Healthcare Fraud Analytics Global Market Report 2024

Healthcare fraud analytics refers to on-premise and on-demand analytical solutions that assist in identifying issues such as duplication/repetition of claims and errors in claim healthcare operations and applications. Healthcare fraud analytics aims to help healthcare companies to audit their accounts and find out fraudulent activities in various transactions. It identifies frauds related to billings, claims, prepayment, post payments, and payment integrity.

The main type of solutions in healthcare fraud analytics are descriptive analytics, predictive analytics, prescriptive analytics. Descriptive analytics is a process of using current and historical data to identify trends and relationships. Healthcare fraud analytic solutions are deployed on-premise and on-demand, and they are widely used for insurance claims review, postpayment review, prepayment review, pharmacy billing misuse, payment integrity, other applications. Healthcare fraud analytics are used by public & government agencies, private insurance payers, third-party service providers.

The healthcare fraud analytics market research report is one of a series of new reports that provides healthcare fraud analytics market statistics, including healthcare fraud analytics industry global market size, regional shares, competitors with a healthcare fraud analytics market share, detailed healthcare fraud analytics market segments, market trends and opportunities, and any further data you may need to thrive in the healthcare fraud analytics industry. This healthcare fraud analytics market research report delivers a complete perspective of everything you need, with an in-depth analysis of the current and future scenarios of the industry.

The healthcare fraud analytics market size has grown exponentially in recent years. It will grow from $3 billion in 2023 to $3.8 billion in 2024 at a compound annual growth rate (CAGR) of 26.6%. The growth in the historic period can be attributed to rise in healthcare costs, complexity of healthcare systems, increasing volume of healthcare data, transition to electronic health records (ehrs), billing fraud challenges.

The healthcare fraud analytics market size is expected to see exponential growth in the next few years. It will grow to $9.66 billion in 2028 at a compound annual growth rate (CAGR) of 26.3%. The growth in the forecast period can be attributed to increasing sophistication of fraud schemes, integration of predictive analytics, regulatory evolution, global pandemic impact, enhanced patient identity verification. Major trends in the forecast period include adoption of cloud-based analytics, user-friendly interfaces, automation in fraud investigations, real-time fraud detection, behavioral analytics.

A large number of fraudulent activities in the healthcare sector contribute to the growth of the healthcare fraud analytics market. Medical providers, patients, and third parties who intentionally deceive the healthcare system into acquiring unlawful benefits can commit fraud based on deception or misrepresentation. These fraud and abuse involve kickbacks, billing, billing for services not provided, medical testing, and other fraudulent activities. For instance, according to Blue Cross Blue Shield Association, a US-based federation, in 2021, The National Heath Care Anti-Fraud Association estimated that health care fraud costs the nation about $68 billion annually, about 3 percent of the nation's $2.26 trillion in health care spending. Other estimates range as high as 10 percent of annual health care expenditure, or $230 billion. Thus, the increasing number of fraudulent activities in healthcare is contributing to the healthcare fraud market growth.

Increased healthcare expenditure is expected to propel the growth of the healthcare fraud analytics market. Healthcare expenditure refers to the total amount of resources, including financial and non-financial, spent on healthcare services and related activities within a specific period of time. Healthcare organizations and payers are investing in advanced fraud analytics solutions to protect their financial resources. For instance, in October 2022, according to the Willis Towers Watson Public Limited Company, a UK-based risk management, insurance brokerage, and advisory company, the healthcare benefit cost increased from 8.2% in 2021 to 8.8% in 2022 and is expected to grow again in 2023 to a high global average of 10%. Therefore, increased healthcare expenditure is driving the growth of the healthcare fraud analytics market.

Major players in the healthcare fraud analytics market are focusing on investments to expand in the market. Rising investments in healthcare fraud analytics denote the increasing allocation of financial resources towards advanced analytical tools and technologies aimed at detecting and preventing fraudulent activities within the healthcare sector. For instance, in January 2021, Healthcare Fraud Shield, a US-based company that provides new and unique Fraud, Waste and Abuse (FWA) automated solutions to the healthcare industry, received a $50 million investment from Charlesbank Technology Opportunities Fund, a fund managed by Charlesbank Capital Partners, a New York-based middle market private investment firm. Through this investment, Healthcare Fraud Shield will be able to quickly create new features and implement the capabilities of its platform, such as the newly released AIShield product and the ground-breaking PreShield product, across insurance policies that cover millions of people.

Major players in the healthcare fraud analytics market are focusing on strategic partnership to protect customers. Strategic partnerships refer to a process in which companies leverage each other's strengths and resources to achieve mutual benefits and success. For instance, in May 2023, Mastercard, a New-York-based credit card company, partnered with HealthLock, a US-based comapny that provides medical fraud and overbilling protection solution. The collaboration between Mastercard and HealthLock will help safeguard consumers from healthcare fraud and billing errors by delivering a no-fee, core HealthLock breach alert and fraud remediation solution. This service will assist clients in detecting and correcting any fraudulent activity or billing problems on their healthcare bills.

In August 2021, Equifax, an Atlanta-based consumer credit reporting agency, acquired Appriss Insights for $1.825 billion. The acquisition broadened Equifax's data and analytics capabilities, allowing it to deliver more complete solutions to its clients. Appriss Insights is a US-based company that provides data and analytics solutions, including healthcare fraud analytics.

Major companies operating in the in the healthcare fraud analytics market report are International Business Machines Corporation, Optum Inc., Statistical Analysis Software Institute Inc., Change Healthcare, EXL Service Holdings Inc., Cotiviti Inc., DXC Technology Company, Wipro Limited, Conduent Incorporated, Consultants to Government and Industry Inc., HCL Technologies Limited, Qlarant Inc., Northrop Grumman Corporation, LEXIS-NEXIS Group, Healthcare Fraud Shield, Sharecare Inc., FraudLens Inc., HMS Holding Corp., Codoxo, H20. ai, Pondera Solutions Inc., Friss International B. V., MultiPlan Inc., FraudScope, Osp Labs Private Limited, Fair Isaac Corporation, Mckesson Corp, Relx Group PLC, FraudHunt, FraudGuardian

North America was the largest region in the healthcare fraud analytics market in 2023. North America is expected to be the fastest-growing region in the forecast period. The regions covered in the healthcare fraud analytics market report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East, Africa

The countries covered in the healthcare fraud analytics market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA, Italy, Canada, Spain.

The healthcare fraud analytics market includes revenues earned by entities by providing services such as fraud detection, predictive analytics, and Medicaid. The market value includes the value of related goods sold by the service provider or included within the service offering. Only goods and services traded between entities or sold to end consumers are included.

The market value is defined as the revenues that enterprises gain from the sale of goods and/or services within the specified market and geography through sales, grants, or donations in terms of the currency (in USD, unless otherwise specified)).

The revenues for a specified geography are consumption values that are revenues generated by organizations in the specified geography within the market, irrespective of where they are produced. It does not include revenues from resales along the supply chain, either further along the supply chain or as part of other products.


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