Healthcare Fraud Detection Market By Type (Descriptive Analytics, Predictive Analytics, Prescriptive Analysis), By Component (Services, Software), By Application (Insurance Claims Review, Payment Integrity), By End User (Healthcare Payer, Government Agencies, Others): Global Opportunity Analysis and Industry Forecast, 2021-2031
The global healthcare fraud detection Market was valued at $1,098.2 million in 2021, and is projected to reach $3,600.0 million by 2031, registering a CAGR of 12.6% from 2022 to 2031.
The goal of fraud detection is to stop someone from obtaining money or other items through deceptive means. Various industries, including medical and healthcare, use fraud detection techniques. healthcare fraud detection involves account audits and detective work. A thorough account audit might discover suspect policy holders and suppliers. It is ideal to carefully audit each and every claim one at a time. However, there are no realistic way to audit all claims. Fraud detection management is done by the techniques such as to look through millions of transactions, classify, organize, and segment data in order to locate patterns and identify fraud, data mining, estimation of the connections between independent and dependent variables. Data matching is a technique used to compare two collections of data, remove out duplicates, and establish connections between data.
Healthcare fraud, waste, and abuse are actually prevented by the healthcare fraud detection industry. Healthcare fraud is the deliberate distortion of facts by patients or healthcare personnel that results in unlawful payments or benefits. Examples of healthcare fraud include the filing of numerous claims by different providers for the same patients, the falsification of data by doctors, the submission of claims for services that have not been rendered, and the misrepresentation of dates for various treatments, frequency, duration, or service descriptions. The various activities involving fraud in medical industries has increased. Furthermore, the increased fraud cases, abuse of medical products and equipment and misuse of healthcare funds is projected to drive the market growth.
The major factor that drives the market growth of healthcare fraud detection in healthcare market is increase in number of patients seeking health insurance. The other factors such as increase in fraudulent cases, and misuse of funds offered by healthcare boost the growth of the healthcare fraud detection market. A small number of auditors must manually evaluate and pinpoint the dubious medical insurance claims to manually discover healthcare fraud.
However, more effective and automated methods of detecting healthcare frauds have been developed because to recent breakthroughs in machine learning and data mining techniques. In recent years, there has been an increase in interest in mining healthcare data for fraud detection also boosting the global healthcare fraud detection market. The breakthrough advances in machine learning and artificial intelligence, increased in data security concern in healthcare industry restraining the global healthcare fraud detection market.
The healthcare fraud detection market segmented on the basis of type, component, application, end user and region. By type, the market is segmented into descriptive analytics, predictive analytics and prescriptive analysis. By component the market is fragmented into service and software. By application the market divided into insurance claims review and payment integrity.
By end user, the market is segmented into healthcare payer, government agencies and others. The healthcare payer further segmented into public payer and private payer. The others segment includes employers, healthcare providers and third-party service providers. Region wise, the market is analyzed across North America, Europe, Asia-Pacific, and LAMEA.
Major key players that operate in the global healthcare fraud detection market are International Business Machines Corporation (IBM), Optum, Verscend Technologies, McKesson Corporation, FAIR ISAAC Corporation, SAS Institute Inc., HCL Technologies, Wipro Limited, Conduent, CGI Group, DXC Technology Company, UnitedHealth Group, Exlservice Holdings Inc., Scio inspire Corp, LexisNexis, OSP Labs, Northrop Grumman.
Key Benefits For Stakeholders
This report provides a quantitative analysis of the market segments, current trends, estimations, and dynamics of the healthcare fraud detectionmarket analysis from 2021 to 2031 to identify the prevailing healthcare fraud detection market opportunities.
The market research is offered along with information related to key drivers, restraints, and opportunities.
Porter's five forces analysis highlights the potency of buyers and suppliers to enable stakeholders make profit-oriented business decisions and strengthen their supplier-buyer network.
In-depth analysis of the healthcare fraud detection market segmentation assists to determine the prevailing market opportunities.
Major countries in each region are mapped according to their revenue contribution to the global market.
Market player positioning facilitates benchmarking and provides a clear understanding of the present position of the market players.
The report includes the analysis of the regional as well as global healthcare fraud detection market trends, key players, market segments, application areas, and market growth strategies.
Key Market Segments
Insurance Claims Review
By End User
Rest of Europe
Rest of Asia-Pacific
Rest of LAMEA
Key Market Players
International Business Machines Corporation (IBM)
FAIR ISAAC Corporation
SAS Institute Inc.
DXC Technology Company
UnitedHealth Group, Inc.
Exlservice Holdings Inc.
Northrop Grumman Corp
Please Note: It will take 7-10 business days to complete the report upon order confirmation.
Learn how to effectively navigate the market research process to help guide your organization on the journey to success.Download eBook