Global Healthcare Fraud Analytic Market Overview
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.
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.
Disclaimer: This data is only a representation. Actual data may vary and will be available in the report.
Global Healthcare Fraud Analytic Market Dynamics
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.
Global Healthcare Fraud Analytic Market Segmentation
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:
Disclaimer: This data is only a representation. Actual data may vary and will be available in the report.
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:
|
Attribute |
Details |
|
Market Size 2024 |
US$ 2.1 billion |
|
Projected Market Size 2034 |
US$ 15.8 billion |
|
CAGR Growth Rate |
22.4% |
|
Base year for estimation |
2023 |
|
Forecast period |
2024 – 2034 |
|
Market representation |
Revenue in USD Billion & CAGR from 2024 to 2034 |
|
Market Segmentation |
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 |
|
Regional scope |
North America - U.S., Canada Europe - UK, Germany, Spain, France, Italy, Russia, Rest of Europe Asia Pacific - Japan, India, China, South Korea, Australia, Rest of Asia-Pacific Latin America - Brazil, Mexico, Argentina, Rest of Latin America Middle East & Africa - South Africa, Saudi Arabia, UAE, Rest of Middle East & Africa |
|
Report coverage |
Revenue forecast, company share, competitive landscape, growth factors, and trends |
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
- Middle East & Africa
Global Healthcare Fraud Analytic Market Key Players
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.
Global Healthcare Fraud Analytic Market Company Profile
- DXC Technology Company
- Company Overview
- Type Portfolio
- Key Highlights
- Financial Performance
- Business Strategies
- Optum
- EXL Service Holdings
- SAS Institute
- Wipro Limited
- IBM Corporation
- Change Healthcare
- Cotiviti, Conduent
- HCL
- LexisNexis Group
- Northrop Grumman Corporation
“*” marked represents similar segmentation in other categories in the respective section
Global Healthcare Fraud Analytic Market Table of Contents
- Research Objective and Assumption
- Preface
- Research Objectives
- Study Scope
- Years Considered for the study
- Assumptions
- Abbreviations
- Research Methodology
- Research data
- Primary Data
- Primary Interviews
- Primary Breakdown
- Key data from Primary Sources
- Key Thickness Insights
- Secondary Data
- Major Secondary Sources
- Secondary Sources
- Market Estimation
- Top-Down Approach
- Approach for estimating Market Share by Top-Down Analysis (Supply Side)
- Bottom-Up Approach
- Approach for estimating market share by Bottom-up Analysis (Demand Side)
- Market Breakdown and Data Triangulation
- Research Assumptions
- Market Purview
- Executive Summary
- Key Findings—Global Outlook for Healthcare Fraud Analytic Strategies
- Key Questions this Study will Answer
- Market Snippet, By Type
- Market Snippet, By Component
- Market Snippet, By Delivery Model
- Market Snippet, By Application
- Market Snippet, By End-user
- Market Snippet, By Region
- Opportunity Map Analysis
- Executive Summary—3 Big Predictions
- Market Dynamics, Regulations, and Trends Analysis
- Market Dynamics
- Drivers
- Restraints
- Market Opportunities
- Market Trends
- DR Impact Analysis
- PEST Analysis
- Porter’s Five Forces Analysis
- Opportunity Orbit
- Market Investment Feasibility Index
- Macroeconomic Factor Analysis
- Market Dynamics
- Global Healthcare Fraud Analytic Market, By Type, 2020 – 2025, (US$ Mn)
- Overview
- Market Value and Forecast (US$ Mn), and Share Analysis (%), 2020 – 2025
- Y-o-Y Growth Analysis (%), 2020 – 2025
- Segment Trends
- Descriptive Analytics
- Overview
- Market Size and Forecast (US$ Mn), and Y-o-Y Growth (%), 2020 – 2025
- Predictive Analytics
- Overview
- Market Size and Forecast (US$ Mn), and Y-o-Y Growth (%), 2020 – 2025
- Prescriptive Analytics
- Overview
- Market Size and Forecast (US$ Mn), and Y-o-Y Growth (%), 2020 – 2025
- Overview
- Global Healthcare Fraud Analytic Market, By Component, 2020 – 2025, (US$ Mn)
- Overview
- Market Value and Forecast (US$ Mn), and Share Analysis (%), 2020 – 2025
- Y-o-Y Growth Analysis (%), 2020 – 2025
- Segment Trends
- Services
- Overview
- Market Size and Forecast (US$ Mn), and Y-o-Y Growth (%), 2020 – 2025
- Software
- Overview
- Market Size and Forecast (US$ Mn), and Y-o-Y Growth (%), 2020 – 2025
