Healthcare Fraud Detection Market Report by Component (Software, Services), Type (Descriptive Analytics, Predictive Analytics, Prescriptive Analytics), Delivery Mode (On-premises, On-demand), Application (Insurance Claims Review, Payment Integrity), End User (Private Insurance Payers, Government Agencies, and Others), and Region 2024-2032
The global healthcare fraud detection market size reached US$ 2.5 Billion in 2023. Looking forward, IMARC Group expects the market to reach US$ 14.0 Billion by 2032, exhibiting a growth rate (CAGR) of 20.7% during 2024-2032.
Healthcare fraud detection aids in detecting and preventing healthcare fraud, waste, and abuse at every stage of the claim process and reducing inappropriate payments. It connects existing payment integrity solutions and consolidates data from internal and external sources, such as claims systems, watch lists, third parties, and unstructured texts for efficient data management. It relies on various advanced analytic and artificial learning (AI) techniques, including modern statistical, machine learning (ML), deep learning, and text analytics algorithms. Apart from this, it uses a flexible process to assist operational, clinical, and investigative evaluations and store all relevant case information.
Healthcare Fraud Detection Market Trends:
Due to an increase in the number of patients seeking health insurance, there is a rise in the demand for healthcare fraud detection solutions. This, along with the growing prepayment review model in the healthcare industry, represents one of the key factors driving the market. Moreover, the increasing number of pharmacy claims-related frauds across the globe is propelling the growth of the market. In addition, there is a rise in the demand for solutions that have biometric sensors to identify frauds. This, coupled with the growing adoption of healthcare fraud analytics, especially in developing countries, is positively influencing the market. Besides this, the increasing integration of artificial intelligence (AI) in healthcare fraud detection is offering lucrative growth opportunities to industry investors. Apart from this, governments of several countries are undertaking initiatives to review healthcare insurance claims and save money of consumers and nations. In line with this, the burgeoning healthcare industry is bolstering the growth of the market. Other growth-inducing factors are the increasing returns on investment (ROI), rising use of social media, and funding for the implementation of several information and technology (IT) platforms.
Key Market Segmentation:
IMARC Group provides an analysis of the key trends in each sub-segment of the global healthcare fraud detection market report, along with forecasts at the global, regional and country level from 2024-2032. Our report has categorized the market based on component, type, delivery mode, application and end user.
Breakup by Component:
Software
Services
Breakup by Type:
Descriptive Analytics
Predictive Analytics
Prescriptive Analytics
Breakup by Delivery Mode:
On-premises
On-demand
Breakup by Application:
Insurance Claims Review
Payment Integrity
Breakup by End User:
Private Insurance Payers
Government Agencies
Others
Breakup by Region:
North America
United States
Canada
Asia-Pacific
China
Japan
India
South Korea
Australia
Indonesia
Others
Europe
Germany
France
United Kingdom
Italy
Spain
Russia
Others
Latin America
Brazil
Mexico
Others
Middle East and Africa
Competitive Landscape:
The competitive landscape of the industry has also been examined along with the profiles of the key players being CGI Inc., Conduent Inc., ExlService Holdings Inc., Fair Isaac Corporation, HCL Technologies Limited, International Business Machines Corporation, Northrop Grumman Corporation, RELX Group plc, SAS Institute Inc., UnitedHealth Group and Wipro Ltd.
Key Questions Answered in This Report:
How has the global healthcare fraud detection market performed so far and how will it perform in the coming years?
What has been the impact of COVID-19 on the global healthcare fraud detection market?
What are the key regional markets?
What is the breakup of the market based on the component?
What is the breakup of the market based on the type?
What is the breakup of the market based on the delivery mode?
What is the breakup of the market based on the application?
What is the breakup of the market based on the end user?
What are the various stages in the value chain of the industry?
What are the key driving factors and challenges in the industry?
What is the structure of the global healthcare fraud detection market and who are the key players?
What is the degree of competition in the industry?
