Re: I think a lot (if not most) of these calls are from VOIP
"You don't need VoIP to trivially spoof caller IDs: Just a connection to a compliant telco."
You don't even need that in the USA. All you need is a circuit (as opposed to POTS). Caller ID on a circuit is self reported. The PBX inserts that data when an outgoing call is made. You can make that number anything you want.
There is a fairly simple solution. Append the circuit ID data to the caller ID data. With the circuit ID the Telco can tell exactly where the call is originating on their equipment. And who is paying for that call. It also makes call blocking much easier as blocking a circuit will block any call from that location no matter what CID is being used.