Three weeks ago, Blair was notified that he would have to move out of the H.E.L.P. House. He has yet to be told why, though HOPWA regulations state that "at a minimum," residents are entitled to a written statement of the reasons for eviction and an opportunity to present their case, with legal counsel present, for review by an independent party. The regulations also say eviction should occur "only in the most severe cases."

Apparently, Blair's only act of "noncompliance" was his refusal to continue attending the River Oaks Health Alliance's Wellness Program — that, and the two-page letter of complaint he wrote to Mandel, which she had yet to respond to before Blair packed up and moved out on July 5.

"I don't feel like I need any more [therapy]," says Blair. "I made the best of it, but basically I just sat there, talking, from nine to three. One day, they were talking about having us paint the place. I didn't come here to paint JoAnne's place. That's not therapeutic for me."

It wasn't for Steve Berk, either. After the Wellness Program moved from West Clay to 9611 Marlive, Berk says, it took on a "false structure," designed to look good on paper. While the program still proposed to offer a range of therapeutic activity, the reality, he says, was that patients sat in the same hard-backed chairs all day and rarely enjoyed a change of therapists, let alone therapy, more than three times a day.

Jim Hesser, a former resident, says there was "constant mingling" in therapy sessions between the H.E.L.P. House clients, who were mostly receiving substance-abuse counseling, and the more seriously ill residents of the Paraclete Foundation. "There was very little privacy," he says.

A former Methodist minister who took to drinking when his homosexuality forced him to quit the church, Hesser had been sober for a few years when he found himself needing a place to stay. A friend suggested he try the H.E.L.P. House. Mandel, he says, took him in immediately once he told her he was on Medicare.

"I had been there three months or so before I got the first statement, and it was for $14,000," Hesser says. "I was like, 'What? $14,000 for what?' And Medicare was paying $11,000 of that. It was like that for several months and I finally said, 'This is just ridiculous.' But I was in a position where I needed the housing."

Hesser says he left the H.E.L.P. House and moved into a similar arrangement at the nonprofit Milam House because, after he completed the six-week Wellness Program, Mandel tried to make him continue the sessions three times a week.

"She told me I had to keep going to the program," he says. "But, to me, that was just outright, blatant greediness."

Steve Berk has come to the same conclusion, though it pains him to admit it. Berk was a client of Mandel's for about 18 months, he says, minus the four and a half months he spent in jail. Like most therapy patients, he had almost total trust and faith in the therapist. He had no reason to question that commitment to Mandel until May, when he took a closer look at his Medicare statements.

According to those statements, from mid-November through March, Mandel was billing Medicare as much as $560 per day, five days a week. While Berk has been unable to get an accounting of all the time he spent in group and individual sessions, a ROHA employee copied one month's attendance off his chart and gave it to O'Malley, who passed it along to Berk. He was surprised to learn that, over the course of 17 days in January, he attended 89 separate therapy sessions — an average of more than five a day.

Mandel apparently looked for every opportunity to bill for therapy sessions. Therapists say a two-minute chat with a client in the hallway was an excuse to bill for a one-hour session. Mandel required daily progress notes on each patient, which she claimed were for record-keeping purposes. Therapists later discovered she had used the notes to bill insurance companies or Medicare for more sessions.

Mandel also billed for lunch.
"There were hot meals served at Paraclete, right across the street," says Roxanne Kelly-King, a former therapist. "But JoAnne would not allow them to go. Instead, someone at ROHA would drop off some peanut butter sandwiches or cold cuts, or, on a good day, some stew or chicken soup. And these were supposed to be people with a serious illness. All so she could bill for another hour a day."

Indeed, Mandel had a lot to gain by billing for as many sessions as she could. Her therapists were independent subcontractors, earning $25 to $30 for each session. Because they were required to prepare materials and keep post-therapy charts on their own time, their wages were diluted to about $10 or $15 an hour.