Philip Esformes was pretty flashy for someone who ran nursing homes.
对于经营养老院的人来说,菲利普·埃斯福姆斯(Philip Esformes)相当耀眼。
He's this kind of insanely handsome - drives a $2 million Ferrari, cavorts with models.
他英俊无比,开着一辆价值200万美元的法拉利,和模特们嬉戏。
This is Malcolm Gladwell, the host of the "Revisionist History" podcast and the author of many books. His upcoming book is "Revenge Of The Tipping Point," and it has a chapter all about Philip Esformes.
这是马尔科姆·格拉德威尔,播客《修正主义者的历史》的主持人,也是多部书籍的作者。他即将出版的新书是Revenge Of The Tipping Point,其中有一章专门讲述菲利普·埃斯福姆斯。
He and his father build this nursing home empire, and they expand from Chicago to Miami. And Philip moves down there, and he goes crooked.
他和他的父亲建立了这个养老院帝国,他们从芝加哥扩展到迈阿密。菲利普搬到了那里,开始走上不正当的道路。
In 2019, Philip goes on trial for one of the biggest Medicare fraud cases in history. In his defense, a rabbi who had known Philip's wider family for decades took the stand.
2019 年,菲利普因美国历史上最大医保欺诈案受审。一位认识菲利普一家子几十年的拉比出庭为他辩护。
He said when he was in - living in Chicago, he was an upstanding citizen from this, you know, deeply philanthropic family.
他说,当他住在芝加哥时,他是一位正直的公民,有一个非常热衷慈善的家庭。
And then he goes to Miami, and everything falls apart. And the rabbi, the family friend, says it's Miami's fault. Right. And I actually agree with him. I think it's Miami's fault.
然后他去了迈阿密,一切都崩溃了。而这位拉比,也就是我们家的朋友,说这是迈阿密的错。没错。我其实也同意他的观点。我认为这是迈阿密的错。
It's this idea that a city can ruin an individual that fascinated Malcolm Gladwell. This is THE INDICATOR FROM PLANET MONEY. I'm Wailin Wong.
正是这个城市可以毁掉一个人的想法让马尔科姆·格拉德威尔着迷。这里是THE INDICATOR FROM PLANET MONEY。我是Wailin Wong。
And I'm Darian Woods. Today on the show, how Miami became known as the capital of Medicare fraud. We learn what went wrong in South Florida and what it says about how places can change our behavior.
我是Darian Woods。今天我们来谈谈迈阿密如何成为医保欺诈之都。我们了解了南佛罗里达州出了什么问题,以及这说明了这些地方如何改变我们的行为。
Medicare is the United States' way of providing near-universal health care for over 65-year-olds and people with disabilities.
医疗保险是美国为65岁以上老人和残疾人提供近乎全民医疗保健的方式。
It spends about $900 billion a year, and that's growing with the aging population. It is this tempting pot of money for criminals.
每年花费约9000亿美元,而且随着人口老龄化,这一数字还在增长。这对罪犯来说是一大笔诱人的钱。
Billions are fraudulently skimmed from Medicare each year. It's the equivalent of $238 for every American adult, and fixing this won't come easily.
每年有数十亿美元被欺诈性地从医疗保险中挪用。这相当于每个美国成年人要支付238美元,解决这个问题并不容易。
There's no way to police the system. It's too large. So basically, it works on faith.
没有办法监管这个系统。它太大了。所以基本上靠信仰运作。
Malcolm Gladwell points out that there are a range of ways to defraud Medicare in the U.S. An unscrupulous doctor can exaggerate bills that the government reimburses. They can fake treatments, even create fake patients.
马尔科姆·格拉德威尔指出,在美国,有各种各样的方法可以欺骗医疗保险。不道德的医生可以夸大政府报销的账单。他们可以伪造治疗,甚至制造假病人。
The doctor files for a claim for treating a patient. Medicare pays. And after the fact, if they notice a pattern of - that's suspicious, they investigate - only after the fact.
医生为治疗患者申请索赔。医保支付。事后,如果他们发现一种可疑的模式,他们会调查——只是事后。
Another form of Medicare fraud involves sending the government invoices for nonexistent medical equipment, things like wheelchairs, crutches and oxygen tanks. Now, to send those phony invoices, you have to be a medical establishment.
