The global healthcare fraud detection market size reached US$ 2.5 Billion in 2023. Looking forward, the publisher expects the market to reach US$ 14.0 Billion by 2032, exhibiting a growth rate (CAGR) of 21.1% during 2023-2032.
Healthcare fraud detection aids in detecting and preventing healthcare fraud, waste, and abuse at every stage of the claim process and reducing inappropriate payments. It connects existing payment integrity solutions and consolidates data from internal and external sources, such as claims systems, watch lists, third parties, and unstructured texts for efficient data management. It relies on various advanced analytic and artificial learning (AI) techniques, including modern statistical, machine learning (ML), deep learning, and text analytics algorithms. Apart from this, it uses a flexible process to assist operational, clinical, and investigative evaluations and store all relevant case information.
Services
Predictive Analytics
Prescriptive Analytics
On-demand
Payment Integrity
Government Agencies
Others
United States
Canada
Asia-Pacific
China
Japan
India
South Korea
Australia
Indonesia
Others
Europe
Germany
France
United Kingdom
Italy
Spain
Russia
Others
Latin America
Brazil
Mexico
Others
Middle East and Africa
What has been the impact of COVID-19 on the global healthcare fraud detection market?
What are the key regional markets?
What is the breakup of the market based on the component?
What is the breakup of the market based on the type?
What is the breakup of the market based on the delivery mode?
What is the breakup of the market based on the application?
What is the breakup of the market based on the end user?
What are the various stages in the value chain of the industry?
What are the key driving factors and challenges in the industry?
What is the structure of the global healthcare fraud detection market and who are the key players?
What is the degree of competition in the industry?
Healthcare fraud detection aids in detecting and preventing healthcare fraud, waste, and abuse at every stage of the claim process and reducing inappropriate payments. It connects existing payment integrity solutions and consolidates data from internal and external sources, such as claims systems, watch lists, third parties, and unstructured texts for efficient data management. It relies on various advanced analytic and artificial learning (AI) techniques, including modern statistical, machine learning (ML), deep learning, and text analytics algorithms. Apart from this, it uses a flexible process to assist operational, clinical, and investigative evaluations and store all relevant case information.
Healthcare Fraud Detection Market Trends:
Due to an increase in the number of patients seeking health insurance, there is a rise in the demand for healthcare fraud detection solutions. This, along with the growing prepayment review model in the healthcare industry, represents one of the key factors driving the market. Moreover, the increasing number of pharmacy claims-related frauds across the globe is propelling the growth of the market. In addition, there is a rise in the demand for solutions that have biometric sensors to identify frauds. This, coupled with the growing adoption of healthcare fraud analytics, especially in developing countries, is positively influencing the market. Besides this, the increasing integration of artificial intelligence (AI) in healthcare fraud detection is offering lucrative growth opportunities to industry investors. Apart from this, governments of several countries are undertaking initiatives to review healthcare insurance claims and save money of consumers and nations. In line with this, the burgeoning healthcare industry is bolstering the growth of the market. Other growth-inducing factors are the increasing returns on investment (ROI), rising use of social media, and funding for the implementation of several information and technology (IT) platforms.Key Market Segmentation:
The report provides an analysis of the key trends in each sub-segment of the global healthcare fraud detection market report, along with forecasts at the global, regional and country level from 2024-2032. Our report has categorized the market based on component, type, delivery mode, application and end user.Breakup by Component:
SoftwareServices
Breakup by Type:
Descriptive AnalyticsPredictive Analytics
Prescriptive Analytics
Breakup by Delivery Mode:
On-premisesOn-demand
Breakup by Application:
Insurance Claims ReviewPayment Integrity
Breakup by End User:
Private Insurance PayersGovernment Agencies
Others
Breakup by Region:
North AmericaUnited States
Canada
Asia-Pacific
China
Japan
India
South Korea
Australia
Indonesia
Others
Europe
Germany
France
United Kingdom
Italy
Spain
Russia
Others
Latin America
Brazil
Mexico
Others
Middle East and Africa
Competitive Landscape:
The competitive landscape of the industry has also been examined along with the profiles of the key players being CGI Inc., Conduent Inc., ExlService Holdings Inc., Fair Isaac Corporation, HCL Technologies Limited, International Business Machines Corporation, Northrop Grumman Corporation, RELX Group plc, SAS Institute Inc., UnitedHealth Group and Wipro Ltd.Key Questions Answered in This Report:
How has the global healthcare fraud detection market performed so far and how will it perform in the coming years?What has been the impact of COVID-19 on the global healthcare fraud detection market?
What are the key regional markets?
What is the breakup of the market based on the component?
What is the breakup of the market based on the type?
What is the breakup of the market based on the delivery mode?
What is the breakup of the market based on the application?
What is the breakup of the market based on the end user?
What are the various stages in the value chain of the industry?
What are the key driving factors and challenges in the industry?
What is the structure of the global healthcare fraud detection market and who are the key players?
What is the degree of competition in the industry?
Table of Contents
1 Preface3 Executive Summary13 Value Chain Analysis15 Price Analysis
2 Scope and Methodology
4 Introduction
5 Global Healthcare Fraud Detection Market
6 Market Breakup by Component
7 Market Breakup by Type
8 Market Breakup by Delivery Mode
9 Market Breakup by Application
10 Market Breakup by End User
11 Market Breakup by Region
12 SWOT Analysis
14 Porters Five Forces Analysis
16 Competitive Landscape
List of Figures
List of Tables
Companies Mentioned
- CGI Inc.
- Conduent Inc.
- ExlService Holdings Inc.
- Fair Isaac Corporation
- HCL Technologies Limited
- International Business Machines Corporation
- Northrop Grumman Corporation
- RELX Group plc
- SAS Institute Inc.
- UnitedHealth Group
- Wipro Ltd.
Methodology
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Table Information
| Report Attribute | Details |
|---|---|
| No. of Pages | 143 |
| Published | July 2024 |
| Forecast Period | 2023 - 2032 |
| Estimated Market Value ( USD | $ 2.5 Billion |
| Forecasted Market Value ( USD | $ 14 Billion |
| Compound Annual Growth Rate | 21.1% |
| Regions Covered | Global |
| No. of Companies Mentioned | 11 |
