Market Analysis

The global healthcare fraud detection market share is projected to reach at CAGR 29.5% during the forecast year 2023-2032. Healthcare fraud takes places when a healthcare provider or an insured person offers misleading or false information to health insurance companies with an intention to have it paid to another party, individual, healthcare provider or policy holder for unauthorized benefits. Health care fraud comprise of medical fraud, drug fraud and health insurance fraud. Some common examples of such fraud include misrepresenting dates, duration, description of services and frequency, submitting claims for services that is not provided, numerous claims filed for same patients by different providers, data falsification by physicians. Healthcare fraud detection will help to prevent healthcare fraud, abuse and waste.

There are many factors that is driving the growth of the healthcare fraud detection market. Some of these factors as per the Market Research Future (MRFR) report include increasing fraudulent activities in the healthcare sector, growing number of patients looking for health insurance, prepayment review model, increasing pressure of abuse, waste and fraud on healthcare spending, high investment returns, and thorough and stringent checks in claims procedure to reduce losses to insurance companies. On the contrary, factors such as requirement for recurrent upgrades made in the fraud detection software, time-consuming deployment and the reluctance to use healthcare fraud analytics especially in the developing economies may impede the healthcare fraud detection market growth.

Key Players

healthcare fraud detection market players include Pondera Solutions, Northrop Grumman, DXC Technology, CGI Group, Scio Health Analytics, International Business Machines Corporation (IBM), LexisNexis, Wipro, Conduent, HCL Technologies, SAS Institute, Fair Isaac, McKesson, Verscend Technologies, Optum and others.  

Market Segmentation

Market Research Future report offers an all-inclusive segmental analysis of the healthcare fraud detection market on the basis of component, end-user, delivery model, application and type.

Based on component, it is segmented into software and services. Of these, services will dominate the market over the estimated years.

Based on end-users, the healthcare fraud detection market outlook is segmented into private insurance payers, employers, government agencies and others.

Based on delivery model, it is segmented into on-premise and on-demand delivery models. Of these, on-demand will dominate the market.

Based on application, the healthcare fraud detection market is segmented into insurance claims review and payment integrity. The insurance claims review is again segmented into post and prepayment review. Of these, insurance claims review will dominate the market.

Based on type, it is segmented into prescriptive analytics, descriptive analytics and predictive analytics. Of these, descriptive analytics will lead the healthcare fraud detection market over the estimated years.

Regional Analysis

Based on region, the healthcare fraud detection market insights covers growth opportunities and latest trends across Americas, Europe, Asia Pacific and Middle East and Africa. Of these, Americas will govern the market over the estimated years owing to increasing fraud cases in healthcare sector, promising government initiatives for preventing fraud in healthcare sector and more and more people requesting for health insurance. This will be followed by Europe that holds the second position owing to rising incidences of corruption and healthcare fraud in the region, developing state to cut down fraud within the healthcare sector and progress of the information technology sector. In the APAC region, the healthcare fraud detection market is predicted in being the fastest developing due to increasing frequency of frauds, evolving IT sector and constantly developing economies. On the other hand, the healthcare fraud detection market in the Middle East and Africa will have the least share. The Middle Eastern region however is anticipated to have a key share owing to the increasing health insurance frauds cases.

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