Healthcare Fraud Analytic Market is estimated to be US$ 15.8 billion by 2034 with a CAGR of 22.4% during the forecasted period.

Published Date: February 2024

The major factors driving the growth of the market are the rising number of patients opting for health insurance, growing healthcare expenditure, and increasing pressure to rise the operational efficiency and decrease healthcare spending, and surging fraudulent activities in the healthcare sector, worldwide.Healthcare Fraud Analytic Market was valued at US$ 2.1 billion in 2024 and is projected to grow at a CAGR of 22.4% to reach US$ 15.8 billion by 2034.

The report "Healthcare Fraud Analytic Market, By Type (Descriptive Analytics, Predictive Analytics, and Prescriptive Analytics), By Component (Services and Software), By Delivery Model (On-Premise and Cloud-Based), By Application (Insurance Claims Review and Payment Integrity), By End User (Private Insurance Payers, Public/Government Agencies, and Third Party Service Providers),  and By Region (North America, Europe, Asia Pacific, Latin America, and Middle East & Africa) - Trends, Analysis and Forecast till 2034”

Key Highlights:

  • On March 2020, DXC Technology launched an advanced patient-centered care solution, a personalized and customizable-health offering that gives healthcare providers the technology to meet the high expectations of today’s patients — clinician satisfaction and without sacrificing cost containment.

Analyst View:

Rising number of patients opting for health insurance

The healthcare industry has been undergoing a number of cases of frauds, done by physicians, doctors, patients, and other medical specialists. Many healthcare specialists and providers have been detected to be involved in fraudulent activities, for the sake of profit. Healthcare fraud detection solutions play a vital role in the evaluation of insurance claims, as several fraud cases arise while claiming the insurance. According to the data published by National Health Care Anti-Fraud Association (NHCAA), health care fraud costs the U.S. nearly US$ 68 billion, per year. Worldwide, numerous organizations, such as the Canadian Life and Health Insurance Association (CLHIA), Insurance Fraud Bureau of Australia (IFBA), the European Healthcare Fraud & Corruption Network (EHFCN), and NHS Counter Fraud Authority (NHSCFA), among others, aim to decrease healthcare insurance fraud. The presence of such organizations is projected to create more awareness among the users, thus, resulting to high demand for healthcare fraud detection solutions.

Increasing healthcare expenditure

Worldwide, the healthcare expenditure is increasing, particularly in the low- and middle-income countries. According to the study reported by World Health Organization’s in 2016, the growth in healthcare expenditure in these countries was around 6% annually, as compared to 4% in the high-income countries. As per WHO’s article on global healthcare expenditure in 2016, the governments in the low- and middle-income nations spend US$ 60 per person on healthcare, whereas those in the upper-middle-income nations spend US$ 270. Further, in the upper-income countries, healthcare expenditure was seen to be distributed equally, resulting in the overall development of the healthcare system. In contrast, people in the low- and middle-income countries have to pay from their own pockets, because of less contribution from the governments toward healthcare expenditure.

Browse 60 market data tables* and 35 figures* through 140 slides and in-depth TOC on “Healthcare Fraud Analytic Market”, By Type (Descriptive Analytics, Predictive Analytics, and Prescriptive Analytics), By Component (Services and Software), By Delivery Model (On-Premise and Cloud-Based), By Application (Insurance Claims Review and Payment Integrity), By End User (Private Insurance Payers, Public/Government Agencies, and Third Party Service Providers), and By Region (North America, Europe, Asia Pacific, Latin America, and Middle East & Africa) - Trends, Analysis and Forecast till 2034"

Key Market Insights from the report:        

Healthcare Fraud Analytic Market was valued at US$ 2.1 billion in 2024 and is projected to grow at a CAGR of 22.4% to reach US$ 15.8 billion by 2034.The market report has been segmented on the basis of type, component, delivery model, application, end-user, and region.

  • By type, the descriptive analytics segment estimates for highest share of the market in 2019. Descriptive analytics forms the base for the effective application of prescriptive or predictive analytics. Hence, these analytics utilizes the basics of descriptive analytics and integrate them with extra sources of data in order to produce meaningful insights.
  • By component, the target market is segmented into services and software
  • By delivery model, the target market is segmented into on-premise and cloud-based.
  • By application, in 2019, the insurance claims review segment lead the healthcare fraud analytics market. The rising number of fraudulent claims, growing number of patients seeking health insurance, and the growing adoption of the prepayment review model are projected to boost the growth of this segment over the forecast period.
  • By end-user, the public & government agencies segment estimates for the highest share of the healthcare fraud analytics market in 2019.
  • By region, North America is expected to register the highest market share over the forecast period. The dominance of the North American market is basically owing to increasing healthcare fraud, growing number of people opting for health insurance, and also supportive government anti-fraud initiatives.

Competitive Landscape:

The prominent player operating in the global healthcare fraud analytic market includes DXC Technology Company, Optum, EXL Service Holdings, SAS Institute, Wipro Limited, IBM Corporation, Change Healthcare, Cotiviti, Conduent, HCL, LexisNexis Group, and Northrop Grumman Corporation.

The market provides detailed information regarding industrial base, productivity, strengths, manufacturers, and recent trends which will help companies enlarge the businesses and promote financial growth. Furthermore, the report exhibits dynamic factors including segments, sub-segments, regional marketplaces, competition, dominant key players, and market forecasts. In addition, the market includes recent collaborations, mergers, acquisitions, and partnerships along with regulatory framework across different regions impacting the market trajectory. Recent technological advances and innovations influencing the global market are included into the report.

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