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Healthcare Fraud Detection Market Analysis 2024-2033 : Market Size, Top Segments, Leading Region Forecast | International Business Machines Corporation, Cotiviti Inc., Fair Isaac Corporation
Healthcare Fraud Detection Global Market Report 2024
The healthcare fraud detection market size 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%. The growth in the forecast period can be attributed to regulatory changes, increasing digitalization, sophistication of fraud schemes, focus on insurance fraud, data security enhancement. Major trends in the forecast period include advanced technology integration, real-time monitoring, behavioral analytics, blockchain for security, patient identity verification.
Market Overview -
Healthcare fraud detection refers to a group of actions performed to stop someone from obtaining patient data or property under false pretences and involves account auditing and detective investigation. It is used to promote transparency and accountability, risk assessment by identifying data usage, detection, prevention, and management of suspicious fraud, waste, and abuse, and reduce leakage of sensitive information such as patient medical records and other credentials.
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Surging Healthcare Fraud Incidents Fuel Growth In Healthcare Fraud Detection Market
The rise in fraudulent events in the healthcare industry is expected to propel the healthcare fraud detection market going forward. Fraudulent events in healthcare refer to the deliberate misrepresentation of patient data and insurance information in order to obtain an unfair or illegal gain or to deprive a user of a legal right. For instance, in 2021, the Department of Justice (DOJ) opened 831 new criminal health care fraud investigations. Moreover, in 2021, DOJ opned 805 new civil health care fraud investigations. According to data published by the United States Sentencing Commission, a US-based agency that articulates sentencing guidelines, in August 2022, 336 health care fraud offenders were identified in fiscal year 2021, making up 8.0% of total theft, property damage, and fraud charges. Therefore, the rise in fraudulent events in the healthcare industry is expected to drive the growth of the healthcare fraud detection market.
Competitive Landscape -
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, FraudCracker LLC
Innovative Analytics Tools Drive Evolution In Healthcare Fraud Detection Market
Adoption of advanced analytics tools is a key trend gaining popularity in the healthcare fraud detection market. Major players are concentrating their efforts on creating innovative technologies to sustain their position in the healthcare fraud detection market. For instance, in January 2022, Premier, Inc., a US-based healthcare technology company, launched "INSights" based on PINC AITM technology. Insights is a vendor-neutral analytics platform that has access to the risk-adjusted, standardised, and cleaned healthcare data from PINC AITM. Insights is designed for healthcare providers to lower the workload associated with data preparation and analytics development for quick gains in clinical, quality, and financial outcomes.
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Key Segments -
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
Key highlights covered in the report -
1. Detailed market size forecast and historical data analysis
2. Key drivers influencing market growth
3. Identification of upcoming trends and potential opportunities in the market
4. Analysis of major players strategies, to understand competitive dynamics and market positioning
5. Evaluation of regional dynamics
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