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- Trends, Analysis and Forecast till 2034

Healthcare Fraud Analytic Market was valued at USD 2.1 Billion in 2024 and is projected to grow at a CAGR of 22.4% to reach USD 15.8 Billion by 2034.

Frauds in healthcare raises the burden on the healthcare industry as the growth in the cost of healthcare directly affect the services and types. Healthcare fraud is an intentional deception or misrepresentation of facts by either patients or healthcare professionals, which can result in illegal payments or benefits.

The healthcare fraud analytics market involves the use of advanced analytical tools and techniques to detect, prevent, and mitigate fraudulent activities within the healthcare industry. Healthcare fraud encompasses various fraudulent practices, such as billing fraud, insurance fraud, prescription drug fraud, and identity theft, which result in financial losses, compromised patient care, and erosion of trust in the healthcare system.

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.

However, the unwillingness of the end users to undertake healthcare fraud analytics systems in emerging regions are expected to hamper the growth of the global healthcare fraud detection market in the coming years.

The healthcare fraud analytic market is segmented based on type, component, delivery model, application, end-user, and region.

On the basis of type, the global healthcare fraud analytic market is segmented into descriptive analytics, predictive analytics, and prescriptive analytics. Based on component, the target market is segmented into services and software. Based on delivery model, the target market is segmented into on-premise and cloud-based. Based on application, the target market is segmented into insurance claims review and payment integrity. Based on end-user, the target market is segmented into private insurance payers, public/government agencies, and third party service providers.

Regional Insights:

On region the global healthcare fraud analytic market is segmented into North America, Europe, Asia Pacific, Latin America, and Middle East & Africa. 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. In addition, technological innovations, the pressure to lower healthcare costs, and the growing availability of service and type in this region is projected to drive the target market growth. Furthermore, the existence of headquarters of many of the leading key players in the healthcare fraud analytics market in North America will boost the global market growth.

Report Scope:

Segments Covered in the Report:

This report forecasts revenue growth at global, regional, and country levels and provides an analysis of the latest industry trends and opportunities in each of the sub-segments from 2024 to 2034. For the purpose of this study, has segmented the Healthcare Fraud Analytic Market report based on type, component, delivery model, application, end-user, and region.

Healthcare Fraud Analytic Market, By Type:

• Descriptive Analytics
• Predictive Analytics
• Prescriptive Analytics

Healthcare Fraud Analytic Market, By Component:

• Services
• Software

Healthcare Fraud Analytic Market, By Delivery model:

• On-Premise
• Cloud-Based

Healthcare Fraud Analytic Market, By Application:

• Insurance Claims Review
• Payment Integrity

Healthcare Fraud Analytic Market, By End-user:

• Private Insurance Payers
• Public/Government Agencies
• Third Party Service Providers

Healthcare Fraud Analytic Market, By Region:

• North America
  • Middle East & Africa
    • • GCC
      • Israel
      • South Africa
      • Rest of Middle East & Africa
  • Latin America
    • • Brazil
      • Mexico
      • Rest of Latin America
  • Asia Pacific
    • • China
      • India
      • Japan
      • South Korea
      • Rest of Asia Pacific
  • Europe
    • • Germany
      • UK
      • France
      • Russia
      • Italy
      • Rest of Europe
  • • U.S.
    • Canada

The key players operating the 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 prominent companies operating in the global healthcare fraud detection market are focusing on expanding their global footprints by undergoing type launches, along with by entering untapped markets.  For instance, in 2019 Optum, Inc. acquired DaVita Medical Group, one of the chief independent medical groups in the U.S.

• DXC Technology Company
• Optum
• EXL Service Holdings
• SAS Institute
• Wipro Limited
• IBM Corporation
• Change Healthcare
• Cotiviti, Conduent
• HCL
• LexisNexis Group
• Northrop Grumman Corporation