The really flagrant companies will have their registration revoked by the SEC and the Pinksheet will no longer perform quotation services for that stock. In other words, the company will be “delisted” from the Pinksheets and it becomes a Grey Market stock. Yes, there are things worse than the Pinksheets
That said, it is true that companies can violate their periodic reporting obligations for years and still remain as a pinkie. The SEC just doesn’t have the manpower to go after each of them. However, there is an unwritten SEC rule that if the stock consistently trades in volumes worth more than $1 million per day. the SEC will keep you on their watch list and eventually come after you.