- Overview
- Global Healthcare Fraud Analytic Market, By Delivery Model, 2020 – 2025, (US$ Mn)
- Overview
- Market Value and Forecast (US$ Mn), and Share Analysis (%), 2020 – 2025
- Y-o-Y Growth Analysis (%), 2020 – 2025
- Segment Trends
- On-Premise
- Overview
- Market Size and Forecast (US$ Mn), and Y-o-Y Growth (%), 2020 – 2025
- Cloud-Based
- Overview
- Market Size and Forecast (US$ Mn), and Y-o-Y Growth (%), 2020 – 2025
- Overview
- Global Healthcare Fraud Analytic Market, By Application, 2020 – 2025, (US$ Mn)
- Overview
- Market Value and Forecast (US$ Mn), and Share Analysis (%), 2020 – 2025
- Y-o-Y Growth Analysis (%), 2020 – 2025
- Segment Trends
- Insurance Claims Review
- Overview
- Market Size and Forecast (US$ Mn), and Y-o-Y Growth (%), 2020 – 2025
- Payment Integrity
- Overview
- Market Size and Forecast (US$ Mn), and Y-o-Y Growth (%), 2020 – 2025
- Overview
- Global Healthcare Fraud Analytic Market, By End-user, 2020 – 2025, (US$ Mn)
- Overview
- Market Value and Forecast (US$ Mn), and Share Analysis (%), 2020 – 2025
- Y-o-Y Growth Analysis (%), 2020 – 2025
- Segment Trends
- Private Insurance Payers
- Overview
- Market Size and Forecast (US$ Mn), and Y-o-Y Growth (%), 2020 – 2025
- Public/Government Agencies
- Overview
- Market Size and Forecast (US$ Mn), and Y-o-Y Growth (%), 2020 – 2025
- Third Party Service Providers
- Overview
- Market Size and Forecast (US$ Mn), and Y-o-Y Growth (%), 2020 – 2025
- Overview
- Global Healthcare Fraud Analytic Market, By Region, 2020 – 2025, (US$ Mn)
- Overview
- Market Value and Forecast (US$ Mn), and Share Analysis (%), 2020 – 2025
- Y-o-Y Growth Analysis (%), 2020 – 2025
- Regional Trends
- North America
- Market Size and Forecast (US$ Mn), By Type, 2020 – 2025
- Market Size and Forecast (US$ Mn), By Component, 2020 – 2025
- Market Size and Forecast (US$ Mn), By Delivery Model, 2020 – 2025
- Market Size and Forecast (US$ Mn), By Application, 2020 – 2025
- Market Size and Forecast (US$ Mn), By End-user, 2020 – 2025
- Market Size and Forecast (US$ Mn), By Country, 2020 – 2025
- U.S.
- Canada
- Europe
- Market Size and Forecast (US$ Mn), By Type, 2020 – 2025
- Market Size and Forecast (US$ Mn), By Component, 2020 – 2025
- Market Size and Forecast (US$ Mn), By Delivery Model, 2020 – 2025
- Market Size and Forecast (US$ Mn), By Application, 2020 – 2025
- Market Size and Forecast (US$ Mn), By End-user, 2020 – 2025
- Market Size and Forecast (US$ Mn), By Country, 2020 – 2025
- Germany
- UK
- France
- Russia
- Italy
- Rest of Europe
- Asia Pacific
- Market Size and Forecast (US$ Mn), By Type, 2020 – 2025
- Market Size and Forecast (US$ Mn), By Component, 2020 – 2025
- Market Size and Forecast (US$ Mn), By Delivery Model, 2020 – 2025
- Market Size and Forecast (US$ Mn), By Application, 2020 – 2025
- Market Size and Forecast (US$ Mn), By End-user, 2020 – 2025
- Market Size and Forecast (US$ Mn), By Country, 2020 – 2025
- China
- India
- Japan
- South Korea
- Rest of Asia Pacific
- Latin America
- Market Size and Forecast (US$ Mn), By Type, 2020 – 2025
- Market Size and Forecast (US$ Mn), By Component, 2020 – 2025
- Market Size and Forecast (US$ Mn), By Delivery Model, 2020 – 2025
- Market Size and Forecast (US$ Mn), By Application, 2020 – 2025
- Market Size and Forecast (US$ Mn), By End-user, 2020 – 2025
- Market Size and Forecast (US$ Mn), By Country, 2020 – 2025
- Brazil
- Mexico
- Rest of Latin America
- Middle East & Africa
- Market Size and Forecast (US$ Mn), By Type, 2020 – 2025
- Market Size and Forecast (US$ Mn), By Component, 2020 – 2025
- Market Size and Forecast (US$ Mn), By Delivery Model, 2020 – 2025
- Market Size and Forecast (US$ Mn), By Application, 2020 – 2025
- Market Size and Forecast (US$ Mn), By End-user, 2020 – 2025
- Market Size and Forecast (US$ Mn), By Country, 2020 – 2025
- GCC
- Israel
- South Africa
- Rest of Middle East
- Overview
- Competitive Landscape
- Heat Map Analysis
- Market Presence and Specificity Analysis
- Company Profiles
-
- includes DXC Technology Company
- Company Overview
- Type Portfolio
- Key Highlights
- Financial Overview
- Business Strategies
- Optum
- EXL Service Holdings
- SAS Institute
- Wipro Limited
- IBM Corporation
- Change Healthcare
- Cotiviti, Conduent
- HCL
- LexisNexis Group
- Northrop Grumman Corporation
- includes DXC Technology Company
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- The Last Word
- Future Impact
- About Us
- Contact