Podcast Summary: The Hidden Third with Mariana van Zeller

Episode: Kurt McKenzie
Date: October 15, 2025
Duration: ~82 minutes

Overview

In this episode of The Hidden Third, Emmy- and Peabody-winning journalist Mariana van Zeller sits down with Kurt McKenzie, a former FBI agent, to explore the hidden world of pill mills, pain clinic scams, health care fraud, and birth tourism. Their candid, wide-ranging conversation highlights the ways in which underground economies—often in plain sight—fuel the opioid epidemic, exploit vulnerabilities in the health care system, and impact national security. Both share personal stories from their investigations, discuss the challenges of law enforcement, and reflect on the broader societal implications of their work.

Main Discussion Themes

1. Introduction & Shared Background ([00:37]–[01:12])

• Mariana and Kurt realize their investigative paths have crossed before, particularly during the Florida pill mill crises.
• Mariana teases a personal connection to one of Kurt’s cases (“Miami Mama” birth tourism), foreshadowing later discussion.

2. Kurt’s Early Career and Path to the FBI ([01:12]–[03:08])

• Kurt’s initial ambition was to be a scientist—he worked in pharmaceuticals and met FBI agents by chance.
• He joined the FBI as a forensic DNA analyst, working on violent crimes: “It’s rape, robbery, and murder. It’s mayhem all, all day long.” (Kurt, [02:18])
• Transitioned from lab work to field agent, assigned to Miami, just before 9/11.

3. Miami: America's Fraud Capital ([03:08]–[05:12])

• Kurt describes Miami as “the epicenter” of all types of fraud—investment, health care, identity theft, and more.
• South Florida’s unique blend of crime made the Miami FBI office “like the varsity team.” Despite being smaller than New York, it often had more indictments.

4. Operation Oxy Alley: Tackling America’s Biggest Pill Mills ([05:16]–[24:50])

Genesis of the Case

• Both Mariana and Kurt separately investigated “American Pain” and the George brothers, Florida twins behind the largest oxycodone/pill mill operation in US history.
• “Operation Oxy Alley is the name we gave to what ended up becoming the single largest drug diversion investigation in US history.” (Kurt, [05:51])

What Were Pill Mills?

• Clinics outnumbered McDonald’s in Broward County; strip malls might have several side by side.
• Clinics sold prescriptions and sometimes the pills themselves, “which seems like a conflict of interest… but it was legal at the time.” (Mariana, [17:53])
• Patients—often out-of-state—lined up, paid for sham MRIs, and received huge quantities of oxycodone, benzodiazepines, and muscle relaxants.

How Did the Scheme Work?

• Pills sold for $2–$3 each at clinics, then resold for $1/milligram in Appalachia: a 30mg pill could net $30 on the street ([20:18]).
• The lack of a prescription drug monitoring program in Florida allowed for rampant “doctor shopping.”
• “What we found were smaller organized crime groups… would sponsor a vehicle, four or five of your buddies, give them a couple thousand dollars, drive all the way down to Florida… visit as many clinics as they could.” (Kurt, [20:28])

Shocking Details and Notable Moments

• Physicians were “drug dealers with white coats” ([16:42])—many were retired, marginal, or previously sanctioned doctors, now incentivized by profit-sharing.
• In 12 months, one George brothers doctor, Dr. Cynthia Cadet, had 51 of her patients die soon after clinic visits ([38:31]).
• Clinic staff knew the patients were dying. In files, “D / slashee” meant “deceased” or “discharged,” with files archived once someone died ([37:32]).
• Prescriptions were handed out with little to no exam: “The average time was 3 minutes and 45 seconds.” (Kurt, [33:07])
• Stamping and rapid batch-processing of prescriptions kept the clinics running efficiently: “He was the original criminal efficiency expert.” (Kurt, [34:12])

Law Enforcement Response

• Investigators relied on evidence of intent, cash flows, and ARCOs (DEA tracking of all legal narcotics).
• Five of the top 20 highest-prescribing doctors in America worked for the George brothers ([23:04]).
• The total: over 20 million doses of oxycodone dispensed in under two years ([24:37]).

Impact

• After shutting down the operation, Florida saw a 41% drop in oxycodone deaths ([54:34]).

Memorable Quote

"Most Americans are raised to see doctors as the healer. These people were drug dealers with white coats." — Kurt McKenzie ([16:42])

5. Journalists & Law Enforcement: Working Side by Side ([12:50]–[15:51])

• Kurt explains why law enforcement nearly never asks journalists for sources; it’s a line they don’t cross for First Amendment and safety reasons.
• “Never a journalist. Not once. It’s just not done.” (Kurt, [15:20])

6. The Anatomy of the US Opioid Crisis ([41:35]–[47:58])

Societal Impact

• Death toll: Over a million Americans have died in 20 years from opioid overdoses ([42:13]); 3,000 people die weekly from drugs/alcohol in the US.
• Many addicts were initially prescribed opioids for legitimate pain, only to spiral into addiction.
• Prosecutors struggled to convict doctors on overdose death charges—jury bias against “junkies” cited as a barrier ([39:03]).
• The cases set the blueprint for prosecuting pill mill doctors; now, convictions are more common ([50:07]).

