Healthcare Fraud Analytics Market – By Solution Type (Descriptive, Prescriptive, Predictive), Deployment Mode (On-premises, Cloud-based), Application (Insurance Claims Review, Pharmacy Billing Issue, Payment Integrity), End-use & Forecast, 2024 – 2032
Report ID: GMI11010
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Published Date: August 2024
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Report Format: PDF
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Premium Report Details
Base Year: 2023
Companies covered: 15
Tables & Figures: 181
Countries covered: 23
Pages: 100
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Healthcare Fraud Analytics Market Size
Healthcare Fraud Analytics Market size was valued at USD 2.3 billion in 2023 and is expected to exhibit growth at a CAGR of 24.1% from 2024 and 2032. High market growth can be attributed to the ongoing advancements in data analytics, rising incidence of healthcare fraud, increased healthcare spending and complexity, and increasing adoption of digital health solutions, among other contributing factors.
Moreover, the growing incidence of healthcare fraud, including fraudulent claims, billing schemes, identity theft, and prescription fraud, is a significant driver for the market. For instance, according to data from the U.S. Sentencing Commission, in 2022, there were 431 healthcare fraud offenders, representing 8.4% of all theft, property destruction, and fraud offenses. This marks a 1.4% increase in healthcare fraud offenders since 2018. Fraudulent activities result in substantial financial losses for healthcare providers, insurers, and governments, creating a strong demand for analytics solutions that can detect and prevent fraud.
Furthermore, as healthcare spending continues to rise, so does the complexity of healthcare systems and transactions. This complexity provides more opportunities for fraudulent activities to occur. Healthcare fraud analytics tools help manage this complexity by analyzing large volumes of data and identifying suspicious patterns or anomalies.
Healthcare fraud analytics refers to the use of data analysis techniques, including statistical methods, machine learning, and artificial intelligence, to detect, prevent, and investigate fraudulent activities in healthcare. This includes identifying patterns, anomalies, and suspicious behavior in claims, billing, and other healthcare-related data to mitigate financial losses and ensure compliance with regulations.
Healthcare Fraud Analytics Market Trends
The market is experiencing several notable trends that are shaping its growth and development. Factors such as continuous innovations in technology, growing demand for integrated artificial intelligence in healthcare and machine learning, increased focus on real-time fraud detection, and expansion of cloud-based fraud analytics solutions, among other factors are propelling the industry growth.
Healthcare Fraud Analytics Market Analysis
Based on solution type, the market is categorized into descriptive analytics, prescriptive analytics, and predictive analytics. The descriptive analytics segment generated the highest revenue of USD 1.2 billion in 2023.
Based on deployment mode, the healthcare fraud analytics market is classified into on-premises and cloud-based. The on-premises segment dominated the market in 2023 with a market share of 58%.
Based on application, the healthcare fraud analytics market is classified into insurance claims review, pharmacy billing issue, payment integrity, and other applications. The insurance claims review segment is further bifurcated into postpayment review and prepayment review. The insurance claims review segment dominated the market and is expected to grow at a pace of 24.2% CAGR between 2024 – 2032.
Based on end-use, the healthcare fraud analytics market is segmented into healthcare providers, insurance companies, government organizations, and other end-users. The healthcare providers segment dominated the market in 2023 and is anticipated to reach USD 6.7 billion by 2032.
North America healthcare fraud analytics market accounted for USD 883.8 million market revenue in 2023 and is anticipated to grow at CAGR of 23.8% between 2024 – 2032 period.
Germany healthcare fraud analytics market is projected to grow remarkably in the coming years.
Japan holds a dominant position in the Asia Pacific healthcare fraud analytics market.
Healthcare Fraud Analytics Market Share
The market is highly competitive, featuring a mix of established players and emerging startups. Major companies like IBM, SAS Institute, and Optum offer comprehensive analytics solutions with advanced AI and machine learning capabilities. New entrants are innovating with specialized tools and niche solutions, enhancing fraud detection and prevention. The market is characterized by rapid technological advancements and evolving regulatory requirements, driving continuous innovation. Companies compete on the basis of technological sophistication, integration capabilities, and compliance with data privacy regulations.
Healthcare Fraud Analytics Market Companies
Prominent players operating in the healthcare fraud analytics industry include:
Healthcare Fraud Analytics Industry News:
The healthcare fraud analytics market research report includes an in-depth coverage of the industry with estimates & forecast in terms of revenue in USD Million from 2021 - 2032 for the following segments:
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Market, By Solution Type
Market, By Deployment Mode
Market, By Application
Market, By End-use
The above information is provided for the following regions and countries: