An Idaho safe house claimed it was saving trafficking victims. Women said it was like being ‘trafficked all over again’

Editor’s note: As concerns about sex trafficking escalate, one prominent Idaho nonprofit is providing a form of rescue that some survivors say leaves them trapped in another cycle of control and coercion, funded by questionable Medicaid billing. This is part one of a three-part series called “Savior Complex.” EastIdahoNews.com will publish the other two parts this week.

(Investigate West) — Three years ago, Paula Barthelmess — the mother of Idaho’s first anti-trafficking task force, the fiery advocate with the ear of policymakers, the devoted social worker allowed inside police interrogation rooms — dropped by an Idaho jail to visit a woman called Franky.

Franky, on the run from her trafficker, was behind bars after she made an attempt at suicide by cop. Responding to a report of a woman “sobbing and crying,” officers found Franky smoking a cigarette outside a church. She had warrants for her arrest. She refused to be handcuffed. Finally wrestled to the ground by four officers, she bit one cop’s knee — a felony — in hopes he would kill her.

Barthelmess, her blond hair hanging to her shoulders, visited the jail to offer Franky a way out. Barthelmess leads a nonprofit in Idaho called Community Outreach Behavioral Services that operates safe houses for trafficking survivors that she said provides therapy. Instead of serving her full sentence in prison, Barthelmess said, Franky could leave prison early and live in one of the safe houses.

It was the same promise Barthelmess has made to dozens of other women trapped in a world of exploitation and misery, cycling between jail and trafficking. The safe house offered a chance at shelter and recovery. If Franky went with her, she could leave her former life behind.

“She said, ‘It’s going to be so great. It’s going to be rough. But it’s going to be good,’” Franky said.

Franky believed her.

A web of influence

Franky, who asked to go by her street name, is part of a growing number of sex trafficking victims identified across the country in the last decade. In 2021, reports of people being trafficked — often described as a form of slavery in which people are forced into commercial sex work or other labor — was nearly double the reported number in 2015, according to the National Human Trafficking Hotline, a 24/7 phone line that maintains one of the nation’s most extensive human trafficking data sets. And awareness of the problem has risen sharply, boosted by high-profile cases like those against disgraced financier Jeffrey Epstein and, more recently, hip-hop mogul Sean “Diddy” Combs.

It’s emerged as a critical issue for politicians on both sides of the spectrum. The Trump administration, weeks before the 2020 election, announced it was “committed to combating human trafficking,” as his administration released a national plan that included the “first-ever grants for safe housing for survivors.” A year later, the Biden administration released an updated plan intended to address the needs of “underserved individuals, families, and communities.”

The federal response includes more than 500 grants of more than $350 million managed by the Department of Justice Office for Victims of Crime to strengthen trafficking victim service programs as of 2022.

And that money is often directed by state and local agencies into smaller, local anti-trafficking organizations like Community Outreach Behavioral Services, or COBS, which in Idaho needs no license to operate a safe house even as women are referred there by judges, police and public defenders. The funding helped fuel Barthelmess’ rise to prominence in the Boise area, where she’s the subject of flattering local TV reports calling her a hero and praising the nonprofit’s work to “rescue” survivors of human trafficking with its “amazing” volunteer team.

An investigation of the program by InvestigateWest, however, reveals a different story. It’s one that highlights a widespread lack of accountability for a growing anti-trafficking movement wrestling with competing philosophies on how to serve victims, as a booming industry of safe and sober homes rakes in billions of dollars on the premise of helping those most in need.

As COBS gained influence in Idaho, former COBS employees and residents say the program recruited women into the safe houses and kept them there using manipulative tactics mirroring those of traffickers. The residents were then drawn into a self-dealing scheme in which a for-profit counseling company — owned by Barthelmess’ son — tapped into clients’ Medicaid insurance and billed for services residents say they never received, InvestigateWest has found.

Several residents say the program was overly restrictive. One former safe house resident, who goes by Jay, described living in a COBS safe house like this: “You’re told where to live, what you can sleep in, what clothes you can wear, if you can cut your hair, if you can dye your hair, if you can wear makeup.

“You cannot leave the house. If you go outside the front door, you get reprimanded. You go outside the back door and if you’re doing anything besides vaping, you get reprimanded. You have to go to all the classes they say, you’re not allowed to have a phone, you’re not allowed to drive your own vehicle.

“You have to go to all the counselors they tell you to go to, all the doctors they tell you to go to. They want to keep your money. They don’t give you your money or your food stamps. They hold on to everything and tell you when you can use it, what you use it on and how you can use it.”

Barthelmess even read therapists’ notes from one-on-one sessions with clients, and former employees and residents say she used that information to make residents fall in line. For those who still rebelled, COBS would sometimes notify their probation officer or kick them out of the safe house entirely, sending women back to jail or the streets.

Jay, there on a court order, was later kicked out of the safe house for saying “negative things” about the program, according to a text Barthelmess sent her.

Isolated and controlled, residents were then made to do Barthelmess’ bidding, including representing COBS at public events — sometimes sharing information about their trafficking experience with the public — when they didn’t feel comfortable doing so.

In the last four years, a for-profit company linked to COBS has received Medicaid reimbursements totaling nearly $2.6 million, a figure that includes reimbursements for some clients who didn’t stay in a safe house. A detailed review of Medicaid records and interviews with residents indicates that the program would routinely bill for case management services for short car rides, a practice not allowed under federal regulations. Residents felt they had no choice but to go on those rides.

“That sounds like it’s fraud,” said Stephen Teller, a whistleblower attorney based in Seattle who reviewed InvestigateWest’s analysis. Teller has extensive experience representing those exposing fraud under the False Claims Act, a federal law that allows individuals with information about fraud to sue on the government’s behalf.

In interviews with InvestigateWest, Barthelmess said COBS does not force residents into treatment at any one company. She stressed that the complaints from some former residents of the safe houses do not reflect the positive work COBS does every day, noting that one state agency received written complaints from residents and allowed COBS to continue operating. She declined to answer questions about potential Medicaid and grant fraud.

“We’re doing some good stuff,” she said. “We’re taking care of some people.”

Barthelmess today sits at the center of a network of influence on state policy to push legislation, work with police and lead a coalition of anti-trafficking efforts in the Treasure Valley in southwest Idaho.

InvestigateWest interviewed several dozen people including former safe house residents and employees; current and former board members, police and service providers who have worked with COBS; whistleblower attorneys, federal investigators, and national experts on issues such as trafficking, Medicaid billing, and nonprofit governance. To verify claims about the conditions of the safe houses, InvestigateWest reviewed formal complaints and inspection records, Medicaid billing records, government contracts and transactions with COBS, court records, and social media accounts.

Megan Landen, a former employee at one of the safe houses, said the survivors speaking up about the program now describe COBS the same way she remembers it in 2021, when Landen quit because she believed COBS was hurting women. One of the residents she worked with was left homeless and returned to sex work because Barthelmess evicted her without a transition plan, Landen said.

“Every client I witnessed,” Landen said, “ended up going back to the situation they came from, or worse.”

‘You cannot leave’

In October 2022, Franky was picked up and driven to the safe house by Barthelmess and a police escort.

The last time she’d gotten out of prison, in 2020, Franky ended up being trafficked shortly after by a guy she met through a friend. He gave her rides and money, and she felt like she owed him. Before she knew it, she said, he made her do things she “didn’t want to do.” She was sold for sex out of a hotel, she said, and he shoved drugs down her throat if she wouldn’t comply.

That’s who she was running from when cops found her at the church that day in 2021.

“It’s the control, manipulation and fear,” Franky said. “It’s not being able to do anything outside of your own will. You’re under their command. And if you move the wrong way, in the trafficking world, you either get beat or you end up dead.”

Franky welcomed the idea of being in a truly safe house because she still feared he’d find her. But she hoped to be released from probation by January 2024 so she could leave Idaho entirely. She was under strict court orders, however, to follow and graduate the COBS “rehabilitation” program first.

In the first month, Franky entered what staff calls the blackout period. No phone. No going out in public. No connection with society. She had to give all of her things to the program. She couldn’t buy her own food. And Franky said they wouldn’t let her have tarot cards for her to practice her religion — a possible violation of federal anti-discrimination laws since COBS receives federal funding.

But Franky, along with several other residents and employees who spoke to InvestigateWest, said it was surprising how unsafe the safe houses actually seemed to be. She lived with five people in a three-bedroom house, but there was no full-time supervisor. Women found ways to communicate with traffickers, or they engaged in sex work voluntarily while living at a safe house, residents and former employees say.

Some used drugs. One resident in Nampa overdosed on fentanyl and nearly died. With no supervisor on site, residents were able to save her life using Narcan, Franky said.

Franky saw a therapist, but she said she had no choice but to use one provided by Advanced Clinical Trauma Services, the for-profit company owned by Barthelmess’ son, Tylar Bell. Group therapy was run by Barthelmess, too, records confirm.

Within days of Franky arriving at the safe house, the company — referred to as ACTS — started billing her Medicaid. And they had Franky go with other residents to a local substance use recovery center. On each 20-minute car ride, she was crammed in with several other residents, and ACTS would claim more than $100 for “targeted case management” under her name, InvestigateWest found.

Records suggest ACTS billed the other residents in the car for case management, too. In just over a year, Franky alone brought the company roughly $25,000 from Medicaid, with $8,560 in case management reimbursements alone, records show. She doesn’t remember getting real case management more than once or twice.

Bell declined to comment when asked to explain ACTS’ billing of Medicaid. Instead, Bell sent a cease and desist letter to InvestigateWest through his lawyer, calling the allegations of illegal Medicaid billing practices “categorically false and entirely without merit.”

Eventually, Franky was moved to a different safe house also run by COBS with fewer restrictions. She was able to get a job. Amanda Carpenter, who worked as Barthelmess’ assistant at COBS in 2023, said Franky served as a mentor to some of the other residents. Franky had a car at this point and was expected to drive other residents to appointments. Franky said she wasn’t paid.

At times, it felt like residents were forced to do work for Barthelmess. Residents say they were expected to attend meets at a gymnastics business, Gem State Gymnastics, owned by Bell. Other days, residents were expected to work at an animal farm for “therapeutic” purposes, when in reality residents were shoveling manure without pay, multiple residents say.

Barthelmess would get “angry” if the residents didn’t speak to the media at events or fundraisers, Franky said.

In September, nearly a year into Franky’s stay with COBS, Elizabeth Smart, the once-abducted teen whose survival grabbed international headlines, came to speak at an event a short drive away in Nampa. Franky was asked to share with the public her trafficking experience before coming to COBS. Franky nervously described the horrors she’d experienced, dating back to her childhood, to hundreds of people. Afterwards, she said, she stood onstage as Barthelmess accepted a check as a donation to the nonprofit.

To the public, Franky represented a COBS success story.

But privately, Franky felt used. Manipulated. Controlled.

Leaving didn’t feel like an option. Residents knew that those who rebelled at the safe house were punished — kicked out onto the street or back into jail.

They felt they couldn’t trust police, who Barthelmess worked with to identify trafficking victims on the street.

They couldn’t trust their public defenders. One was actually on the COBS board of directors.

And they couldn’t even trust their therapists, they said, because Barthelmess would read their counseling notes.

“This is almost like being trafficked all over again,” Franky said.

‘A clear conflict’

In training sessions, fundraising events and news stories, Barthelmess presents herself as a humble yet powerful fighter of human trafficking, the head of a scrappy, underfunded nonprofit who has managed to pioneer a crucial statewide response to a growing problem.

A licensed social worker, she was once the president of the Mental Health Providers Association of Idaho and has decades of experience in the field, advocating on behalf of clinicians in the state Legislature.

Barthelmess frequently touts her partnership with law enforcement to create Idaho’s first human trafficking task force. In an interview, she repeated the notion that COBS provides trauma therapy and case management services to victims of human trafficking, “pro bono.”

COBS said it serves dozens of victims each year. In a recent six-month period, the program said it housed 39 survivors. Community donations keep them going, she said.

In private, Barthelmess maintains a comfortable lifestyle. She owns a home on 10 acres valued at $1.5 million, overlooking sprawling fields southwest of Boise. She takes her family on tropical vacations, even inquiring on her last trip to Costa Rica in May about buying property, social media posts show.

A deeper look at her family businesses reveals that the safe houses she runs bring her family much more money than she lets on.

COBS, which was founded in 2015, hasn’t filed the annual reports to the IRS required for nonprofit status since 2017, according to IRS records. Its tax-exempt status was revoked in 2021, though COBS continued to hold fundraising events until its status was restored the next year. COBS declined to provide tax filings for the missing years to InvestigateWest.

Yet despite COBS saying publicly that it offers therapy, and Barthelmess signing contracts that describe COBS as offering case management, it doesn’t actually offer therapy. It’s her son’s for-profit, ACTS, providing those services to residents. And it’s not “pro bono.”

The for-profit company, registered with the Secretary of State’s Office under the name Wells and Bell LLC, was opened in 2020 by her son, Bell, and Kenneth Wells, a mental health clinician who was also on the COBS’ board of directors. Wells said he cut off ties with both organizations in 2020 because he didn’t agree with the therapeutic direction they were going. Bell currently is on the COBS board, records show. One of Barthelmess’ daughters is also an ACTS social worker.

COBS and ACTS have seemed to effectively operate as one entity since opening the first safe house in late 2020. The companies share an office space in Meridian. On social media and in news stories, employees identify themselves as working for both ACTS and COBS. ACTS clinicians are listed in photo captions as COBS employees as they pose with giant checks for the local news. Contracts for federal grant dollars meant for COBS list Barthelmess’ ACTS email.

And each new resident brings both companies more money.

Housing one survivor alone allowed COBS to collect thousands of grant dollars. The city of Nampa, which was awarded a $350,000 grant in 2021 for victim services and another $750,000 in 2023 for Idaho’s human trafficking task force, has a contract with COBS to pay the nonprofit $50 per night for “emergency” beds.

But when Barthelmess, as the COBS director, refers residents to herself in her role as a licensed social worker at ACTS, that’s a conflict of interest, according to Idaho administrative rules. When InvestigateWest presented a situation like it to Delmar Stone, the executive director of the Idaho chapter of the National Association of Social Workers, he didn’t hesitate, though he made clear that he was commenting only hypothetically.

“She’s profiting from something, a vulnerable population, and they’re not getting any alternative other than receiving services, which is in a for-profit situation. A peer group would look at that and say there is a clear conflict,” Stone said.

The Idaho Board of Social Work Examiners could discipline Barthelmess, up to suspending or pulling the license.

The blurred lines between the two companies could also constitute both grant fraud and Medicaid fraud, due to a potential misrepresentation of services to the federal government in order to receive funds.

If Barthelmess, as a person billing Medicaid at a separate company, has the power to influence whether a client can stay at COBS, then it could be a violation of the False Claims Act, said Ari Yampolsky, a founding partner of Whistleblower Partners, which advocates for those exposing corporate misconduct.

“It seems like there very well could be a conflict of interest,” Yampolsky said, “if the for-profit has a financial incentive to keep people in the nonprofit facility in order for the nonprofit to continue getting reimbursement.”

In an interview, Barthelmess declined to explain the link between COBS and ACTS. She downplayed her role at COBS, objecting to the notion that she “runs” the nonprofit she founded, though she’s identified publicly as the executive director and signs her name under that title in government documents.

And she minimized her role at ACTS, telling InvestigateWest she’s more of a “consultant” and doesn’t provide therapy.

When InvestigateWest noted that records show her billing Medicaid as an ACTS clinician for group therapy sessions attended by safe house residents for years, she backtracked: She was not doing it as “as an ACTS clinician,” she insisted — “just as a person.”

But she was more than that for those at the safe houses. In interviews of employees and residents with InvestigateWest, Barthelmess was described as a “mother figure,” or a “trauma mama.” She took care of everything for them — but they knew not to cross her.

Five current or former trafficking survivors who received individual therapy from an ACTS counselor, along with former employees, say that Barthelmess would read the notes their therapists took. They say the information was used to keep residents from defying COBS, often keeping them in the safe house. The result was that residents were receiving billable services longer.

“Paula really uses clients’ vulnerabilities to shame them into submission in front of the other girls in the safe house,” said Landen, the former employee.

‘The way pimps see you’

In September, a woman named Ally arrived at a COBS safe house. She’d just endured three brutal months of trafficking under three different pimps. She wanted justice for her traffickers and safety for herself.

Barthelmess told her she could find it at COBS. She worked directly with the FBI, and the safe house was a witness protection program, Ally, 25, recalls Barthelmess saying.

“You’re going to feel like you’re trafficked, but that’s not the case,” Barthelmess said, according to Ally. “Pimps take all your things and tell you they love you and care for you. And they really don’t. And that’s what it looks like we’re doing, but we’re not doing that.”

Ally trusted her. But it became difficult to ignore the parallels between COBS and her traffickers.

Ally’s public defender referred her to COBS, which typically finds new safe house residents through the criminal justice system. Ally’s first trafficker found her through the criminal justice system, too — while she was in jail for driving under the influence.

Barthelmess convinced her that COBS, and only COBS, had what Ally needed. Her first trafficker, too, sold her the idea that if Ally — recently cut off from family and staying in a shelter — went with him, her problems would be solved. He didn’t mention anything about sex, she said.

COBS controlled her food, her transportation and her social interactions. Ally’s pimps did too, down to the color of her hair. Today, she’s dyed her hair red simply because one of her pimps wouldn’t have let her.

“I f–ked up. Again,” Ally thought a week into her stay at COBS. “It was definitely like Paula was the pimp, and a couple of the girls were her bottom bitches, and she wanted all of us to stay there and be there.”

Barthelmess said residents can leave whenever they want — “I always tell the girls, there’s the door,” she said. For many residents, however, that would be considered a probation violation that could land them back in jail. But, as Barthelmess argued, “it’s still a choice.”

“She says that,” Ally said, “but it’s more like, ‘There’s the door. Go. Do it. Watch. I dare you.’”

It’s not unusual for safe houses to impose conditions on residents to preserve the safety of the house. Among anti-trafficking service providers, rules such as taking away a survivor’s phone, or installing cameras in the house, fall into a gray area: When is it necessary for safety, and when is it taking away a survivor’s agency?

But experts say there are important distinctions: Residents should always give written consent and know what they’re getting into. And the rules should be consistent for each resident. At COBS, residents and employees say that wasn’t the case — some women would be kicked out for saying the wrong thing, but others did drugs in the house and were allowed to stay.

Shobana Powell, CEO and founder of a consulting company for entities working to end gender-based violence and human trafficking, said the use of unpredictable expectations is one of many methods of psychological coercion used by traffickers. It often leaves survivors feeling insecure, as if they’re walking on eggshells, and when they fail to comply with unrealistic expectations, they blame themselves.

“When we talk about re-exploitation, it doesn’t always mean that there’s trafficking happening again, but there’s elements of the same psychological coercion that’s happening,” Powell said.

Isolation is another method of coercion, she said. So is controlling access to food. And then there are threats — of deportation, of losing custody of children, of jail.

“These girls knew they were going to get maybe three months of housing and food coverage. They didn’t have any other support network,” Landen said. “They were wholly dependent on Paula. Could they have said no? Yes. And then what were they going to do?”

In late 2023, Ally demanded that they allow her to leave just over a month into her time at COBS. It took hours for them to give her back her stuff, but legally, they couldn’t keep her there.

“It was the way pimps see you,” Ally said. “You’re literally a thing, and you have a bag of money over your head.”

Unnecessary services

Though some states — Washington, for example — do have licensing requirements for a safe house, many others like Idaho have none, said Rachel Karper, director of programs and operations for the National Trafficking Sheltered Alliance, an organization that accredits programs based on certain standards.

“There’s very little regulation around programs that serve adults,” said Karper. “A lot of states don’t have anything at all. It’s basically a wild, wild West.”

Federal investigators in recent years have uncovered and taken down a surge in criminal schemes across the country among sober homes or addiction treatment centers.

At the center of these schemes is the fact that clients at those homes are a “captive audience,” said Patrick Neubert, a commander for the U.S. Health and Human Services Office of the Inspector General investigative unit. And since Medicare and Medicaid don’t directly pay for recovery housing, these facilities would find other services to bill for. Sometimes that might include unnecessary drug tests.

“What we see is the unnecessary services being rendered to essentially fund a person to stay in this recovery housing,” Neubert said.

Back in 2021 when the first COBS safe house had just opened, Landen remembers being told to log time with clients for Medicaid billing when she didn’t believe she should, such as driving a resident to church. Other times case managers were told they could bill for making phone calls for clients. That further raised questions, because she thought she could only bill for case management if she met with a client in person.

In an interview, Barthelmess confirmed that ACTS billed Medicaid for case management for driving residents around.

“A lot of the stuff and the steps and the treatment plan is happening in a vehicle, yes,” Barthelmess said. “It’s easier to discuss and have things in a vehicle versus in a home.”

