ESRB Outlines Publisher Fines
1up reports that the ESRB has laid out what publishers can expect if they step out of line regarding game content. From the article: "Vance says the ESRB has the power to enforce up to $1 million in monetary fines for the 'most egregious offenses,' and could potentially suspend publisher's access to the ratings system. Most retailers will not carry games without a rating. Further corrective actions could include pulling advertising until content's corrected, stickered packaging, product recalls and 'other steps the publisher must take.'"
If the ESRB were a consumer group instead of a trade group, and somebody misrepresented the content of their games, they'd have to take the software publisher to court on negligent misrepresentation. Despite the name, the fine is really liquidated damages; it says, "your subverting the rating system hurt our public credibility this much, and you agreed in advance to pay us back." The $1M cap means the fines never get so high that a publisher has an incentive to take ESRB to court and risk derailing the entire system one way or another.
And I don't know of anybody (wholesaler, retailer, et c.) who would blackball an entire publisher because they didn't submit one game for ratings. Just like movies, that one edgy title has to find its own way, but the next mainstream release can still be rated and distributed in mainstream channels.
One might ask the same about birds. What ARE birds? We just don't know.