A nonverbal resident with Alzheimer’s was found in bed covered in ants, the bites swelling her eyes shut. Her family spotted it, not the staff. A July 2025 CMS report recorded the case, and Hunterbrook Media put it at the front of an investigation into Ensign Group, one of the largest names in skilled nursing.
The report came out on June 8 under the title “Ensign: The Nursing Home Empire Built on Fatal Neglect.” Hunterbrook spent five months on it. It also holds a short position in ENSG, which is worth knowing before reading its conclusions.
The staffing numbers
Hunterbrook’s central claim is that Ensign bills Medicare and Medicaid for high-acuity residents while giving them fewer nursing hours than they need. Using a formula from a 2025 peer-reviewed study, it counted a shortfall of more than 5 million nursing hours between July and November 2024. It valued that gap at roughly $161 million in avoided staffing costs, or about $386 million annualized. Ensign reported net income of $298 million for 2024.
Hunterbrook also went through CMS records from 2020 through 2025. In California, Washington, Tennessee and Kansas, Ensign facilities fell below the state numeric staffing minimums on more than 18,000 cumulative days, it found. Separately, it tracked 161 facilities over 72 months against roughly 15,000 national peers. Total nursing hours dropped after Ensign took over, RN hours fell steadily, and the mix tilted toward CNAs and LPNs, even though resident acuity stayed above the national average. Ensign’s 2025 10-K describes a “strong history of quickly improving the quality of care in the facilities we acquire.”
Star ratings and affiliate payments
On self-assessed quality measures, Ensign scored 22-24% better than the national average, according to CMS data from January 2020 to March 2026. On RN hours per resident day it scored roughly 17% worse. Facility-reported incidents ran 38% worse, and complaint health deficiencies 20% worse. Former employees told Hunterbrook that managers directed staff to downgrade falls to “slips” and to inflate therapy minutes and acuity.
The report says CMS’s methodology lets self-reported scores lift an overall rating by as many as two stars. Park Village Healthcare and Rehabilitation in DeSoto, Texas, held five stars on those self-assessed measures and one star each for health inspections and staffing.
Money moving to affiliates is the other thread. Cost reports show Ensign facilities paid about $339 million to affiliated entities in 2024, around 8% of consolidated revenue and more than the company’s net income. A 2024 congressional letter to then-executive chairman Christopher Christensen called such arrangements a “deceptive tactic” for hiding profit.
Muddy Waters and the market
A second short seller piled on June 11. Muddy Waters Research published “Ensign: Deceiving the Government at Estimated ~20% of Facilities,” alleging that at roughly 20% of facilities Ensign used consulting agreements with nominal administrators who were not running operations. Federal law requires a licensed administrator at each skilled nursing facility that bills Medicare and Medicaid. Muddy Waters estimated theoretical False Claims Act sanctions could reach $7 billion.
Together the two reports sent the stock down more than 11% and took over half a billion dollars off its market capitalization, according to BriefGlance. Bleichmar Fonti & Auld LLP opened a securities fraud investigation, and other firms began soliciting shareholders for a possible class action.
Ensign did not respond to Hunterbrook’s detailed requests for comment. CEO Barry Port told The Arizona Republic in 2023 that staffing decisions rest with individual facility management and that the idea Ensign siphons money to lift profit is “categorically false.” Company officials later met UBS analysts and pointed to strong occupancy and referral volumes. The board approved a $100 million share repurchase authorization and declared its regular quarterly dividend.
Politics and history
A May 2024 federal rule would have required 3.48 nursing hours per resident per day. AHCA, whose board includes Port, sued to block it, and the Trump administration rescinded the rule by February 2026. An FEC filing shows Ensign gave $750,000 to MAGA Inc. on August 8, 2025.
Ensign has been here before. It paid $48 million in 2013 to resolve federal allegations of false claims for unnecessary therapy, and in 2024 it settled a whistleblower case for over $47.3 million over alleged kickbacks and breaches of its 2013 Corporate Integrity Agreement.
Charlene Harrington, professor emerita at UCSF, whose research Hunterbrook used for its staffing formula, put it bluntly to the firm: “When you have a multibillion-dollar corporation, there’s no excuse for killing people.”
Sources
- Ensign's Crisis: Where Alleged Fraud Meets Patient Neglect – BriefGlance.com
- Ensign: The Nursing Home Empire Built on Fatal Neglect – HUNTERBROOK – The Short Report
