Civil Money Penalties (CMPs): What Nursing Homes Need to Know in 2026
A CMS civil money penalty, also called a civil monetary penalty, is the fine behind most nursing home enforcement headlines. Here is what a CMP is, the 2026 amounts, how payment and collection work, and where the money goes.
Quick answer
A civil money penalty (CMP) is a federal fine that CMS or a state imposes on a Medicare- or Medicaid-certified nursing home that is not in substantial compliance with federal participation requirements. It is assessed per day of noncompliance, per instance, or both (42 CFR 488.430). For penalties assessed on or after January 28, 2026, per-day CMPs range from $136 to $27,378 and per-instance CMPs from $2,739 to $27,378.
This guide is general information about federal nursing home enforcement rules, not legal advice.
What Is a Civil Money Penalty (Civil Monetary Penalty)?
A civil money penalty is a federal fine that CMS or a state survey agency imposes on a certified nursing home that is not in substantial compliance with Medicare and Medicaid participation requirements. “Civil monetary penalty” is the same thing; HHS uses that wording for its penalties generally.
A CMS civil money penalty is one of several enforcement remedies, alongside denial of payment for new admissions, directed Plans of Correction, temporary management, and termination. The rules sit in 42 CFR Part 488, Subpart F.
A CMP follows a survey finding, recorded as an F-tag on the CMS-2567. The penalty and the deficiency are separate: paying one does not resolve the other.
Per-Day vs. Per-Instance Civil Money Penalties
A per-day civil money penalty accrues for every day a nursing home is out of substantial compliance, while a per-instance CMP is a fixed amount for one instance of noncompliance regardless of how long it lasted (42 CFR 488.440(a)).
Per-day penalties produce the largest totals, because the daily amount multiplies across weeks or months. A per-day CMP can start as early as the date the facility was first out of compliance, as determined by CMS or the state.
Since October 1, 2024, CMS can use both on the same survey. Under 42 CFR 488.430(a), it may impose per-day CMPs, per-instance CMPs, or both, in any combination for each instance of noncompliance, and under 488.430(b) it can reach noncompliance cited since the last three standard surveys.
2026 CMS Civil Monetary Penalty Amounts
For nursing home penalties assessed on or after January 28, 2026, the CMS civil monetary penalty ranges are $8,351–$27,378 per day for Immediate Jeopardy, $136–$8,211 per day for other deficiencies, and $2,739–$27,378 per instance, under HHS’s annual inflation adjustment (91 FR 3665).
| CMP type | Applies to | Range in regulation | Assessed before Jan. 28, 2026 | Assessed on or after Jan. 28, 2026 |
|---|---|---|---|---|
| Per day, upper range 42 CFR 488.438(a)(1)(i) | Immediate Jeopardy deficiencies | $3,050–$10,000 | $8,140–$26,685 | $8,351–$27,378 |
| Per day, lower range 42 CFR 488.438(a)(1)(ii) | Non-IJ deficiencies that caused actual harm or risk more than minimal harm | $50–$3,000 | $133–$8,003 | $136–$8,211 |
| Per instance 42 CFR 488.438(a)(2) | A single instance of noncompliance, regardless of duration | $1,000–$10,000 | $2,670–$26,685 | $2,739–$27,378 |
The regulation states the original ranges “as adjusted annually under 45 CFR part 102,” so the adjusted figures are the ones that apply. The January 28, 2026 rule is HHS’s most recent annual adjustment as of this update; the earlier column reflects the 2024 adjustment.
Other CMS civil monetary penalties that affect nursing homes
Beyond survey-based CMPs, HHS’s 2026 penalty table lists other civil monetary penalties tied to long-term care facilities and their staff. The amounts below are the adjusted figures from the same January 28, 2026 rule.
| Violation | 2026 adjusted amount | Authority |
|---|---|---|
| Failure to report a reasonable suspicion of a crime against a long-term care resident (covered individuals) | $288,655; $432,981 if the failure worsens harm | 42 U.S.C. 1320b-25(c) |
| A long-term care facility retaliating against an employee for lawful reporting | $288,655 | 42 U.S.C. 1320b-25(d)(2) |
| Administrator failing to give required notice of a facility closure | Minimum $721 (first offense) up to $144,329 | 42 CFR 488.446 |
| Causing another person to certify a false statement in a resident assessment | $13,690 | 42 U.S.C. 1395i-3(b)(3)(B)(ii)(2) |
| Any individual tipping off a facility about the date or time of a survey | $5,478 | 42 U.S.C. 1395i-3(g)(2)(A) |
| Certifying a false statement in a resident assessment | $2,739 | 42 U.S.C. 1395i-3(b)(3)(B)(ii)(1) |
| Failure to meet infection control weekly reporting requirements | $1,227 first occurrence, plus $614 for each subsequent occurrence | 42 CFR 488.447 |
What Is the Maximum Civil Money Penalty for a Nursing Home?
The maximum CMS civil money penalty for a nursing home is $27,378 per day of Immediate Jeopardy noncompliance, or $27,378 per instance, for penalties assessed on or after January 28, 2026. For Immediate Jeopardy, the combined CMPs may not exceed that inflation-adjusted daily cap (42 CFR 488.408(e)(2)(ii)).
