Nursing Home Fines by Chain (2026)
Among nursing home ownership groups with at least 5 homes, Pacs Group has the largest total fines in the Medicare (CMS) data: $8.7 million across 277 homes over about the last three years. The 40 groups listed here account for $131.1 million of the $445.7 million in nursing home fines nationwide.
Source: Centers for Medicare & Medicaid Services (CMS), Nursing Homes, “Provider Information”; Centers for Medicare & Medicaid Services (CMS), “Nursing Home Ownership”. Data updated October 1, 2026.
Ten highest values
Total finesThe full table below is the text version of this chart. It shows the highest values only; it does not say which places are better or worse.
The full table
40 rows| Ownership group (chain) | Rank | Nursing homes | States | Homes with a fine | Number of fines | Total fines | Fines per home |
|---|---|---|---|---|---|---|---|
| Pacs Group | 1 | 277 | 16 | 141 | 251 | $8,659,163 | $31,261 |
| Creative Solutions in Healthcare | 2 | 150 | 1 | 107 | 235 | $7,811,891 | $52,079 |
| Genesis Healthcare | 3 | 183 | 18 | 104 | 195 | $7,301,726 | $39,900 |
| Avir Health Group | 4 | 118 | 1 | 83 | 194 | $6,850,448 | $58,055 |
| The Ensign Group | 5 | 347 | 17 | 162 | 280 | $6,500,986 | $18,735 |
| Reliant Care Management | 6 | 35 | 2 | 28 | 87 | $5,290,161 | $151,147 |
| Arcadia Care | 7 | 25 | 2 | 22 | 70 | $5,146,010 | $205,840 |
| Infinity Healthcare Consulting | 8 | 70 | 3 | 27 | 85 | $4,491,914 | $64,170 |
| Lifeworks Rehab | 9 | 64 | 5 | 41 | 85 | $4,119,106 | $64,361 |
| Communicare Health | 10 | 109 | 5 | 50 | 76 | $3,873,086 | $35,533 |
| Legacy Healthcare | 11 | 96 | 4 | 55 | 131 | $3,813,100 | $39,720 |
| Opco Skilled Management | 12 | 68 | 4 | 45 | 90 | $3,450,191 | $50,738 |
| Saber Healthcare Group | 13 | 126 | 6 | 65 | 110 | $3,068,752 | $24,355 |
| Marquis Health Services | 14 | 90 | 9 | 47 | 91 | $2,990,031 | $33,223 |
| Life Care Centers of America | 15 | 194 | 26 | 81 | 118 | $2,988,763 | $15,406 |
| Ciena Healthcare/Laurel Health Care | 16 | 80 | 4 | 36 | 63 | $2,968,972 | $37,112 |
| Bria Health Services | 17 | 10 | 1 | 9 | 55 | $2,895,029 | $289,503 |
| Icare Consulting Services | 18 | 7 | 1 | 7 | 40 | $2,659,388 | $379,913 |
| Tutera Senior Living & Health Care | 19 | 24 | 5 | 20 | 65 | $2,636,410 | $109,850 |
| Saba Healthcare | 20 | 11 | 1 | 10 | 39 | $2,625,339 | $238,667 |
| Nexion Health | 21 | 51 | 3 | 33 | 77 | $2,567,972 | $50,352 |
| The Alden Network | 22 | 27 | 2 | 19 | 53 | $2,518,834 | $93,290 |
| Good Samaritan Society | 23 | 92 | 9 | 48 | 88 | $2,273,948 | $24,717 |
| Goldwater Care | 24 | 11 | 1 | 8 | 26 | $2,238,881 | $203,535 |
| Evercare Skilled Nursing | 25 | 9 | 1 | 9 | 46 | $2,228,847 | $247,650 |
| Evergreen Healthcare Group | 26 | 43 | 6 | 37 | 86 | $2,226,621 | $51,782 |
| Wellsential Health | 27 | 67 | 1 | 50 | 89 | $2,185,664 | $32,622 |
| Aperion Care | 28 | 33 | 2 | 20 | 62 | $2,173,914 | $65,876 |
| Eduro Healthcare | 29 | 34 | 7 | 26 | 71 | $2,070,772 | $60,905 |
| Allaire Health Services | 30 | 21 | 4 | 15 | 28 | $2,053,356 | $97,779 |
| Elevate Care | 31 | 14 | 2 | 13 | 51 | $2,037,437 | $145,531 |
| Aliya Healthcare | 32 | 14 | 1 | 13 | 39 | $1,948,567 | $139,183 |
| Optalis Health & Rehabilitation | 33 | 36 | 2 | 23 | 37 | $1,922,548 | $53,404 |
| Avardis Health | 34 | 38 | 4 | 26 | 50 | $1,915,072 | $50,397 |
| Complete Care | 35 | 85 | 8 | 47 | 73 | $1,891,872 | $22,257 |
| James & Judy Lincoln | 36 | 55 | 2 | 22 | 34 | $1,768,656 | $32,157 |
| Embassy Healthcare | 37 | 33 | 2 | 19 | 30 | $1,762,253 | $53,402 |
| Bedrock Healthcare | 38 | 9 | 3 | 8 | 21 | $1,735,745 | $192,861 |
| Adviniacare | 39 | 14 | 3 | 12 | 36 | $1,732,082 | $123,720 |
| Jenmax Group | 40 | 7 | 1 | 7 | 31 | $1,722,886 | $246,127 |
How we calculated this
CMS's Ownership file names the owners and managers ("affiliated entities") of each nursing home. We group the homes that share one affiliated entity (the same groups as on our chain pages), add up each home's fines from the Provider Information file, and list the 40 groups with the largest totals among those with at least 5 homes. "Fines per home" is the group total divided by its number of homes.
Fines and counts are from the CMS Provider Information file, which covers about the last three years of inspections and complaints. States run their own inspection programs and differ in how often and how strictly they cite homes, so a state with higher totals is not necessarily one with worse care.
Data sources and dates
- Centers for Medicare & Medicaid Services (CMS), Nursing Homes: “Provider Information”, updated October 1, 2026.
- Centers for Medicare & Medicaid Services (CMS): “Nursing Home Ownership”, updated October 1, 2026.
Limits of the data
Larger groups have more homes and therefore more fines; use the per-home column to compare. A home can be tied to several affiliated entities, so the groups overlap and their totals should not be added together. Ownership data is as reported to CMS.
Every figure is a count, sum or average of values in the official files above; none is estimated. Read the about page for how this site works and data freshness for when each source was last refreshed.
Download and cite
Download the table as CSV One row per row of the table, English column names, no totals row.
Cite this page
US Patient Guide. “Nursing Home Fines by Chain (2026).” Computed from Centers for Medicare & Medicaid Services (CMS), Nursing Homes, “Provider Information”; Centers for Medicare & Medicaid Services (CMS), “Nursing Home Ownership” (data updated October 1, 2026). https://uspatientguide.com/statistics/nursing-home-fines-by-chain/
Common questions
Which nursing home chain has the most fines?
Pacs Group: $8.7 million across 277 homes.