Healthcare fraud detection aids in detecting and preventing healthcare fraud, waste, and abuse at every stage of the claim process and reducing inappropriate payments. It connects existing payment integrity solutions and consolidates data from internal and external sources, such as claims systems, watch lists, third parties, and unstructured texts for efficient data management. It relies on various advanced analytic and artificial learning (AI) techniques, including modern statistical, machine learning (ML), deep learning, and text analytics algorithms. Apart from this, it uses a flexible process to assist operational, clinical, and investigative evaluations and store all relevant case information.
Healthcare Fraud Detection Market Trends:
Due to an increase in the number of patients seeking health insurance, there is a rise in the demand for healthcare fraud detection solutions. This, along with the growing prepayment review model in the healthcare industry, represents one of the key factors driving the market. Moreover, the increasing number of pharmacy claims-related frauds across the globe is propelling the growth of the market. In addition, there is a rise in the demand for solutions that have biometric sensors to identify frauds. This, coupled with the growing adoption of healthcare fraud analytics, especially in developing countries, is positively influencing the market. Besides this, the increasing integration of artificial intelligence (AI) in healthcare fraud detection is offering lucrative growth opportunities to industry investors. Apart from this, governments of several countries are undertaking initiatives to review healthcare insurance claims and save money of consumers and nations. In line with this, the burgeoning healthcare industry is bolstering the growth of the market. Other growth-inducing factors are the increasing returns on investment (ROI), rising use of social media, and funding for the implementation of several information and technology (IT) platforms.
Key Market Segmentation:
IMARC Group provides an analysis of the key trends in each sub-segment of the global healthcare fraud detection market report, along with forecasts at the global, regional and country level from 2024-2032. Our report has categorized the market based on component, type, delivery mode, application and end user.
Breakup by Component:
Software
Services
Breakup by Type:
Descriptive Analytics
Predictive Analytics
Prescriptive Analytics
Breakup by Delivery Mode:
On-premises
On-demand
Breakup by Application:
Insurance Claims Review
Payment Integrity
Breakup by End User:
Private Insurance Payers
Government Agencies
Others
Breakup by Region:
North America
United States
Canada
Asia-Pacific
China
Japan
India
South Korea
Australia
Indonesia
Others
Europe
Germany
France
United Kingdom
Italy
Spain
Russia
Others
Latin America
Brazil
Mexico
Others
Middle East and Africa
Competitive Landscape:
The competitive landscape of the industry has also been examined along with the profiles of the key players being CGI Inc., Conduent Inc., ExlService Holdings Inc., Fair Isaac Corporation, HCL Technologies Limited, International Business Machines Corporation, Northrop Grumman Corporation, RELX Group plc, SAS Institute Inc., UnitedHealth Group and Wipro Ltd.
Key Questions Answered in This Report:
How has the global healthcare fraud detection market performed so far and how will it perform in the coming years?
What has been the impact of COVID-19 on the global healthcare fraud detection market?
What are the key regional markets?
What is the breakup of the market based on the component?
What is the breakup of the market based on the type?
What is the breakup of the market based on the delivery mode?
What is the breakup of the market based on the application?
What is the breakup of the market based on the end user?
What are the various stages in the value chain of the industry?
What are the key driving factors and challenges in the industry?
What is the structure of the global healthcare fraud detection market and who are the key players?
What is the degree of competition in the industry?
