Senior Care Regulatory Compliance
Skilled nursing facilities, assisted living, and memory care providers regulated by CMS, state health departments, and OCR.
34,458
Total Enforcement Actions
28,703
Actions This Year
$3M
Total Penalties Tracked
34,424
Critical / High Severity
Regulatory Overview
Skilled nursing facilities (SNFs) and assisted living facilities are among the most heavily regulated care settings in the U.S. CMS conducts annual unannounced surveys under 42 CFR Part 483 and can impose civil monetary penalties (CMPs) ranging from $108 to $21,393 per day or per instance. OIG exclusions permanently bar providers from billing Medicare and Medicaid. State Departments of Health add a second enforcement layer through licensing and Medicaid integrity programs.
Primary Enforcement Focus
CMS surveys, OIG exclusions, and State DOH licensing actions dominate enforcement. Abuse and neglect findings trigger mandatory reporting and often parallel criminal investigations.
Common Violation Patterns
Staffing Deficiencies
Minimum nurse aide and licensed nurse staffing ratios not met; inadequate staffing plans; failure to use payroll-based journal (PBJ) data accurately.
Abuse & Neglect
Failure to prevent, identify, investigate, and report resident abuse or neglect. Often triggers APS referral and mandatory CMS reporting.
Infection Control (F880)
Inadequate infection prevention and control programs — the most cited deficiency category nationally following COVID-19.
Quality of Care
Pressure ulcer prevention failures, medication administration errors, inadequate nutrition/hydration, and unplanned hospitalizations.
Billing Fraud
Upcoding, services not rendered, kickback arrangements with hospice or pharmacy vendors, and false RUG classification.
Enforcement Actions — Senior Care
Violations Signal Board
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Key Regulations
42 CFR Part 483 — SNF Conditions of Participation
Federal standards governing resident rights, quality of care, staffing, infection control, and physical environment.
42 CFR Part 488 — Survey and Certification
CMS survey procedures, deficiency classification, and CMP determination methodology.
HIPAA 45 CFR Parts 160 & 164
Privacy and security requirements for protected health information (PHI). OCR enforces for breach events and complaints.
OIG LEIE — Exclusion Authority (42 USC 1320a-7)
Mandatory and permissive exclusion authority. Providers on the LEIE cannot be paid by any federal health program.
State Medicaid Integrity
State Medicaid Integrity Programs (MIPs) conduct independent audits and can impose recoupment, overpayment demands, and provider termination.