Overview and Scope
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.
Sizing and Forecast
The healthcare fraud detection market size has grown exponentially in recent years. It will grow from $2.78 billion in 2023 to $3.6 billion in 2024 at a compound annual growth rate (CAGR) of 29.3%. The growth in the historic period can be attributed to increased cyberthreats, patient identity verification, market competition, fraudulent claim identification, increased awareness and training..
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..
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Segmentation & Regional Insights
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
North America was the largest region in the healthcare fraud detection market in 2023. The regions covered in the healthcare fraud detection market report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East, Africa.
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Major Driver Impacting Market Growth
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.
Key Industry Players
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
The healthcare fraud detection market report table of contents includes:
1. Executive Summary
2. Market Characteristics
3. Market Trends And Strategies
4. Impact Of COVID-19
5. Market Size And Growth
6. Segmentation
7. Regional And Country Analysis
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27. Competitive Landscape And Company Profiles
28. Key Mergers And Acquisitions
29. Future Outlook and Potential Analysis
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