In this study, we examined federal cases involving fraud by pharmaceutical manufacturers between 2000 and 2022, including only publicly held companies whose settlements were at least $1 million. 169 cases were identified. Our goal was to determine if the penalties would simply be a nuisance to the company or if they would have a significant financial impact. In addition, we discussed a private pharmaceutical company and included the findings from a content analysis of public sentiment to assess the lingering impact of fraud on a brand. For both the public and private firms, we found evidence of negative impact, both financial and reputational. We also highlighted the fact that the financial penalties were significant for only a portion of the companies analyzed and that many of the manufacturers continue to commit violations repeatedly, regardless of the penalties assessed.