United States Healthcare Fraud Detection Market By Type (Descriptive Analytics, Predictive Analytics, and Prescriptive Analytics), By Application (Review of insurance claims, and Payment Integrity), and By End User (Private Insurance payers, Government Agencies, and Other End Users) - Trends, Analysis and Forecast till 2034

United States Healthcare Fraud Detection Market was valued at USD 0.8 Billion in 2024 and is projected to grow at a CAGR of 22.9% to reach USD 5.2 Billion by 2034.

Healthcare fraud detection involves account auditing and detective investigation. Careful account auditing can reveal suspicious providers and policy holders. Ideally, it is best to audit all claims one-by-one carefully. However, auditing all claims is not feasible by any practical means. Furthermore, it's very difficult to audit providers without concrete smoking clues. A practical approach is to develop short lists for scrutiny and perform auditing on providers and patients in the short lists. Various analytic techniques can be employed in developing audit short lists. Keep in mind that excessive fraudulent claims lead deviations in aggregate claims statistics. In addition, fraudulent claims often develop into patterns that can be detected using predictive models.

Increase demand of healthcare fraud detection

Such cases of frauds in health insurance are causing damages to the medical history of people. Few years back, it was difficult for the healthcare providers to identify the fraud, as criminals were using all types of patient identifications and insurance information. Due to such frauds, patients are compelled to pay higher premiums. Therefore, the US healthcare department is currently more focused toward the reduction of such cases by implementing the fraud detection technology. Therefore, it is believed that due to the rising fraudulent activities in the US healthcare department, the market studied may grow in the future.

Reason Behind rising adoption of healthcare fraud detection

Another key factor for increase growth of market are increase awareness among people associated with its benefits is augmented the growth of market as people are more focused in adopting policy insurance, and meanwhile are also easily get attract more towards bucket of benefits. Thereby the probability of caught into their frame trapped are more. Also, criminals are already looking forward to profit from the people across the country. As most of the people in the country are having health insurance, free medical treatments or complementary consultation offers are being stolen.

The United States healthcare fraud detection market is segmented based on type, application, and end user.

Based on type, the United States healthcare fraud detection market is segmented into descriptive analytics, predictive analytics, and prescriptive analytics. Based on application, the target market is segmented into review of insurance claims, and payment integrity. Based on end user, the target market is segmented into private insurance payers, government agencies, and other end users.

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 2019 to 2029. For the purpose of this study, has segmented the global United States healthcare fraud detection market report based on type, application, and end user:

United States Healthcare Fraud Detection Market, By Type:

• Descriptive Analytics
• Predictive Analytics
• Prescriptive Analytics

United States Healthcare Fraud Detection Market, By Application:

• Review of insurance claims
• Payment Integrity

United States Healthcare Fraud Detection Market, By End User:

• Private Insurance Payers
• Government Agencies
• Other End Users

The key players operating the United States Healthcare Fraud Detection market includes Conduent Inc., DXC Technology Company, EXL (Scio Health Analytics), International Business Machines Corporation (IBM), and Mckesson, among others. Prominent players operating in the target market are focusing on the strategic partnerships as well as launching of the products in order to gain competitive edge in the target market. For instance, in January 2020, DXC Technology Named a Leader for Healthcare IT Security Services in Everest Group PEAK Matrix Assessment 2020.

• Conduent Inc.
• DXC Technology Company
• EXL (Scio Health Analytics)
• International Business Machines Corporation (IBM)
• Mckesson Corporation