What Has Been The Historical And Current Growth Of The Healthcare Fraud Analytics Market?
The healthcare fraud analytics market has seen considerable growth due to a variety of factors.
• The size of the healthcare fraud analytics market has seen a remarkable growth in the past few years. The market size is projected to increase from $3.73 billion in 2024 to $4.67 billion in 2025, exhibiting a compound annual growth rate (CAGR) of 25.4%.
Factors such as rising healthcare expenses, intricate healthcare systems, growing volume of health-related data, shift to electronic health records (EHRs), and challenges related to billing fraud, have contributed to the surge witnessed in the historic period.
What Is The Forecast For The Healthcare Fraud Analytics Market By 2029?
The healthcare fraud analytics market is expected to maintain its strong growth trajectory in upcoming years.
• The expected expansion of the healthcare fraud analytics market in the imminent years is set to be significant, with predictions indicating a growth to $12.38 billion by 2029, boasting a compound annual growth rate (CAGR) of 27.6%.
This growth throughout the forecast period is likely due to advanced fraud schemes, the incorporation of predictive analytics, changes in regulation, the global pandemic's influence, and improved patient identity verification. Prominent trends to be observed in this period include the integration of cloud-based analytics, accessible user interfaces, the automation of fraud investigations, real-time fraud detection, and behavioral analytics.
What Are The Essential Drivers Behind The Growth Of The Healthcare Fraud Analytics Market?
The healthcare fraud analytics market is witnessing significant growth due to a surge in dishonest practices in the healthcare sector. These fraudulent acts are executed by medical service providers, patients, and third parties with the intention to unlawfully profit from the healthcare system through deceit or misrepresentation. Instances of fraudulence and abuse encompass kickbacks, fraudulent billing, charging for unprovided services, unjustified medical testing, among others. As per the U.S. Department of Health and Human Services (HHS), fraudulent investigations in the healthcare sector led to recuperation of over $1.72 billion in December 2023. Out of this, around $1.2 billion was reinstated to the Medicare Trust Funds. Furthermore, the Department of Justice (DOJ) disclosed that the settlements and verdicts under the False Claims Act went past $2.68 billion in the fiscal year 2023, indicating robust action towards fraudulent activities. These statistics underline the considerable fiscal impact of healthcare fraud, which is believed to drain the nation's coffers by billions every year, with some projections suggesting that losses might reach up to 10% of the annual healthcare spending. As such, the rising incidences of fraud in healthcare are largely augmenting the expansion of the healthcare fraud market.
How Is The Global Healthcare Fraud Analytics Market Divided Into Key Segments?
The healthcare fraud analytics market covered in this report is segmented –
1) By Solution Type: Descriptive Analytics, Predictive Analytics, Prescriptive Analytics
2) By Delivery Model: On-Premise, On-Demand
3) By Application: Insurance Claims Review, Postpayment Review, Prepayment Review, Pharmacy Billing Misuse, Payment Integrity, Other Applications
Subsegments:
1) By Descriptive Analytics: Data Aggregation, Reporting Tools, Visualization Techniques
2) By Predictive Analytics: Risk Assessment Models, Trend analysis, Anomaly Detection
3) By Prescriptive Analytics: Recommendation Engines, Simulation Models, Resource Allocation Tools
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What Trends Are Reshaping The Future Of The Scope Market?
Key participants in the healthcare fraud analytics market are concentrating their efforts on investments to broaden their market presence. The escalating progression of technology in healthcare fraud analytics highlights the increased financial commitment to sophisticated analytical tools and technologies purposed for revealing and averting fraud within the healthcare industry. For example, in August 2024, an innovative AI-driven fraud detection system named Sherlock was rolled out by MediBuddy, a digital healthcare enterprise based in India. This system is designed to tackle healthcare fraud, especially in the area of medical reimbursement claims. By utilizing forefront artificial intelligence (AI) and machine learning (ML) technologies, Sherlock can spot and prevent fraudulent activities in real-time, thereby bolstering the integrity of the healthcare system.
Who Are the Key Players in the Healthcare Fraud Analytics Market?
Major companies operating in the healthcare fraud analytics market include:
• 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
• HCL Technologies Limited
• Qlarant Inc.
• LEXIS-NEXIS Group
• Healthcare Fraud Shield
• 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
• Relx Group PLC
What are the Regional Insights into the Healthcare Fraud Analytics Market?
North America was the largest region in the healthcare fraud analytics market in 2024.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
