2024 Double G Citations: Significant Increase in Nursing Home Noncompliance and Penalties
Long Term Care Community Coalition
Substandard care, abuse, and neglect are persistent and widespread problems in nursing homes, primarily due to inadequate enforcement of minimum safety standards. To help combat this, the federal Centers for Medicare & Medicaid Services (CMS) imposes automatic penalties on facilities receiving “Double G” citations. These citations occur when a facility is cited for violations at a G level or higher in two consecutive surveys. A classification of G-level or higher indicates that the violation has either caused harm to one or more residents or placed them in immediate jeopardy of serious harm.
Double G Data
Scope and Severity Grid
Today, LTCCC is releasing the 2024 State Double G Data Report, which provides a detailed report of Double G citations by state and CMS region, along with trends in related penalties. Drawing on data from CMS Quality, Certification, and Oversight Reports, the report offers valuable insights into how effectively states identify serious issues in nursing homes. It also highlights an upward trend in both the issuance of Double G citations and the penalties imposed for violations of minimum care standards.
“The increasing number of Double G citations signals a deeply concerning trend of ongoing, serious noncompliance in nursing homes,” said Richard Mollot, LTCCC’s Executive Director. “This reflects the growing number of reports of substandard care and neglect that we are hearing from desperate families.”
The following are key national and regional findings. For information on specific facilities, visit our Provider Data page.
Key Findings:
- The number of facilities receiving Double G citations increased almost 18%, from 1,526 in 2023 to 1,801 in 2024.
- The per diem CMPs (civil money penalties) associated with these citations also increased by almost 18%, from $55.87 million in 2023 to $65.97 million in 2024.
- Per diem CMPs increased in both the total number and dollar amount, with a rise from 1,140 instances in 2023 to 1,365 in 2024.
- Per instance CMPs increased slightly from 432 in 2023 to 466 in 2024.
- The average dollar amount of per diem CMPs decreased slightly from $49,007.49 in 2023 to $48,326.57 in 2024, while the average per instance CMP increased about 12%, from $13,246.32 in 2023 to $14,807.02 in 2024.
| Category | 2023 Totals | 2024 |
|---|---|---|
| Number of Providers with Double G Citations | 1,176 | 1,340 |
| Number of Double G Citations | 1,526 | 1,801 |
| Total Number Per Diem Citations | 1,140 | 1,365 |
| Total Number of Per Instance CMPs | 432 | 466 |
| Total Dollar Amount Per Diem CMPs | $55,868,535.54 | $65,965,766.45 |
| Total Dollar Amount Per Instance CMPs | $5,722,411.67 | $6,900,071.66 |
| Average Dollar Amount Per Diem CMPs | $49,007.49 | $48,326.57 |
| Average Dollar Amount Per Instance CMPs | $13,246.32 | $14,807.02 |
| Average Days in Effect Per Diem CMPs | 30 | 28 |
| Total Number Discretionary DPNAs (Denial of Payment for New Admissions) | 304 | 338 |
| Average Days in Effect Discretionary DPNAs | 29 | 30 |
For details:
Double G Data
Scope and Severity Grid
For more information, see LTCCC’s study on nursing home oversight.
For information on Massachusetts nursing homes, see Double G Citations Report.
Massachusetts facilities included in the Double G Citations Report:
BLUEBERRY HILL REHABILITATION AND HEALTHCARE CTR (2023)
BLUEBERRY HILL REHABILITATION AND HEALTHCARE CTR (2025)
CARE ONE AT NORTHAMPTON
HAVERHILL REHABILITATION AND HEALTHCARE CENTER
ASPEN HILL REHABILIATION & HEALTHCARE CENTER
MEADOW GREEN NURSING AND REHABILITATION CENTER
HIGHVIEW OF NORTHAMPTON
REGALCARE AT GLEN RIDGE
FALL RIVER HEALTHCARE