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Sam "Ace" Rothstein (Robert De Niro), a sports handicapper for the mob, is entrusted by four Midwest mob bosses in Kansas City, Missouri (Remo Gaggi, Vincent Borelli, Americo Capelli and Vinny Forlano) to oversee the management of the Tangiers Hotel's casino in Las Vegas while they illegally skim the casino profits. Sam's experience in gambling and "hands-on" management style allow him to quickly double the profits of the Tangiers. The bosses send his boyhood friend, Nicholas "Nicky" Santoro (Joe Pesci), who is famous for his violent temper, to "protect" Sam and their interests. Sam falls in love with an attractive hustler named Ginger McKenna (Sharon Stone). Although he is not sure if marriage is a good idea for the both of them, the decision lies purely that married life will cure her addictions.

However, Nicky's recklessness and cheating across various casinos in Las Vegas causes a blow to his working relationship with Sam when he becomes banned from every establishment within the city. Undeterred, Nicky starts working for himself in Vegas, organizing his own crew, Jack Hardy (Jed Mills), Sal Fusco (Clem Caserta), and Bernie Blue (Bret McCormick), plus a jewelry business and a restaurant with his brother Dominick (Philip Suriano) and his right-hand man Frank Marino (Frank Vincent). Tensions rise when an up-and-coming hood, Tony Dogs (Carl Ciarfalio), along with two other men shoot up one of Gaggi's diners, killing two of his men and a young waitress. An enraged Gaggi demands information out of Dogs by any means necessary. Nicky and his men beat and torture Dogs demanding an answer to why he committed the act. After his head is put in a vise, only does he give up one of his partners.

Meanwhile, Sam is interviewed by a reporter concerning the running of the Tangiers' hotel. After hinting he runs the casino, which is technically under the cover of the legal chairman, Phillip Green (Kevin Pollak), Sam is forced to apply for a gaming license and also finds out that his wife, Ginger is financially aiding her former pimp, Lester (James Woods) with his money troubles. Giving the go-ahead for Nicky and his crew to beat Lester up on his own behalf, makes Ginger seek comfort in Nicky telling him that she is disgusted with Sam's behavior. Checking out of a hotel with her daughter, she decides to flee to Europe with Lester. Concerned for the safety of his daughter, Ginger is forced to return home frightened that Sam could threaten them. With their marriage crumbling, Sam and Ginger spilt for good, despite they would continue to live in the house. However, Ginger's affair with Nicky is soon revealed nearly jeopardising the trust of the mob bosses in Kansas City. Ginger's problems with drugs and alcohol start to escalate, when on a night out to a restaurant, Sam finds out returning to the house that their daughter is found tied to the bed. Meeting his drugged wife in the restaurant, he demands an answer. Ginger turns to Nicky for help, but for punishment for creating a public scene to the mob bosses for their alleged affair and his trust in Sam, she is thrown out the restaurant.

The next morning, Ginger turns up at their family home to collect her possessions resulting in the police being called. Getting access into the house, she steals the key to their safety deposit box (which was put under a false name). Leaving the bank with the cash, she is arrested for aiding the mob. The police have enough information to track down all the leads, even being provided by a blueprint of how the scam actually worked along with dates, names and addresses from Piscano's expense reports. The bosses are arrested and taken to court, where they hold a meeting during a recess in a back room to decide which witnesses should be eliminated to stop them from ratting them out. The executed include Andy Stone (head of the Teamsters Union and Pension Fund), three casino executives, John Nance (the money courier, whose son was in trouble with the FBI for drug-related charges), and ultimately, Nicky and Dominick Santoro, who are severely beaten by their own crew with baseball bats and buried alive in an Indiana cornfield. During this time, Sam's enstranged wife who escapes is found perished in a Los Angeles hotel. Going back to the opening sequence, the truth of Sam's car explosion is revealed that he only survived because of a metal plate underneath the driver's seat. The final scene shows Sam being reduced to what he started from, making bets for the mob and watching sporting events on multiple televisions from his home in San Diego. The film slowly fades out as the audience see his aging face looking straight at the camera as he takes his glases off.

