This study examined the relationship among performance validity test (PVT) failure, number of PVTs administered, and participant characteristics including demographic, diagnostic, functional, and contextual factors in a clinical sample (N = 158) of outpatient physiatry referrals. The number of PVTs failed and the number administered showed a small non-significant correlation (rs = .13, p = .10). Participant characteristics showed associations with PVT failure consistent with prior research. A negative binomial regression model was fitted using number of PVTs failed as outcome and age, education, number of PVTs administered, clinical versus medico-legal context, and functional status as predictors. Although education and functional status were significant predictors of number of PVTs failed, the number of PVTs administered was not. A second analytic approach focused on observed false positive rates in a neurologic no-incentive (NNI) sample subset (n = 87). In contrast to a recent proposal based on statistical simulation, observed false positive rates were lower than predicted rates in NNI participants administered six, seven, or eight PVTs using a two-PVT failure cutoff. These results are interpreted as mitigating concerns that increased PVT failure is necessarily the outcome of increased PVT administration.