Artificial Intelligence
Healthcare Fraud Detection Market Size Worth USD 18.3 Billion by 2030 at 29.50% CAGR – Report by Market Research Future (MRFR)
New York, USA, May 31, 2023 (GLOBE NEWSWIRE) — Healthcare Fraud Detection Market Overview:
According to a Comprehensive Research Report by Market Research Future (MRFR), “Healthcare Fraud Detection Market Information By Type, Component, Delivery Model, Application, End User And By Region – Market Forecast Till 2030”, the market size was valued at USD 3 billion in 2022 and is projected to grow from USD 3.8 Billion in 2023 to USD 18.3 billion by 2030, exhibiting a compound annual growth rate (CAGR) of 29.50% during the forecast period (2023 – 2030).
Market Scope:
The rising number of fraud cases in the healthcare industry, the growing focus on controlling healthcare costs, and technological advancements introducing advanced analytical techniques are the key market drivers enhancing market growth. The increased geriatric population, the increasing cost of healthcare, and the mounting prevalence of certain fatal diseases, including cancer and coronary heart diseases, are the key market drivers enhancing the market growth. Account audits, medical claim audits, and healthcare fund audits are all used in the identification of healthcare fraud.
The healthcare sector has seen a surge in medical insurance fund, other medical fraud cases, claims, and Medicare fraud. The market for detecting healthcare fraud also aids in reducing waste, fraud, and abuse in the industry. A healthcare practitioner or patient who intentionally misrepresents the truth in order to obtain unauthorized benefits or payments is considered to be committing healthcare fraud. Falsifying physician data, submitting multiple claims from various providers for the same patient, failing to provide the services claimed, and misrepresenting dates, frequency, etc. are a few examples of healthcare fraud.
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Report Scope:
| Report Attribute | Details |
| Market Size in 2030 | USD 18.3 Billion |
| CAGR | 29.50% |
| Base Year | 2022 |
| Forecast Period | 2023-2030 |
| Historical Data | 2021 |
| Forecast Units | Value (USD Billion) |
| Report Coverage | Revenue Forecast, Competitive Landscape, Growth Factors, and Trends |
| Segments Covered | By Type, Component, Delivery Model, Application and End User |
| Geographies Covered | North America, Europe, Asia-Pacific, and Rest of the World (RoW) |
| Key Market Drivers | Increasing number of patients seeking health insurance to boost the market growth |
| Rising use of advanced analytics, machine learning and artificial intelligence |
Healthcare Fraud Detection Market Competitive Outlooks:
Key Companies in the market of Healthcare Fraud Detection include.
- DXC Technology Company
- UnitedHealth Group
- SAS Institute Inc.
- WIPRO LIMITED
- EXLSERVICE Holdings Inc.
- International Business Machines Corporation (IBM)
- COTIVITI INC.
- McKesson Corporation
- CGI INC
- FAIR ISAAC Corporation
- LEXISNEXIS
Healthcare Fraud Detection Market Trends:
Market Drivers
The primary market factors promoting market expansion are the rising number of healthcare fraud cases, the increasing emphasis on containing healthcare expenses, and technology advancements introducing advanced analytical methodologies. Because of the numerous innovative software applications used by the healthcare sector, as well as data mining and artificial intelligence-based technologies, the market for healthcare fraud detection is predicted to grow quickly. Additionally, due to an increase in fraud, the global market share for healthcare fraud detection is growing. Patients receiving Medicare benefits have increased, as have the pressures to commit fraud and abuse in the healthcare industry. Additionally, the usage of numerous new pieces of artificial intelligence and data mining-based software in the healthcare sector is fueling market expansion.
Additionally, the market has benefited from the rising usage of sophisticated analytics, machine learning, and artificial intelligence. Healthcare fraud analytics solutions in developing nations are positioned to restrain the growth of the healthcare fraud detection market. Data breaches in the healthcare sector are increasing, while awareness of them is declining. The main factor boosting market expansion amid medical fraud test market estimates is the rise in fraudulent healthcare activities and the rise in patients seeking treatment through medical insurance. Consequently, the CAGR of the global Healthcare Fraud Detection market has been rising in recent years. These are significant elements fueling the expansion of the Healthcare Fraud Detection market’s revenue.
COVID-19 Analysis:
Healthcare fraud existed before COVID, but the pandemic has brought attention to how crucial it is to spot and report healthcare fraud under the Suspicious Activity Report (SAR) system. Healthcare fraud can have life-or-death repercussions, such as the inability to purchase respirators, the performance of unneeded treatments, or the prescription of inadequate medications. However, government payments related to the pandemic are a common target for fraudsters. The majority of countries around the world provided help to qualified providers of healthcare, services, and support for healthcare-related expenses or lost revenue due to COVID-19. In the healthcare sector, fraudsters continue to target COVID-19 health care relief money paid to healthcare employees, health insurance, and vulnerable residents as well as the U.S. government.
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Healthcare Fraud Detection Market Segmentation:
By Type
Due to its widespread adoption and simplicity of use, the descriptive analytics segment held the majority share in 2022 and contributed to almost 40% of the worldwide Healthcare Fraud Detection market revenue. To find patterns and linkages, it makes use of both recent and historical data. This makes it easier to spot potential fraud. Effectively using prescriptive and predictive analytics can also be based on it. This helps the segment’s growth even more.
By Delivery Model
Due to easier field access to data (hospitals, for example), improved records administration, data monitoring, and other factors, the on-premises category will have the biggest revenue share at over 51% in 2021. Current solutions in small firms are functional, but if the organization manages huge data sets, scaling the data might take time and effort. This could need a substantial financial investment in data security and storage.
Application Insights
In 2021, the insurance claims review market segment will hold a market share of over 35%, thanks to rising health insurance uptake and rising fraudulent claims. Pre-payment review and post-payment review are further separated under this section. Due to the increasing demand from healthcare providers, the advance payment review market is predicted to develop at the quickest CAGR.
End User Insights
In 2021, public/government organizations held more than 41.0% of the market for healthcare fraud analytics. The high patient load in government hospitals and the high susceptibility of government institutions to fraud due to a lack of technologically equipped infrastructure, particularly in developing nations, are significant contributors to this enormous percentage.
Healthcare Fraud Detection Market Regional Analysis:
The Healthcare Fraud Detection market in North America, which is projected to reach USD 1.3 billion in 2022, is anticipated to rise at a substantial CAGR during the study period. With a 45.8% global share, the Americas came out on top. The increased use of technologically sophisticated goods, favorable reimbursement regulations, and rising spending on healthcare analytics services have made the Americas a lucrative industry. The market share in the Region has also increased as a result of numerous well-known international businesses providing a variety of healthcare fraud detection solutions.
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The second-largest market share belongs to the Healthcare Fraud Detection market in Europe. Due to the widespread use of cloud-based analytics solutions, the expanding impact of social media on the healthcare sector, and the growing integration of artificial intelligence in various healthcare solutions and services, Europe is ranked No. 1 in the global market for healthcare fraud detection management systems.
From 2022 to 2030, the Healthcare Fraud Detection Market in Asia-Pacific is anticipated to see the quickest CAGR. With a high CAGR, the Asia-Pacific region will experience profitable expansion. Due to an increase in government anti-fraud measures, lower healthcare costs, technology improvements, and rising consumer demand for more services and product availability, the healthcare fraud detection market is growing in the Asia Pacific region.
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