医保欺诈的另一种形式是向政府发送不存在的医疗设备的发票,比如轮椅、拐杖和氧气罐。现在,要发送这些假发票,你必须是一家医疗机构。
An even easier way to make money is to become a completely fake Medicare provider. Basically, you just need a doctor's national provider identifier number, and these can be stolen off the internet. Plus, you need a physical address.
赚钱的更简单的方法是成为一个完全虚假的医保提供商。基本上只需要一个医生的国家医疗服务提供者识别号,而这些识别号可以从互联网上被盗取。另外,你还需要一个实际地址。
So all these fly-by-night operations rent these office spaces in these Medicare mills, and they put it - they install someone behind a desk, and that's their address. And they just bill to that address.
所以所有这些不法之徒都在这些医疗保险工厂里租用这些办公空间,他们把这个地址放在那里——他们安排一个人坐在办公桌后面,这就是他们的地址。他们只是向那个地址收费。
Malcolm Gladwell went to Miami himself to inspect some of these ghost medical offices.
马尔科姆·格拉德威尔亲自去了迈阿密视察这些幽灵医疗办公室。
Looks like a normal office building. And you walk in. It's been divided up into offices the size of closets.
看起来像一栋普通的办公楼,走进去发现它被分成了壁橱大小的办公室。
And each one of these closet-sized offices has some grandiose name - the Miami Rehabilitation Hospital - and there's nothing going on. There's, like, one person sitting there behind an empty desk.
每个壁橱大小的办公室都有一个宏伟的名字——迈阿密康复医院——什么都没有发生。只有一个人坐在空桌子后面。
This is so prevalent in Miami that there are even, like, black market consultants that help set up these fake medical facilities for a fee.
这种情况在迈阿密非常普遍,甚至有黑市顾问收费帮助建立这些假医疗设施。
You know, if you want to - if you and I wanted to move to Miami tomorrow with one connection - if someone just gave us a number - we could be up in business in, like, a week.
如果你愿意——如果你和我想明天搬到迈阿密,只要有一个联系方式——如果有人给我们一个号码——我们大概一个星期就可以开始做生意了。
And this seems to show up in the numbers. For every Medicare patient in 2006, most places in Florida were spending about two or $300 on medical equipment, you know, things like those crutches or that oxygen tank. In Miami, it was about $1,200.
这似乎在数字上有所体现。2006年,佛罗里达州的大多数地方为每位Medicare患者花费约200或300美元购买医疗设备,拐杖或氧气罐之类的东西。在迈阿密,大约是1200美元。
So the question Malcolm Gladwell wanted to figure out was why. Why Miami? One reason is that South Florida has a lot of older people. So there's more legitimate health businesses to blend in with. But where does the drive for fraud come from?
马尔科姆·格拉德威尔想弄清楚的问题是为什么。为什么是迈阿密?一个原因是南佛罗里达州有很多老年人。因此有更多合法的健康企业可以融入其中。但欺诈的动力来自哪里?
There is another argument Malcolm finds compelling, and it begins by winding the clock back about half a century.
马尔科姆认为另一个论点很有说服力,它始于将时钟倒回大约半个世纪。
I got very interested in this really fun theory that was - comes from a wonderful book written by a guy named Nicholas Griffin, who's really obsessed with what happens to Miami in 1979 and 1980.
我对这个非常有趣的理论非常感兴趣,它来自一本很棒的书,作者是尼古拉斯·格里芬(Nicholas Griffin),他非常痴迷于1979年和1980年迈阿密发生的事情。
Within a 12-month span, the city undergoes three seismic shocks that shake the credibility of all the institutions.
在12个月的时间里,这座城市经历了三次重大冲击,动摇了所有机构的信誉。
First, there was a race riot. After four police officers were acquitted of beating a Black man to death, protests turned into looting and rioting, and 18 people died.
首先是种族骚乱。在四名警察因殴打一名黑人致死被判无罪后,抗议活动演变成抢劫和骚乱,造成18人死亡。
The federal government declared Miami a disaster area. This, Malcolm Gladwell says, coincided with an ongoing trend of the white middle-class leaving the city.
联邦政府宣布迈阿密为灾区。马尔科姆·格拉德威尔说,这与白人中产阶级离开这座城市的持续趋势相吻合。
Then there was the cocaine trade. With the demand for cocaine growing, Miami became the major hub for the illicit drug entering the United States.
