It's literally a deal breaker to send back No, so there's a lot of incentive to do what it takes to send a Yes back.
And "subsequent lawsuit" is a very distant threat in this case.
Less cynically, there are some standards that do have some non-zero teeth in them. Some audits are challenging and at least rate "a good exercise". But that's what I mean by even if the vender truly believes they are compliant with ISO-Thirty-Three-Million-And-Two-Subrevision-A24, they're just one error away from ohnoyourdatabase anyhow.
The net-net of it all is that, as I sort of alluded to, are these assessments worthless? I mean, no, not quite literally zero. If you send one of these documents to a startup of two dudes and a cat and they claim ISO-Thirty-Three-Million-And-Two-Subrevision-A24 compliance, they're lying and the person examining their assessment at least has a chance to be suspicious about it. But in real terms, are they going to be the difference? Unlikely.
Or, let me put this another way. I would bet substantial money Okta has in their possession a response to their questionnaire from Rightway Healthcare in which Rightway Healthcare sings the praises of their immense, extraordinary, back-breaking, industry-leading security efforts, complete with citation of the relevant industry standards they comply with, and that it looks as good as anyone else's answers.
Yet, here we are.