Healthcare Fraud Detection Market to Grow at 19.09% CAGR, Reaching USD 13.21 billion by 2033, Led by IBM, Optum, and SAS Institute | DataM Intelligence

The global Healthcare Fraud Detection Market reached USD 2.59 billion in 2024 and is projected to reach USD 13.21 billion by 2033, growing at a CAGR of 19.09% during the forecast period 2025-2033, according to DataM Intelligence.

United States: Recent Industry Developments

✅ In October 2025, IBM Corporation launched a new AI-powered fraud detection platform using natural language processing to analyse unstructured clinical notes.
✅ In October 2025, the Centres for Medicare & Medicaid Services (CMS) implemented a real-time claims monitoring system, reducing fraudulent payments by 35%.
✅ In October 2025, Optum Inc. introduced a blockchain-based solution for verifying provider credentials and preventing identity-based fraud schemes.

Europe: Recent Industry Developments

✅ In October 2025, SAS Institute partnered with the European Healthcare Fraud & Corruption Network to deploy predictive analytics across 15 EU member states.
✅ In October 2025, the UK's National Health Service allocated £150 million for AI-driven fraud prevention systems following a 40% increase in fraudulent claims.
✅ In October 2025, McKesson Corporation expanded its European fraud analytics division, focusing on cross-border healthcare fraud detection.

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Market Trends & Drivers

The Healthcare Fraud Detection Market is experiencing exponential growth driven by increasing healthcare expenditure, sophisticated fraud schemes, and regulatory mandates for fraud prevention. Key trends include the integration of artificial intelligence and machine learning, real-time analytics capabilities, and cross-platform data sharing initiatives. The rising complexity of healthcare fraud, growing pressure to reduce healthcare costs, and advancements in predictive analytics technology are significantly accelerating market adoption.

Competitive Landscape

The market features intense competition among technology giants, specialized analytics firms, and healthcare IT companies.

IBM Corporation leads with its Watson Health platform and comprehensive fraud detection solutions.
Optum, Inc. (UnitedHealth Group) dominates in healthcare analytics with real-time claim monitoring systems.
SAS Institute Inc. provides advanced predictive modeling and analytics for fraud prevention.
McKesson Corporation offers specialized solutions for payer and provider fraud detection.
Change Healthcare delivers AI-powered fraud prevention across the revenue cycle management spectrum.
Cotiviti, Inc. specializes in payment integrity and prospective fraud detection solutions.
Conduent, Inc. provides government-focused healthcare fraud detection systems.
DXC Technology Company offers integrated fraud, waste, and abuse detection platforms.
HCL Technologies Limited provides customized fraud detection solutions for healthcare payers.
Wipro Limited delivers analytics-driven fraud prevention with global deployment capabilities.

Segmentation

By Analytics [Descriptive Analytics, Predictive Analytics, Prescriptive Analytics]
By Delivery Mode [Cloud-based, On-premises]
By Application [Insurance Claims Review, Payment Integrity, Others]
By End-User [Private Insurance Payers, Government Agencies, Others]

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Regional Analysis:

⇥ North America (U.S., Canada, Mexico)
⇥ Europe (Germany, U.K., France, Italy, Spain, Netherlands, Rest of Europe)
⇥ Asia-Pacific (Japan, China, India, Australia, South Korea, Rest of Asia Pacific)
⇥ South America (Brazil, Argentina, Chile, Rest of South America)
⇥ Middle East & Africa (Saudi Arabia, U.A.E., South Africa, Rest of Middle East & Africa)

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✅ Competitive Landscape
✅ Technology Roadmap Analysis
✅ Sustainability Impact Analysis
✅ KOL / Stakeholder Insights
✅ Consumer Behavior & Demand Analysis
✅ Import-Export Data Monitoring
✅ Live Market & Pricing Trends

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