1 PREFACE
2 SCOPE AND METHODOLOGY
2.1 Objectives of the Study
2.2 Stakeholders
2.3 Data Sources
2.3.1 Primary Sources
2.3.2 Secondary Sources
2.4 Market Estimation
2.4.1 Bottom-Up Approach
2.4.2 Top-Down Approach
2.5 Forecasting Methodology
3 EXECUTIVE SUMMARY
4 INTRODUCTION
4.1 Overview
4.2 Key Industry Trends
5 GLOBAL HEALTHCARE FRAUD DETECTION MARKET
5.1 Market Overview
5.2 Market Performance
5.3 Impact of COVID-19
5.4 Market Forecast
6 MARKET BREAKUP BY COMPONENT
6.1 Software
6.1.1 Market Trends
6.1.2 Market Forecast
6.2 Services
6.2.1 Market Trends
6.2.2 Market Forecast
7 MARKET BREAKUP BY TYPE
7.1 Descriptive Analytics
7.1.1 Market Trends
7.1.2 Market Forecast
7.2 Predictive Analytics
7.2.1 Market Trends
7.2.2 Market Forecast
7.3 Prescriptive Analytics
7.3.1 Market Trends
7.3.2 Market Forecast
8 MARKET BREAKUP BY DELIVERY MODE
8.1 On-premises
8.1.1 Market Trends
8.1.2 Market Forecast
8.2 On-demand
8.2.1 Market Trends
8.2.2 Market Forecast
9 MARKET BREAKUP BY APPLICATION
9.1 Insurance Claims Review
9.1.1 Market Trends
9.1.2 Market Forecast
9.2 Payment Integrity
9.2.1 Market Trends
9.2.2 Market Forecast
10 MARKET BREAKUP BY END USER
10.1 Private Insurance Payers
10.1.1 Market Trends
10.1.2 Market Forecast
10.2 Government Agencies
10.2.1 Market Trends
10.2.2 Market Forecast
10.3 Others
10.3.1 Market Trends
10.3.2 Market Forecast
11 MARKET BREAKUP BY REGION
11.1 North America
11.1.1 United States
11.1.1.1 Market Trends
11.1.1.2 Market Forecast
11.1.2 Canada
11.1.2.1 Market Trends
11.1.2.2 Market Forecast
11.2 Asia-Pacific
11.2.1 China
11.2.1.1 Market Trends
11.2.1.2 Market Forecast
11.2.2 Japan
11.2.2.1 Market Trends
11.2.2.2 Market Forecast
11.2.3 India
11.2.3.1 Market Trends
11.2.3.2 Market Forecast
11.2.4 South Korea
11.2.4.1 Market Trends
11.2.4.2 Market Forecast
11.2.5 Australia
11.2.5.1 Market Trends
11.2.5.2 Market Forecast
11.2.6 Indonesia
11.2.6.1 Market Trends
11.2.6.2 Market Forecast
11.2.7 Others
11.2.7.1 Market Trends
11.2.7.2 Market Forecast
11.3 Europe
11.3.1 Germany
11.3.1.1 Market Trends
11.3.1.2 Market Forecast
11.3.2 France
11.3.2.1 Market Trends
11.3.2.2 Market Forecast
11.3.3 United Kingdom
11.3.3.1 Market Trends
11.3.3.2 Market Forecast
11.3.4 Italy
11.3.4.1 Market Trends
11.3.4.2 Market Forecast
11.3.5 Spain
11.3.5.1 Market Trends
11.3.5.2 Market Forecast
11.3.6 Russia
11.3.6.1 Market Trends
11.3.6.2 Market Forecast
11.3.7 Others
11.3.7.1 Market Trends
11.3.7.2 Market Forecast
11.4 Latin America
11.4.1 Brazil
11.4.1.1 Market Trends
11.4.1.2 Market Forecast
11.4.2 Mexico
11.4.2.1 Market Trends
11.4.2.2 Market Forecast
11.4.3 Others
11.4.3.1 Market Trends
11.4.3.2 Market Forecast
11.5 Middle East and Africa
11.5.1 Market Trends
11.5.2 Market Breakup by Country
11.5.3 Market Forecast
12 SWOT ANALYSIS
12.1 Overview
12.2 Strengths
12.3 Weaknesses
12.4 Opportunities
12.5 Threats
13 VALUE CHAIN ANALYSIS
14 PORTERS FIVE FORCES ANALYSIS
14.1 Overview
14.2 Bargaining Power of Buyers
14.3 Bargaining Power of Suppliers
