A study by the Center for Medicare Advocacy finds that facilities that are identified as among the most poorly performing facilities in the country provide extremely poor care and may fail to have sufficient numbers of RNs, but they face limited, if any, fines.  Going forward, nursing facilities are likely to have even lower fines.

http://www.medicareadvocacy.org/special-focus-facilities-poor-care-for-residents-limited-enforcement-consequences-for-facilities/