It’s certainly not punitive but I can imagine at some point an administrator will notice a $9,000 / month expense and wonder if they should be posting prices.

The cost associated with having patients potentially switch to a cheaper hospital could be >$9000/month, at least if the data becomes more accessible. For hospitals that charge exorbitantly high rates, it might actually be worth it to pay the fine.

Add a few zeros to the daily fine if there’s less than 90% compliance at 95% of hospitals by year end.

I'd wager the thought process wasn't so much for enforced compliance, but a tax if you do not wish to be compliant.