然后是可卡因贸易。随着对可卡因的需求不断增长,迈阿密成为非法毒品进入美国的主要枢纽。
By 1980, the city was in the midst of a drug war of feuding cocaine traffickers. This would soon overload the city's morgues.
到1980年,这座城市陷入了可卡因贩运者争斗的毒品战争之中。这很快就会使该市的太平间不堪重负。
Finally, there was the Mariel boatlift, and this was this extraordinary moment in history when about 125,000 Cubans migrated to the U.S., mostly in Miami. And this was all in the space of several months.
最后,发生了马列尔偷渡事件,这是历史上一个非凡的时刻,大约有125000名古巴人移民到美国,其中大部分是在迈阿密。这一切都发生在几个月的时间里。
An analysis in the International Review of Law and Economics finds property crime in Miami increased nearly a quarter to a third due to this particular influx, along with rising murder rates.
《国际法律与经济学评论》的一项分析发现,由于这种特殊的涌入,迈阿密的财产犯罪增加了近四分之一到三分之一,谋杀率也上升了。
That said, the authors are very careful to point out that this was an extremely unusual case and that it's unlikely to apply to other cases of migration where more screening and resettlement efforts happen.
尽管如此,作者非常谨慎地指出,这是一个极其不寻常的案例,它不太可能适用于其他需要更多筛查和安置工作的移民案例。
So Miami had three big shocks in the space of a year. Griffin says any one of these would be sufficient to shake the culture of a city to its foundations.
因此,迈阿密在一年的时间里经历了三次大冲击。格里芬说,其中任何一个都足以动摇一个城市的文化根基。
And perhaps most influential for Medicare fraud was the cocaine trafficking. The knowledge and connections needed for laundering drug money were helpful for building Medicare fraud companies.
而对医保欺诈影响最大的或许是可卡因贩运。洗钱所需的知识和人脉有助于建立医保欺诈公司。
And with all the drug money washing around Miami, police and politicians and banks were becoming susceptible to corruption, bought out and bribed by criminal organizations.
随着毒资在迈阿密四处流通,警察、政客和银行变得容易受到腐败的影响,被犯罪组织收买和贿赂。
Malcolm Gladwell has this term called an overstory, the kind of norms and unspoken rules permeating through a place.
马尔科姆·格拉德威尔有一个术语叫做“overstory”,即渗透到一个地方的规范和不成文的规则。
So the idea was Miami has a kind of particular overstory, a cloud hanging over Miami that influences the people who live there in ways they may not be aware of.
这个想法是迈阿密有一种特殊的overstory,笼罩在迈阿密上空的云层以他们可能不知道的方式影响着那里的居民。
And high-status people were associated with medical fraud. In 1997, the federal government raided a giant for-profit health care company called Columbia/HCA.
而地位高的人与医疗欺诈有关。1997年,联邦政府突击搜查了一家名为Columbia/HCA的大型营利性医疗保健公司。
The government charged it with defrauding Medicare and other federal programs and fined it $1.7 billion.
政府指控该公司欺诈医疗保险和其他联邦计划,并对其处以 17 亿美元的罚款。
The CEO at the time - Rick Scott, as in former governor and now senator for Florida Rick Scott. The senator, we should mention, was never formally charged himself.
当时的首席执行官是里克·斯科特,也就是前州长、现任佛罗里达州参议员里克·斯科特。我们应该提到,参议员本人从未受到正式指控。
That kind of thing matters, right? If the people at the top of the food chain seem to be complicit in a certain kind of behavior, that gives permission to everybody else.
这种事情很重要,对吧?如果食物链顶端的人似乎参与了某种行为,那么其他人也同样可以参与。
Philip Esformes, the guy at the start of the show - you know, the one who was involved in that huge Medicare fraud scheme involving his nursing homes -
菲利普·埃斯福姆斯,节目开头的那个人——他参与了涉及他所在的疗养院的大规模医保欺诈计划——
well, Philip was sentenced to 20 years in prison until the sentence was commuted by a certain president who now lives in south Florida - yeah, Donald Trump.
菲利普被判处20年监禁,直到现在住在南佛罗里达州的某位总统唐纳德·特朗普减刑。
Federal agencies are trying to push back on Medicare fraud generally. In 2007, the government launched its first strike force against health care fraud, of course, located in Miami.
联邦机构正在努力打击医保欺诈。2007年,政府在迈阿密成立了第一支打击医疗保健欺诈的部队。