The federal rules set no per-year cap. The total depends on how many days the noncompliance lasted and how many instances were cited. Duration is bounded in practice: without IJ, CMS terminates a facility still out of compliance six months after the survey, and unremoved IJ leads to termination within 23 calendar days (42 CFR 488.440(f)–(g)).
Repeats can push past the usual ranges. CMS must increase the per-day amount for a repeated deficiency, even beyond the range normally used for non-IJ deficiencies (42 CFR 488.438(d)(2)).
How CMS Decides the Amount of a Civil Money Penalty
CMS decides the amount of a civil money penalty by weighing four factors set by 42 CFR 488.438(f): the facility’s history of noncompliance including repeats, its financial condition, the seriousness factors in 42 CFR 488.404, and its degree of culpability.
In practice, CMS imposes federal CMPs according to the instructions in its CMP Analytic Tool, which is publicly accessible (SOM Ch. 7). Under memo QSO-26-03-NH, the updated tool applies to enforcement cycles starting on or after March 31, 2026. The absence of culpability is not a reason to lower a penalty.
Do Nursing Homes Have to Pay Civil Money Penalties? What Happens If They Don’t
Yes, a nursing home has to pay a civil money penalty once it is due, and if it doesn’t, CMS or the state can deduct (offset) the penalty plus interest from Medicare or Medicaid money owed to the facility (42 CFR 488.442(c); CMS SOM Ch. 7 §7530.2).
Interest is assessed on any unpaid balance from the due date (42 CFR 488.442(d)). CMS-imposed CMPs are payable by ACH through pay.gov or by check to CMS.
For CMS-imposed penalties held in escrow during an appeal, a facility that doesn’t deposit the full amount within 30 calendar days of the collection notice can have it deducted from sums CMS or the state owes it (42 CFR 488.431(b)(4)). The appeal and escrow timeline is in how to appeal a CMS civil money penalty.
Where Does Civil Money Penalty Money Go? The CMS CMP Reinvestment Program
Civil money penalty money goes back into nursing home quality. Of the Medicare share CMS collects, 10% goes to the U.S. Treasury and 90% must fund CMS-approved activities that protect or improve residents’ quality of care or life (42 CFR 488.433(a)); the Medicaid share is returned to the state.
The Civil Money Penalty Reinvestment Program (CMPRP) is how that money is spent. States hold the funds under a CMS-approved plan, must keep an emergency reserve for resident relocations, and must publish what they award and to whom (42 CFR 488.433(e)). Learn more on CMS’s CMPRP page.
What the CMP Reinvestment Program funds
The CMP Reinvestment Program funds projects such as resident and family council support, consumer information for residents and families, quality-improvement training open to multiple nursing homes, quality-of-life activities, and emergency help when a facility closes, according to CMS SOM Chapter 7 §7535.1.
It does not fund capital improvements, nursing home staff salaries, services or supplies a facility is already responsible for, or projects with a conflict of interest. CMS generally won’t approve projects longer than three years.
Can a nursing home get a CMP grant?
Yes, nursing homes and other organizations can receive CMP reinvestment grants. Applications go to the state survey agency first, then to CMS’s CMPRP team, which generally decides within 45 days of receipt (CMS SOM Ch. 7 §7535).
CMS’s manual lists eligible recipients including consumer advocacy groups, resident and family councils, nursing home associations, ombudsman programs, quality improvement organizations, and facilities. Projects run in nursing homes need a signed letter of support from each participating home showing its CCN. Maximum funding amounts are posted on CMS’s CMPRP page.
What’s Changed in CMS Civil Money Penalties (2023–2026)
CMS civil money penalties changed in six dated steps between October 2023 and June 2026, covering the hearing waiver, how penalties combine, the dollar amounts, and public visibility.
October 1, 2023: Automatic 35% reduction for not appealing
The FY 2024 SNF payment rule (88 FR 53200) created a constructive waiver: if CMS receives no hearing request within 60 days of the notice date, the CMP is reduced by 35% without a written waiver (42 CFR 488.436).
October 1, 2024: Combined penalties and a three-survey lookback
The FY 2025 SNF payment rule (89 FR 64048) allowed any combination of per-day and per-instance CMPs within one survey and penalties for noncompliance cited since the last three standard surveys.
January 28, 2026: Inflation-adjusted amounts increased
HHS’s annual adjustment (91 FR 3665) raised the per-day IJ range to $8,351–$27,378, the lower per-day range to $136–$8,211, and the per-instance range to $2,739–$27,378.
April 30, 2026: Revised enforcement guidance took effect
CMS memo QSO-26-03-NH (first issued January 30, 2026, revised April 3, 2026) updated SOM Chapter 7 enforcement and CMP Reinvestment guidance, and said state CMP fund balances will be posted publicly.
June 24, 2026: Per-instance CMPs added to Care Compare
Per-instance CMPs are displayed on Nursing Home Care Compare from this date, under the same memo, alongside the fine totals CMS already published. See how Care Compare works.
