I've been to Appalachia recently, to the hardest hit areas....from the looks of it, the stuff keeps flowing. 90% probably went somewhere else, to a different clinic.
My client is in Appalachia, and you are correct. You have to get further out into the country to find sketchy clinics now. When it was at its height you would find these places in nicer, regular, medical plazas alongside physical therapists etc. Now when you see a pain clinic out in the holler, next to a dollar general, you pretty much know what the business model is.