14.4 Degree of Competition
14.5 Threat of New Entrants
14.6 Threat of Substitutes
15 PRICE ANALYSIS
16 COMPETITIVE LANDSCAPE
16.1 Market Structure
16.2 Key Players
16.3 Profiles of Key Players
16.3.1 CGI Inc.
16.3.1.1 Company Overview
16.3.1.2 Product Portfolio
16.3.1.3 Financials
16.3.1.4 SWOT Analysis
16.3.2 Conduent Inc.
16.3.2.1 Company Overview
16.3.2.2 Product Portfolio
16.3.2.3 Financials
16.3.2.4 SWOT Analysis
16.3.3 ExlService Holdings Inc.
16.3.3.1 Company Overview
16.3.3.2 Product Portfolio
16.3.3.3 Financials
16.3.4 Fair Isaac Corporation
16.3.4.1 Company Overview
16.3.4.2 Product Portfolio
16.3.4.3 Financials
16.3.4.4 SWOT Analysis
16.3.5 HCL Technologies Limited
16.3.5.1 Company Overview
16.3.5.2 Product Portfolio
16.3.5.3 Financials
16.3.5.4 SWOT Analysis
16.3.6 International Business Machines Corporation
16.3.6.1 Company Overview
16.3.6.2 Product Portfolio
16.3.6.3 Financials
16.3.7 Northrop Grumman Corporation
16.3.7.1 Company Overview
16.3.7.2 Product Portfolio
16.3.7.3 Financials
16.3.7.4 SWOT Analysis
16.3.8 RELX Group plc
16.3.8.1 Company Overview
16.3.8.2 Product Portfolio
16.3.8.3 Financials
16.3.8.4 SWOT Analysis
16.3.9 SAS Institute Inc.
16.3.9.1 Company Overview
16.3.9.2 Product Portfolio
16.3.9.3 SWOT Analysis
16.3.10 UnitedHealth Group
16.3.10.1 Company Overview
16.3.10.2 Product Portfolio
16.3.10.3 Financials
16.3.10.4 SWOT Analysis
16.3.11 Wipro Ltd.
16.3.11.1 Company Overview
16.3.11.2 Product Portfolio
16.3.11.3 Financials
2 SCOPE AND METHODOLOGY
2.1 Objectives of the Study
2.2 Stakeholders
2.3 Data Sources
2.3.1 Primary Sources
2.3.2 Secondary Sources
2.4 Market Estimation
2.4.1 Bottom-Up Approach
2.4.2 Top-Down Approach
2.5 Forecasting Methodology
3 EXECUTIVE SUMMARY
4 INTRODUCTION
4.1 Overview
4.2 Key Industry Trends
5 GLOBAL HEALTHCARE FRAUD DETECTION MARKET
5.1 Market Overview
5.2 Market Performance
5.3 Impact of COVID-19
5.4 Market Forecast
6 MARKET BREAKUP BY COMPONENT
6.1 Software
6.1.1 Market Trends
6.1.2 Market Forecast
6.2 Services
6.2.1 Market Trends
6.2.2 Market Forecast
7 MARKET BREAKUP BY TYPE
7.1 Descriptive Analytics
7.1.1 Market Trends
7.1.2 Market Forecast
7.2 Predictive Analytics
7.2.1 Market Trends
7.2.2 Market Forecast
7.3 Prescriptive Analytics
7.3.1 Market Trends
7.3.2 Market Forecast
8 MARKET BREAKUP BY DELIVERY MODE
8.1 On-premises
8.1.1 Market Trends
8.1.2 Market Forecast
8.2 On-demand
8.2.1 Market Trends
8.2.2 Market Forecast
9 MARKET BREAKUP BY APPLICATION
9.1 Insurance Claims Review
9.1.1 Market Trends
9.1.2 Market Forecast
9.2 Payment Integrity
9.2.1 Market Trends
9.2.2 Market Forecast
10 MARKET BREAKUP BY END USER
10.1 Private Insurance Payers
10.1.1 Market Trends
10.1.2 Market Forecast
10.2 Government Agencies
10.2.1 Market Trends
10.2.2 Market Forecast
10.3 Others
10.3.1 Market Trends
10.3.2 Market Forecast
11 MARKET BREAKUP BY REGION
11.1 North America
11.1.1 United States
11.1.1.1 Market Trends
11.1.1.2 Market Forecast
11.1.2 Canada
