What Has Been the Growth Trajectory for the Healthcare Fraud Detection Market in Recent Years?
The healthcare fraud detection market has seen considerable growth due to a variety of factors.
• The market size for healthcare fraud detection has significantly expanded in the past few years. It is projected to increase from $3.62 billion in 2024 to $4.67 billion in 2025, translating to a compound annual growth rate (CAGR) of 28.9%. Factors contributing to the growth recorded in the historic period include increased cyber threats, patient identity verification, market competition, identification of fraudulent claims, as well as elevated awareness and training.
What Can Be Expected from the Healthcare Fraud Detection Market Size Evolve over the Forecast Period?
The Healthcare Fraud Detection market is expected to maintain its strong growth trajectory in upcoming years.
• The market size of healthcare fraud detection is anticipated to experience rapid expansion in the forthcoming years. The market is predicted to reach a value of $13.77 billion in 2029, with a compound annual growth rate (CAGR) of 31.1%.
The growth during this forecast period can be linked to several factors including regulatory modifications, increasing use of digital technology, the evolving complexity of fraud schemes, a focus on insurance fraud, and enhancements in data security. Key trends in this forecast period are the incorporation of advanced technology, real-time surveillance, behavioral analysis, the use of blockchain for enhanced security, and the verification of patient identities.
What Are the Critical Driver Fuelling The Healthcare Fraud Detection Market's Growth?
The increase in falsified occurrences within the healthcare sector is predicted to boost the growth of the healthcare fraud detection market in the upcoming years. These fraudulent events in healthcare typically involve the purposeful misrepresentation of patient information and insurance details with the motive to gain unjustly or unlawfully, or to deprive someone of their rightful entitlement. For instance, data from a UK-based financial institution revealed in 2022 that there were 207,372 instances of APP fraud throughout the year, resulting in a staggering loss of £485.2 million, marking a 17 percent decline when compared to the preceding year. Given these circumstances, it is anticipated that the surge in fraudulent healthcare events will stimulate the expansion of the healthcare fraud detection market.
How Is The Healthcare Fraud Detection Market segmented?
The healthcare fraud detection market covered in this report is segmented –
1) By Type: Descriptive Analytics, Predictive Analytics, Prescriptive Analytics
2) By Model: On-Premise Delivery, On-Demand Delivery
3) By Component: Services, Software
4) By Application: Insurance Claims Review, Payment Integrity
5) By End User: Healthcare Payers, Government Agencies, Other End-Users
Subsegments:
1) By Descriptive Analytics: Data Mining, Reporting Tools, Historical Data Analysis
2) By Predictive Analytics: Risk Scoring Models, Machine Learning Algorithms, Trend Analysis
3) By Prescriptive Analytics: Decision Support Systems, Optimization Algorithms, Scenario Analysis And Simulations
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What New Trends Are Influencing The Healthcare Fraud Detection Market?
The increasing use of advanced analysis tools is an emerging trend within the field of healthcare fraud detection. To maintain their market positions, main participants are focusing on the development of groundbreaking technology. For instance, in January 2022, Premier, Inc., a healthcare technology firm from the U.S., introduced INSights using PINC AITM technology. INSights is an unbiased analytical platform with access to clean, standardized, and risk-adjusted data provided by PINC AITM. This platform aims to help healthcare providers by reducing the burden of data preparation and analytics development, and thereby enhance clinical, quality and financial outcomes more rapidly.
Who Are the Key Players In The Healthcare Fraud Detection Market?
Major companies operating in the healthcare fraud detection market include:
• 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
• FraudCracker LLC
What Is The Most Dominant Region In The Healthcare Fraud Detection Market?
North America was the largest region in the healthcare fraud detection market in 2024. The regions covered in the healthcare fraud detection market report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East, Africa.
