I'm not certain, but I think on my phone incoming calls that fail SHAKEN/STIR show the caller id in red rather than black text. I'm on T-Mobile. It also shows "Number Verified" or something like that.

Now that you mention it, I believe I have seen a couple of red flagged calls, but I still get ~3 calls a day from a very aggressive business loan spammer, it's always a new number and never flagged.

That's because they are bulk purchasing numbers from voip providers, cycling through probably hundreds per day.

Do they actually need to purchase numbers to do that, though?

I always imagined that there are certain shady providers ("grey-market Twilio" sort of idea) that just let you run single outbound call/text requests through a giant pool of numbers shared with other customers of the service. Perhaps specifically a bank of residential numbers plugged into banks of regular cell phones, like a residential IP proxy service provider.

Somebody at some point is purchasing them, probably not the spammers/scammers themselves.

It's very unlikely anybody is placing spam/scam calls with regular cell phones when VoIP numbers are easy and cheap to get, and when VoIP systems are far easier to manage.

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Anybody desperate enough to consider telemarketed merchant cash advances (MCAs) should look into them very carefully first. The contracts often have stipulations that allow them to draw money from your bank account at will, penalty interest rates that jump up 400% APR, have been known to use mafia enforcers to violently extract payments, and the list goes on. There was a more perfect union video (titled something about texting back a loan shark) with a bracing, if sensationalized, look at some of the worst ones.