The research for Casino began when Pileggi read a report from the Las Vegas Sun in 1980 about a domestic argument between Frank "Lefty" Rosenthal, a casino figure and his wife, Geri McGee, a former topless dancer. This gave him an idea to focus on a new book about the true story of mob infrigement in Las Vegas during the 1970s, when filming of Goodfellas (the screenplay which he co-wrote with Martin Scorsese) was coming to an end. Pileggi decided to contact Martin Scorsese about taking helm of the project which would become known as Casino. Scorsese expressed interest in the project calling this an "idea of success, no limits". Although, he was keen to release the book and then concentrate on a film adaption, Scorsese encouraged him to "reverse the order".

Martin Scorsese and Nicholas Pileggi collaborated on the script lasting for a total of five months, towards the end of 1994. Real-life characters such as Frank "Lefty" Rosenthal, Ginger, Nicky Santaro and his brother were reshaped. Some characters were combined as well as parts of the story being set in Las Vegas instead of Chicago. A problem emerged when they were forced to refer Chicago as "back home" and use the words "adapted from a true story" instead of "based from a true story". According to Martin Scorsese, the initial opening sequence was to feature the main character, Sam "Ace" Rosenstein fighting with his enstranged wife, Ginger on the lawn on their house. Since the scene was too detailed, they changed the sequence to show the explosion of Sam's car and see him fly into the air before hovering over the flames in slow motion - like a soul about to go straight down in hell.

Filming took place in The Riveria Casino in Las Vegas during the night - as late as 4.00am in the morning. According to the producer Barbara DeFina, there was no point building a set if the same cost was to use a real-life one.

• The majority of the actual events took place in Kansas City, Missouri, even more so than Las Vegas. In the 1970s, the Kansas City mob was involved in a gangland war over control of the River Quay entertainment district, in which three buildings were bombed and several gangsters were killed. Police investigations into the mob took hold after Kansas City Boss Nick Civella was recorded discussing gambling bets on Super Bowl IV (where the Kansas City Chiefs defeated the Minnesota Vikings). The gang war and investigation would lead to the end of mob control of the Stardust Casino, which was the basis for the film (although the Kansas City connections are minimized in the movie).
• The character of Frank Marino (played by Frank Vincent and based on Frank Cullotta) participates in the killing of the Santoro brothers. In reality, Frank Cullotta was not present and played no part in the beating of the Spilotro brothers (on whom the Santoro brothers were based), and only betrayed them by testifying against them about the M & M murders (as the 1962 murders of James Miraglia and Billy McCarthy in Chicago were called) when Anthony Spilotro ordered him killed over the phone, although Cullotta's testimony was not enough to convict Spilotro. Cullotta also has a cameo as Curly, one of Gaggi's hitmen near the end of the film.
• The character of John Nance, based on George Vandermark, is murdered in the film with two gunshots to the stomach and one to the head and left in open view. The real George Vandermark was murdered along with his drug addict son, Jeffrey, but his body was never found. Furthermore, Bill Allison (Nance's actor), is a former casino owner and served as a technical advisor for the film, along with Frank Cullota (who plays Curly, Nance's killer).
• In the film Artie Piscano, based on Kansas City Underboss Carl A. "Tuffy" DeLuna, dies of a heart attack during an FBI raid on his home. In reality, DeLuna was arrested, tried and sentenced to 30 years. He did in fact keep extensive cryptic notes hidden in his basement which, together with wiretaps, connected all the dots the FBI needed. He was released from prison in 1998 and died in Kansas City in 2008, the last surviving defendant.
• The Tangiers Casino, based on the Stardust Resort & Casino, is shown to be demolished at the end of the movie, whereas in real life, the Stardust Casino was not demolished until March 2007.
• In the movie, Robert De Niro's character, Sam "Ace" Rothstein, juggles on television. However, Frank "Lefty" Rosenthal, the real-life counterpart of Ace, says on his official website that he never did such a thing.
• The Spilotro Brothers were said to be brutally beaten with aluminum bats until they were unconscious in a basement in Bensenville, Illinois, and buried in a cornfield in Indiana according to testimony of Nick Calabrese in the Chicago Family Secrets Mob Trial.
• The place in the film where the bosses of the Chicago mob met to pick up and distribute their Las Vegas money was in a boarded up, out-of-business ARCO gas station on the southeast corner of Harlem Ave. and Division St. in Oak Park, IL.