|---|---|
| With a penalty in the current file | 6,775 |
| With none in the current file | 7,915 |
| of which penalised in an earlier edition | 6,255 |
| with at least $100,000 in fines no longer shown | 1,156 |
| with at least $1,000,000 | 12 |
| of which never penalised in any edition since 2019 | 1,660 |
A clean current record can mean a home improved. Three years is a reasonable span for that. The point is not that these homes are bad now. It's that a family choosing one cannot tell improved apart from always clean, because every public tool built on CMS's current file shows the same blank for both.
Five homes, clean today
The five with the most fines no longer shown. Three have changed name since, which is common after a change of ownership and is itself something a reader would want to know.
| Name today (CMS) | Where | Fines | Total | Dated |
|---|---|---|---|---|
| Siesta Key Health and Rehabilitation Center | Sarasota, FL | 10 | $1,275,391 | 2016–2023 |
| Aperion Care Chicago Heights | Chicago Heights, IL | 22 | $1,271,574 | 2017–2023 |
| Autumn Lake Healthcare at Ruxton | Towson, MD | 7 | $1,162,036 | 2017–2022 |
| Complete Care at Wheaton | Wheaton, MD | 3 | $1,142,745 | 2016–2019 |
| The Orchards at Lapeer | Lapeer, MI | 15 | $1,140,528 | 2017–2022 |
Each one's full record, with the edition that last listed every penalty, is on the Nursing Home Penalty Ledger.
A second question: penalties that left early
Almost every dropped penalty leaves right on schedule. The gap between a penalty's date and the last edition listing it has a sharp cliff just under three years. But 8,550 left well before that. Two explanations can be checked from the data, and they are removed first:
- 4,455 belong to homes CMS no longer inspects (closed, or certified again under a new number). All of a home's rows go together.
- 128 were re-dated: the same home, the same kind of penalty and the same amount appear again later under a new date.
That leaves 3,967 penalties at homes CMS still inspects, including 3,594 fines totalling $97.4 million, that left the current file inside their three-year window. The files do not say why. Appeals, settlements and corrections are all plausible, and this analysis cannot tell them apart. That is a question for CMS, and one a reporter is better placed to ask than a spreadsheet.
How this was done
CMS lists its archived editions as JSON at data.cms.gov/provider-data/api/1/archive/aggregate/theme/nursing-homes/relative. The ledger reads the penalties file out of each of 83 distinct editions from 2019-01-17 to 2026-08-26, and tracks each penalty's first and last appearance. Two checks were run on 2026-09-19. The penalties it marks as still published match CMS's current file row for row (15,696). And 60 of 60 sampled dropped penalties are present in their last edition and absent from the next.
Every figure above is printed by one script, tools/findings.py, with tests for each way a penalty is counted. A penalty whose amount CMS revised while listing it is counted once, at the last amount listed. Fines are dollars and payment denials are days, so the two are never added together.
What this does not show: which rule a home broke. CMS's citation files are 66–165 MB a month and are not archived here, so the ledger holds penalty amounts and dates, not the deficiencies behind them.