But case management, under federal regulations, is supposed to involve detailed coordination and planning of services for people who could not navigate the system on their own. State guidelines also said that “a case manager may not be reimbursed for any transportation of the member to and from appointments.”

Franky’s Medicaid records, which she shared with InvestigateWest, indicate that ACTS billed under her name for “targeted case management” 75 times over the course of more than a year. Unless there’s prior authorization, providers in Idaho are only allowed to bill for 60 hours of targeted case management in one year. ACTS billed Franky for roughly double that threshold.

And the majority of those charges came in the first few months of Franky’s time at the safe house on days Franky was driven to the local recovery center for substance abuse treatment. An analysis of records suggests that ACTS billed each individual in the car for the drive to the recovery center.

Yampolsky, the whistleblower attorney, thinks it could be Medicaid fraud.

“That seems problematic,” Yampolsky said. “It would violate the False Claims Act if you were to establish that it was intentional that they were billing for a code they knew they weren’t providing.”

When pressed on this by InvestigateWest, Barthelmess deflected responsibility, saying she’s “not on the Medicaid side.”

While there’s no regulatory body that monitors conditions of adult homes, the allegations of fraud could trigger criminal investigations.

Federal investigators with the Office of Inspector General would have the ability to investigate grant fraud or Medicaid fraud. They declined to confirm or deny whether any such investigation is active into COBS.

The Idaho Attorney General’s Office would have jurisdiction to look into the conflicts of interest involving the nonprofit. It could also investigate allegations of fraud through its Medicaid Fraud Control Unit. In fact, the office received a complaint in 2022 regarding ethical concerns and violations of victim privacy at COBS, but the complainant told InvestigateWest that they never received a follow-up call and that “clearly nothing came of it.”

The Idaho Attorney General’s Office declined several requests to answer questions about COBS or how it investigates Medicaid fraud or conflicts of interest generally.

Since October 2023, Franky and Ally each submitted formal complaints about COBS to the state agency administering funding to the program, but neither complaint led to consequences for COBS.

And local and state police agencies, along with judges and public defenders, continue to refer victims to COBS.

Franky wasn’t too surprised that nobody took her complaint seriously. She and most of the other safe house residents have a criminal history. She knows that means she’s easily dismissed.

“We’re just drug addicts, we’re felons, we’re not credible. And she uses that to her advantage,” Franky said of Barthelmess.

‘Be careful’

In December 2023, Franky’s probation was almost finished. Only days were left, and to date her case manager at the safe house reported that Franky had been making “amazing progress.”

When she got out, Franky wanted to open her own safe house. It would help survivors in a way that COBS didn’t, she thought.

But Franky couldn’t hide her frustration. She was paying a small amount in rent to COBS each month, and they wanted to increase it. She grew tired of seeing other residents manipulated and controlled. She would mutter under her breath and flip off security cameras in the house. Finally, during a group session with Barthelmess and the other house residents, Franky shared her frustration.

Afterward, Barthelmess told Franky’s probation officer about it, reporting it as “inappropriate.”

“Barthelmess stated that (Franky) needs to work harder at ‘staying in her lane’ and not involving herself in the matters of other residents in the house,” probation notes say.

In texts, Barthelmess scolded Franky for the “push back” and for “telling everyone how terrible our program is and how I lie.”

Days later, Barthelmess found out that Franky wanted to open her own safe house. COBS reported a probation violation, alleging that Franky had been “defiant” for months, had been bad-mouthing the program and had been texting with a felon.

It meant that on Dec. 26, 14 months since she first entered a COBS safe house, Franky was put back in jail.

A month later, Franky’s probation was reinstated for another two years. She had to start all over in her attempt to rebuild her life.

The Ada County judge who made the final order, Nancy Baskin, admonished Franky, warning that she needed to “really be careful” about “bad-mouthing” the safe house.

Then she added one more unwritten rule of probation. It sounded as if it came from Barthelmess herself.

“You,” Baskin said, “need to not speak badly about the COBS program.”

InvestigateWest is an independent news nonprofit dedicated to investigative journalism in the Pacific Northwest. Reach news and investigations editor Wilson Criscione at wilson@invw.org. Reach investigative reporter Kelsey Turner at kelsey@invw.org.