Pharmaceutical Industry’s Role

• Purdue Pharma’s misleading marketing helped fuel the epidemic, claiming 1% addiction rates (“which is bullshit,” Kurt, [46:47]).
• No Sacklers or Purdue execs went to prison; civil fines were minimal compared to profits ([47:44]).
• Insys Pharmaceuticals used similar bribery and fraud tactics around fentanyl prescriptions.
• John Kapoor, Insys CEO, was the first (and possibly only) pharma exec to serve prison time—only two years ([49:46]).

7. Birth Tourism & National Security: The Miami Mama Case ([55:10]–[67:13])

• “Operation Miami Mama” targeted clinics catering to Russian women seeking US birthright citizenship for their children.
• Package deals could range from $20,000–$120,000; included OB/GYN, translators, luxury accommodations ([58:02]).
• The children, born US citizens, are raised in Russia—potential future intelligence concerns.
• Over 600 births traced to just two clinics; schemes extended to illegally sublet apartments ([65:14]).
• Prosecution focused on falsified government records (passport applications); main perpetrators received short sentences ([64:22]).
• Passport revocations were possible, but not citizenship ([67:01]).

Notable Moment

“These are now US Citizens who are going to be raised and indoctrinated in Russia… That is correct. They are playing the long game. We are sitting here watching them go right by.” — Kurt McKenzie ([59:03])

8. Health Care Fraud: Stealing from the System ([67:28]–[75:49])

• The sheer scale: Over 10–15% of Medicare’s half-trillion dollar budget was stolen annually in the mid-2000s ([68:54]).
• Example: One husband-and-wife ring tried to steal $400 million, netting $200 million through fake clinics.
• Fraud methods:
  • Buying lists of patient data (names, SSNs) to bill for phantom services or equipment.
  • Durable medical equipment fraud; “liquid gold” urine testing scams.
  • Body-brokering: paying the vulnerable (homeless, elderly) to show up for fake treatments.

Notable Quote

“If you look at your paycheck…take 10% of that, and it’s going in some dude’s pocket.” — Kurt McKenzie ([69:06])

9. The Hidden Toll of Law Enforcement ([76:13]–[80:31])

• The job is deeply stressful: Kurt shares statistics on divorce, suicide, and illness among law enforcement.
• Support comes from tight colleague bonds; compartmentalizing trauma is necessary but imperfect.
• Mariana and Kurt reflect on “family” among investigative teams—having camaraderie and rituals like group dinners to process tough stories together ([79:22]).
• The emotional consequences on law enforcement and journalists run deep.

Notable Quote

“You will, if you do this job properly for long enough, it will hurt you in some way, shape or form. But you do it for a few reasons: one, you do it because it’s the right thing to do.” — Kurt McKenzie ([77:10])

Notable Quotes & Memorable Moments

• “If you’re an FBI agent, Miami—it’s like the varsity team.” (Kurt, [04:55])
• “There were more pain clinics at one point in Broward County than there were McDonald’s.” (Mariana, [17:16])
• “Doctors were paid by the head—50% of what the patients paid.” (Kurt, [31:17])
• “One of the doctors…prescribed more than every single physician in the entire state of California.” (Kurt, [23:20])
• “They all still had medical licenses. That was a requirement.” (Kurt, [30:53])
• “After shutting them down, oxycodone deaths dropped 41% in Florida.” (Kurt, [54:34])
• “Ten to fifteen percent [of Medicare] was being stolen outright.” (Kurt, [68:54])
• “If you walk into a grimy house and flip the lights on, the roaches all scatter. When you shine the light on something unsavory, it just goes away.” (Kurt, [66:13])

Key Timestamps

• 00:37–03:08: Kurt’s origin story and laboratory work.
• 03:08–05:12: Fraud culture in Miami.
• 05:16–24:50: The rise and mechanics of pill mills, undercover journalism, and law enforcement’s approach.
• 24:50–38:07: The deadly prescribing practices and pill mill profits.
• 38:07–47:58: Legal, societal, and pharma industry complicity in the opioid crisis.
• 55:10–67:13: “Miami Mama”—birth tourism, national security, and the Russian connection.
• 67:28–75:49: Health care fraud, durable medical equipment scams, and insurance fraud nationwide.
• 76:13–81:31: The personal costs of policing underground economies; emotional toll, camaraderie, and resilience.

Tone & Style

• The tone is candid, occasionally darkly humorous, but always seriously committed to exposing underground economies and the real human stakes.
• Both speakers combine insider expertise with personal vulnerability, offering rare insight into both the mechanics of hidden markets and their hidden tolls.

Conclusion

This episode gives a visceral, multifaceted tour of how criminal entrepreneurs—sometimes with white coats and degrees—exploit the cracks in health, legal, and immigration systems to profit from addiction, desperation, and global demand. Through Kurt McKenzie’s unfiltered accounts and Mariana van Zeller’s relentless curiosity, listeners gain both a blueprint of fraud’s mechanisms and a sense of what it costs to fight them. They agree: shining a light helps, but broader, systemic change is needed—from treatment and regulation to accountability in both medicine and government.