Google Ads default settings for location targeting is based on "Presence or interest" in a location, not whether the user is actually in the targeted country. That means even if you have "United States" selected as your target, your ads will still show mostly to people outside the US who "show interest in" the US.
To fix it: Campaign Settings > Location > Location Options, and under "Target" select "Presence". Never use the default "Presence or interest" option, as it will result in exactly the scenario you're describing.
This is my #1 pet peeve with Google Ads. Using the default setting is an incredibly common (and expensive) mistake people make setting up new campaigns.
Click farms click on everything in order to dodge fraud detection, as far as I know.
I simply ended up excluding Ashburn from our campaigns for this reason.