a multi-billion dollar sector involving involuntary confinement and healthcare billing operates with minimal federal inquiry.

The Department of Government Efficiency (DOGE), tasked with identifying waste and abuse, has documented procurement issues, defense overruns, and administrative duplication. Yet it has initiated no formal investigations into psychiatric confinement, a sector with soaring federal costs. Facilities routinely bill $1,200-$2,000 nightly per patient (often aligned with Medicare/Medicaid inpatient psychiatric rates under DRGs), frequently detaining individuals involuntarily via holds or guardianship without trial, functioning more as custodial institutions than therapeutic healthcare with limited oversight. This exclusion persists despite the sector's heavy reliance on public funds (Medicare, Medicaid) and documented regulatory gaps enabling for-profit providers minimal accountability. Public awareness of operational risks has grown, reflected in films depicting real patterns: I Care a Lot (guardianship abuse/estate liquidation, documented by ACLU/NCLER), Unsane (involuntary holds limiting recourse, per HHS OCR concerns), Body Brokers (insurance fraud in addiction treatment, cited in OIG reports). These patterns remain largely unexamined federally. DOGE's inaction contrasts sharply with its scrutiny of other high-cost areas like education contractors (GAO-21-345) or telehealth (OIG audits). Psychiatric confinement, despite comparable costs and public funding dependency, avoids equivalent oversight. Whether due to jurisdictional ambiguity, inadequate reporting, or strategic avoidance, a multi-billion dollar sector involving involuntary confinement and healthcare billing operates with minimal federal inquiry. DOGE's core mandate targets systemic inefficiency and abuse-prone areas. Psychiatric confinement demonstrably meets both criteria. Its continued exclusion from oversight warrants urgent examination.