Jessica Curtis

Record instances and dollar amounts of fines to skilled nursing facilities just made public last month highlight the tense regulatory environment operators are managing through.  

Despite federal “provider relief” funds being distributed, some of that relief is being negated in the form of increased fines removing resources from resident care. Skilled nursing fine data published last month for the last three survey cycles contained more than 10,000 new fines totaling over $187 million dollars for over 1,980 newly fined providers (compared to data published in the prior month).  

In July 2021, the Biden administration reversed a Trump-era policy that limited penalties and reinstated the “per day” methodology as default instead of “per instance.”  It is widely known that the per day methodology leads to larger fines that quickly escalate with no maximum, so stiffer fines were to be expected going forward. 

What was not expected, however, was the bombshell fines data just released by CMS that blows prior years’ penalty averages out of the water.  The newly published data includes millions of dollars in new fines with penalty dates going back to 2018, indicating large fines for prior non-compliance identified during more recent surveys.

Total skilled nursing fine instances and dollar amounts as published by CMS by year, comparing the new November published data to the prior data in October:

More than $20 million dollars in new fines were just reported for penalty dates in each year 2019-2021, with 2021 racking up over $88 million dollars in new fines just made public.

Under the Trump limitation policy from 2017-2020, the industry still saw an increase in the average fine issued compared to under the Obama administration.  Average fines nationwide have been steadily increasing over the years, with a drastic 169% increase in the three-cycle average published this month:

AHCA/NCAL said in a statement that per day fines “only take precious resources away from an already underfunded industry, especially during an unprecedented time when nursing homes need every support to protect their residents.”  

The enormous increase in fines due to per day default methodology along with fines for COVID-19 NHSN data submission issues create doubt about how much financial relief providers are actually experiencing, and what is being done at the federal level to allow quality of care rather than excessive financial penalties detracting from already scarce resources.

Jessica Curtis, CHFP, CRCA is managing partner at Formation Healthcare.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.