Healthcare Fraud Detection Global Market Report 2024

The global healthcare fraud detection market has grown exponentially in recent years. It will grow from $2.78 billion in 2023 to $3.6 billion in 2024 at a compound annual growth rate (CAGR) of 29.3%. During the historical period, growth can be credited to the rise in cyber threats, enhanced patient identity verification, intensified market competition, improved detection of fraudulent claims, and heightened awareness and training efforts.

The global healthcare fraud detection market is expected to see exponential growth in the next few years. It will grow to $10.35 billion in 2028 at a compound annual growth rate (CAGR) of 30.2%. During the projected period, growth is expected due to regulatory shifts, heightened digital adoption, more complex fraud tactics, a concentrated effort on combating insurance fraud, and improvements in data security. Key trends anticipated during this period encompass the integration of advanced technology, real-time monitoring capabilities, the use of behavioral analytics, leveraging blockchain for security purposes, and enhancing patient identity verification.

The anticipated surge in fraudulent activities within the healthcare sector is poised to be a driving force behind the healthcare fraud detection market. Fraudulent occurrences in healthcare involve the intentional misrepresentation of patient and insurance data for illicit gains or the deprivation of legal entitlements. In 2021 alone, the Department of Justice (DOJ) initiated 831 new criminal health care fraud investigations and 805 new civil health care fraud investigations. In fiscal year 2021, 336 health care fraud offenders, constituting 8.0% of total theft, property damage, and fraud charges, were identified according to data from the United States Sentencing Commission in August 2022. Consequently, the uptick in fraudulent activities within the healthcare industry is set to fuel growth in the healthcare fraud detection market.

The ongoing digital revolution in healthcare is projected to be a significant driver of growth in the healthcare fraud detection domain. As healthcare operations increasingly transition to digital formats, the amplification in electronic data volume and complexity, coupled with the integration of cutting-edge technologies like artificial intelligence and machine learning, creates an environment conducive to potential fraudulent endeavors. This digital transformation facilitates real-time monitoring, streamlined data exchange, and fortified security measures, empowering fraud detection systems to promptly identify anomalies. Moreover, the adoption of electronic health records, remote healthcare services, and electronic claims processing necessitates robust fraud detection solutions to fortify against unauthorized access and fraudulent practices. For example, in 2021, nearly all non-federal acute care hospitals (96%) and about 78% of office-based physicians in the United States embraced certified EHR systems, as per HealthIT.gov. Consequently, the escalating digital revolution in healthcare propels the expansion of the healthcare fraud detection market.

The adoption of advanced analytics tools emerges as a significant trend gaining traction within the healthcare fraud detection landscape. Key industry players are channeling efforts into crafting innovative technologies to maintain their foothold in the healthcare fraud detection sphere. For instance, in January 2022, Premier, Inc., a US-based healthcare technology company, introduced 'INSights' built upon PINC AITM technology. INSights stand as a vendor-neutral analytics platform harnessing risk-adjusted, standardized, and cleansed healthcare data from PINC AITM. Tailored for healthcare providers, INSights aim to alleviate the burden associated with data preparation and analytics development, enabling rapid improvements in clinical, quality, and financial outcomes.

Leading companies within the healthcare fraud detection arena are innovating new insurance fraud detection solutions to gain a competitive edge. For example, in June 2023, Verisk Analytics, Inc., a US-based analytics company, collaborated with Kyndryl Holdings, Inc. to introduce an advanced technology suite targeting insurance fraud prevention in Israel's compulsory insurance market. Leveraging Kyndryl's robust computing resources and Verisk's domain expertise, this solution fortified the anti-fraud engine for real-time monitoring of auto claims concerning bodily injury. Supported by round-the-clock managed services and advanced analytics, the system verified applicant details against databases and government sources, facilitating comprehensive data investigations for insurance claim adjusters. This collaboration aimed to streamline claims processes, detect potential fraud, and meet evolving consumer expectations in the digitized insurance landscape.

In January 2021, Cedar Gate Technologies, a US-based company specializing in prescriptive analytics and healthcare performance management, successfully acquired Enli Health Intelligence. This strategic acquisition, completed for an undisclosed sum, bolstered Cedar Gate's enterprise value-based care platform by integrating Enli's population, cohort, and patient management technologies. This incorporation aimed to enhance outcomes and long-term financial performance by introducing critical features such as risk and quality measurement, identification of care gaps, and opportunities for patient outreach.

Major companies operating in the healthcare fraud detection market report are International Business Machines Corporation, Cotiviti Inc., Fair Isaac Corporation, SAS Institute Inc., CGI Inc., DXC Technology Company, RELX Group PLC, EXL Service Holdings Inc., HCL Technologies Limited, UnitedHealth Group Incorporated, Conduent Incorporated, Change Healthcare LLC, OSP Labs LLC, Codoxo Inc., Wipro Limited, Qlarant Inc., Northrop Grumman Corporation, LexisNexis Risk Solutions Group, Healthcare Fraud Shield LLC, Sharecare Inc., FraudLens Inc., HMS Holdings Corp., H2O.ai Inc., Pondera Solutions Inc., FRISS B.V., MultiPlan Corporation, FraudScope Inc., McKesson Corporation, FraudGuard LLC, and FraudCracker LLC

North America was the largest region in the healthcare fraud detection market in 2023. The regions covered in the healthcare fraud detection market report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East, Africa. The countries covered in the healthcare fraud detection market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA, Canada, Italy, Spain.

The primary categories of healthcare fraud detection comprise descriptive, predictive, and prescriptive analytics. Descriptive analytics, leveraging historical and current data, unearth patterns and connections to flag suspicious activities. These analytics support the management of medical imaging, clinical data, and outcomes. There are two delivery models such as on-premise and on-demand, utilizing services and software components. These methods find application in insurance claim reviews and payment integrity, serving healthcare payers, government bodies, and other stakeholders.

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

The health fraud detection market includes revenues earned by entities by tracking secondary data, providing technology specialist. 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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