The Business Research Company’s report on the Healthcare Fraud Analytics Market provides insights into the global market size, growth rate, regional distribution, competitive landscape, key segments, emerging trends, and strategic opportunities.
How have key drivers contributed to the rapid growth of the healthcare fraud analytics market?
A large number of fraudulent activities in the healthcare sector contribute to the growth of the healthcare fraud analytics market. Medical providers, patients, and third parties who intentionally deceive the healthcare system into acquiring unlawful benefits can commit fraud based on deception or misrepresentation. These fraud and abuse involve kickbacks, billing, billing for services not provided, medical testing, and other fraudulent activities. For instance, in December 2023, the U.S. Department of Health and Human Services (HHS) reported that healthcare fraud investigations resulted in recoveries totaling over $1.72 billion. The majority of these recoveries, approximately $1.2 billion, were returned to the Medicare Trust Funds. Additionally, the Department of Justice (DOJ) reported that in fiscal year 2023, settlements and judgments under the False Claims Act exceeded $2.68 billion, indicating a strong enforcement response to fraudulent practices. These figures reflect the significant financial impact of healthcare fraud, which is estimated to cost the nation billions annually, with some estimates suggesting losses could be as high as 10% of annual healthcare expenditure. Thus, the increasing number of fraudulent activities in healthcare is contributing to the healthcare fraud market growth.
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How has the healthcare fraud analytics market size evolved, and what are the latest forecasts for its expansion?
The healthcare fraud analytics market size has grown exponentially in recent years. It will grow from $3.73 billion in 2024 to $4.67 billion in 2025 at a compound annual growth rate (CAGR) of 25.4%. The growth in the historic period can be attributed to rise in healthcare costs, complexity of healthcare systems, increasing volume of healthcare data, transition to electronic health records (EHRs), billing fraud challenges.
The healthcare fraud analytics market size is expected to see exponential growth in the next few years. It will grow to $12.38 billion in 2029 at a compound annual growth rate (CAGR) of 27.6%. The growth in the forecast period can be attributed to increasing sophistication of fraud schemes, integration of predictive analytics, regulatory evolution, global pandemic impact, enhanced patient identity verification. Major trends in the forecast period include adoption of cloud-based analytics, user-friendly interfaces, automation in fraud investigations, real-time fraud detection, behavioral analytics.
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Which major companies dominate 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 trends will shape the future of the healthcare fabrics market?
Major players in the healthcare fraud analytics market are focusing on investments to expand in the market. Rising technological advancements in healthcare fraud analytics denote the increasing allocation of financial resources towards advanced analytical tools and technologies aimed at detecting and preventing fraudulent activities within the healthcare sector. For instance, in August 2024, MediBuddy, an India-based digital healthcare company an innovative AI-powered fraud detection system named Sherlock aimed at combating healthcare fraud, particularly in the realm of medical reimbursement claims. This advanced platform utilizes cutting-edge artificial intelligence (AI) and machine learning (ML) technologies to identify and prevent fraudulent activities in real-time, thereby enhancing the integrity of the healthcare system.
Which region dominates the healthcare fraud analytics market, and what factors contribute to its leadership?
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
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How is the healthcare fraud analytics market segmented, and which segment holds the largest share?
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 defines the structure and scope of the healthcare fraud analytics market?
Healthcare fraud analytics refers to on-premise and on-demand analytical solutions that assist in identifying issues such as duplication/repetition of claims and errors in claim healthcare operations and applications. Healthcare fraud analytics aims to help healthcare companies to audit their accounts and find out fraudulent activities in various transactions. It identifies frauds related to billings, claims, prepayment, post payments, and payment integrity.
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