June 26, 2026: SOM Chapter 7 Revision 244 issued
CMS reissued Chapter 7 sections on the hearing waiver, payment due dates, CMP disposition, and allowable uses of CMP funds. Other 2026 updates are in our 2026 CMS regulatory changes roundup.
How to Avoid or Appeal a CMS Civil Money Penalty
Avoiding a CMS civil money penalty depends on preventing repeat, harm-level, and Immediate Jeopardy deficiencies, while appealing one depends on a written hearing request within 60 days. Each has its own guide: how to avoid CMS civil money penalties and how to appeal a CMS civil money penalty.
If the dispute is about the survey finding rather than the penalty, see how to appeal a CMS survey citation. To see how fines run in your state, use the free State Enforcement Report.
PoC360 CMP Shield
CMP Shield timestamps every corrective action from the moment your survey is imported, keeps a per-citation evidence log, and tracks estimated per-day exposure. A provable correction date is what stops a per-day CMP from growing.
Frequently Asked Questions
What are CMS civil monetary penalties?+
A CMS civil monetary penalty (CMP) is a fine CMS or a state imposes on a Medicare- or Medicaid-certified nursing home that is not in substantial compliance with federal participation requirements. It is assessed per day of noncompliance, per instance, or both (42 CFR 488.430). CMS also imposes separate civil monetary penalties on facility administrators, for example for failing to give required notice of a closure (42 CFR 488.446).
What can a civil monetary penalty be?+
A nursing home civil monetary penalty can be a per-day amount, a per-instance amount, or both. For penalties assessed on or after January 28, 2026, per-day CMPs run $8,351 to $27,378 for Immediate Jeopardy and $136 to $8,211 for other deficiencies, and per-instance CMPs run $2,739 to $27,378 (91 FR 3665). It is one remedy among several, alongside denial of payment and termination.
What is civil monetary penalties law in healthcare?+
The Civil Monetary Penalties Law, 42 U.S.C. 1320a-7a, is the federal statute penalizing health care fraud and abuse, such as false claims and kickbacks; HHS’s Office of Inspector General enforces it under 42 CFR Part 1003. Nursing home survey CMPs are a separate remedy CMS imposes under Social Security Act §1819(h) and 42 CFR Part 488, Subpart F, although that statute borrows the Law’s hearing and judicial review procedures.
What happens if you don't pay a civil money penalty?+
If a nursing home does not pay a civil money penalty when due, CMS or the state can deduct (offset) the penalty plus interest from any Medicare or Medicaid payments owed to the facility (42 CFR 488.442(c)). Interest accrues on the unpaid balance from the due date (488.442(d)). For escrowed CMPs, any amount not deposited within 30 calendar days of the collection notice can be deducted the same way (488.431(b)(4)).
What does CMP mean in a nursing home?+
In a nursing home, CMP stands for civil money penalty, sometimes written civil monetary penalty. It is a federal fine CMS or the state imposes when a certified facility is out of substantial compliance with federal participation requirements, assessed per day of noncompliance, per instance, or both, under 42 CFR Part 488, Subpart F. It is one of several enforcement remedies.
Are nursing home civil money penalties public?+
Yes. CMS already publishes each facility’s total federal fines in its public nursing home data, and under CMS memo QSO-26-03-NH, per-instance CMPs are displayed on Nursing Home Care Compare beginning June 24, 2026. Families comparing facilities can therefore see one-time penalties as well as the larger per-day penalties that accrue over weeks of noncompliance.
Who is a nursing home civil money penalty paid to?+
A CMP that CMS imposes is paid to CMS, by ACH through pay.gov or by check, according to CMS’s State Operations Manual. A penalty a state imposes on a Medicaid-only facility is collected by the state. After a final decision, CMS returns the Medicaid share of collected penalties to the state, and the Medicare share funds the CMP Reinvestment Program and the Treasury.
Does paying a civil money penalty close the deficiency?+
No. Paying a CMP resolves the financial remedy, not the underlying deficiency. The facility still has to reach substantial compliance, verified by revisit or credible written evidence, and other remedies such as denial of payment for new admissions can continue until it does. The deficiency also stays on the facility’s survey record and feeds its Five-Star health inspection rating.
How long can a per-day civil money penalty last?+
A per-day CMP accrues from the date the facility was first out of compliance until it achieves substantial compliance or is terminated (42 CFR 488.440). Without Immediate Jeopardy, CMS terminates a facility still out of compliance six months after the last day of the survey. With Immediate Jeopardy that is not removed, termination must come within 23 calendar days.
Sources: 42 CFR §§488.408, 488.430, 488.431, 488.433, 488.436, 488.438, 488.440, 488.442, 488.446, 488.447; 45 CFR Part 102; 91 FR 3665 (Jan. 28, 2026); 88 FR 53200 (Aug. 7, 2023); 89 FR 64048 (Aug. 6, 2024); CMS State Operations Manual Chapter 7 (Rev. 244, June 26, 2026); CMS memo QSO-26-03-NH (revised April 3, 2026); CMS Civil Money Penalty Reinvestment Program. This article is general information, not legal advice. Last reviewed 2026-10-07. We review it as CMS regulations and enforcement guidance change.
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