They would be paying CP issuers with USD out of a bank account (the same USD used for creation/redemption of USDT).
I think many people believe they don't even have enough USD to start with, eg because some of their assets are loans collateralised by crypto (such as the Celsius 1B loan).
I believe both are true - Tether printed USDT against non-cash, and used some of the actual cash to buy dodgy assets for more yield.