11.1.2.1 Market Trends
11.1.2.2 Market Forecast
11.2 Asia-Pacific
11.2.1 China
11.2.1.1 Market Trends
11.2.1.2 Market Forecast
11.2.2 Japan
11.2.2.1 Market Trends
11.2.2.2 Market Forecast
11.2.3 India
11.2.3.1 Market Trends
11.2.3.2 Market Forecast
11.2.4 South Korea
11.2.4.1 Market Trends
11.2.4.2 Market Forecast
11.2.5 Australia
11.2.5.1 Market Trends
11.2.5.2 Market Forecast
11.2.6 Indonesia
11.2.6.1 Market Trends
11.2.6.2 Market Forecast
11.2.7 Others
11.2.7.1 Market Trends
11.2.7.2 Market Forecast
11.3 Europe
11.3.1 Germany
11.3.1.1 Market Trends
11.3.1.2 Market Forecast
11.3.2 France
11.3.2.1 Market Trends
11.3.2.2 Market Forecast
11.3.3 United Kingdom
11.3.3.1 Market Trends
11.3.3.2 Market Forecast
11.3.4 Italy
11.3.4.1 Market Trends
11.3.4.2 Market Forecast
11.3.5 Spain
11.3.5.1 Market Trends
11.3.5.2 Market Forecast
11.3.6 Russia
11.3.6.1 Market Trends
11.3.6.2 Market Forecast
11.3.7 Others
11.3.7.1 Market Trends
11.3.7.2 Market Forecast
11.4 Latin America
11.4.1 Brazil
11.4.1.1 Market Trends
11.4.1.2 Market Forecast
11.4.2 Mexico
11.4.2.1 Market Trends
11.4.2.2 Market Forecast
11.4.3 Others
11.4.3.1 Market Trends
11.4.3.2 Market Forecast
11.5 Middle East and Africa
11.5.1 Market Trends
11.5.2 Market Breakup by Country
11.5.3 Market Forecast
12 SWOT ANALYSIS
12.1 Overview
12.2 Strengths
12.3 Weaknesses
12.4 Opportunities
12.5 Threats
13 VALUE CHAIN ANALYSIS
14 PORTERS FIVE FORCES ANALYSIS
14.1 Overview
14.2 Bargaining Power of Buyers
14.3 Bargaining Power of Suppliers
14.4 Degree of Competition
14.5 Threat of New Entrants
14.6 Threat of Substitutes
15 PRICE ANALYSIS
16 COMPETITIVE LANDSCAPE
16.1 Market Structure
16.2 Key Players
16.3 Profiles of Key Players
16.3.1 CGI Inc.
16.3.1.1 Company Overview
16.3.1.2 Product Portfolio
16.3.1.3 Financials
16.3.1.4 SWOT Analysis
16.3.2 Conduent Inc.
16.3.2.1 Company Overview
16.3.2.2 Product Portfolio
16.3.2.3 Financials
16.3.2.4 SWOT Analysis
16.3.3 ExlService Holdings Inc.
16.3.3.1 Company Overview
16.3.3.2 Product Portfolio
16.3.3.3 Financials
16.3.4 Fair Isaac Corporation
16.3.4.1 Company Overview
16.3.4.2 Product Portfolio
16.3.4.3 Financials
16.3.4.4 SWOT Analysis
16.3.5 HCL Technologies Limited
16.3.5.1 Company Overview
16.3.5.2 Product Portfolio
16.3.5.3 Financials
16.3.5.4 SWOT Analysis
16.3.6 International Business Machines Corporation
16.3.6.1 Company Overview
16.3.6.2 Product Portfolio
16.3.6.3 Financials
16.3.7 Northrop Grumman Corporation
16.3.7.1 Company Overview
16.3.7.2 Product Portfolio
16.3.7.3 Financials
16.3.7.4 SWOT Analysis
16.3.8 RELX Group plc
16.3.8.1 Company Overview
16.3.8.2 Product Portfolio
16.3.8.3 Financials
16.3.8.4 SWOT Analysis
16.3.9 SAS Institute Inc.
16.3.9.1 Company Overview
16.3.9.2 Product Portfolio
16.3.9.3 SWOT Analysis
16.3.10 UnitedHealth Group
16.3.10.1 Company Overview
16.3.10.2 Product Portfolio
16.3.10.3 Financials
16.3.10.4 SWOT Analysis
16.3.11 Wipro Ltd.
16.3.11.1 Company Overview
16.3.11.2 Product Portfolio
16.3.11.3 Financials
