Health Care Fraud Analytics Market Size, Share, Growth Analysis, By Application(Insurance claims, payment integrity, pharmacy billing, and others), By Type(Predictive, prescriptive, and descriptive analytics), By Region - Industry Forecast 2024-2031


Report ID: SQMIG35E2032 | Region: Global | Published Date: February, 2024
Pages: 157 |Tables: 64 |Figures: 75

Health Care Fraud Analytics Market Insights

Health Care Fraud Analytics Market size was valued at USD 1.63 billion in 2021 and is poised to grow from USD 2.52 billion in 2023 to USD 11.55 billion by 2030, at a CAGR of 24.3% during the forecast period (2023-2030).

The global healthcare fraud analytics market is experiencing significant growth as healthcare providers and insurance companies increasingly adopt advanced analytics solutions to detect and prevent fraudulent activities.

These solutions leverage data analysis, AI, and machine learning to identify irregular patterns and suspicious claims, thereby mitigating financial losses and enhancing regulatory compliance.

The market's expansion is driven by rising healthcare fraud cases, stringent regulations, and the need for efficient fraud management. It's anticipated that continued technological advancements and collaboration between healthcare and tech sectors will further fuel the market's development.

US Health Care Fraud Analytics Market is poised to grow at a sustainable CAGR for the next forecast year.

Market Snapshot - 2024-2031

Global Market Size

USD 1.63 billion

Largest Segment

Insurance claims

Fastest Growth

Insurance claims

Growth Rate

24.3% CAGR

Global Health Care fraud analytics market by region
Country Share for North America (%)

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Health Care Fraud Analytics Market Segmental Analysis

The global healthcare fraud analytics market is divided into segments based on type, application, and region. By type, it includes predictive, prescriptive, and descriptive analytics. Application segments encompass insurance claims, payment integrity, pharmacy billing, and others. Geographically, the market spans North America, Europe, Asia-Pacific, Latin America, and Middle East & Africa.

Health Care Fraud Analytics Market Analysis by Application

The market segmentation by application in healthcare fraud analytics typically includes areas such as insurance claims review, payment integrity, pharmacy billing, and identity theft. Among these segments, insurance claims review has historically been one of the largest application segments. This is because insurance claims form a significant portion of healthcare transactions and are often targeted by fraudsters seeking to exploit loopholes in the system.

On the other hand, the fastest-growing application segment has been payment integrity. As healthcare payment models become more complex, the potential for fraud increases, necessitating robust analytics solutions to ensure that payments are accurate and transparent.

Health Care Fraud Analytics Market Analysis by Type

The largest segment in the healthcare fraud analytics market is often predictive analytics. This is because predictive models play a crucial role in identifying potential fraud patterns and preventing fraudulent activities before they occur. By using historical data and machine learning algorithms, these models can effectively predict suspicious behavior and patterns that might indicate fraudulent activities, enabling healthcare organizations to take proactive measures.

The fastest-growing segment in the healthcare fraud analytics market could vary depending on technological advancements and the specific needs of the healthcare industry. Historically, predictive and prescriptive analytics have shown significant growth potential due to their ability to provide actionable insights and help healthcare organizations improve fraud detection and prevention strategies.

Global Health Care fraud analytics market by application

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Health Care Fraud Analytics Market Regional Insights

The largest market for healthcare fraud analytics has traditionally been North America, particularly the United States. The region's extensive healthcare system, high healthcare spending, and strict regulatory environment have driven the adoption of advanced fraud detection technologies.

The fastest-growing market could potentially be the Asia-Pacific region. With countries like China and India experiencing significant healthcare industry expansion and digital transformation, there is a growing need for efficient fraud prevention measures. The increasing healthcare expenditures in these countries, combined with the adoption of technology, could contribute to rapid market growth.

Global Health Care fraud analytics market by geography
  • Largest
  • Fastest

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Health Care Fraud Analytics Market Dynamics

Health Care Fraud Analytics Market Drivers

Increasing Need to Monitor Fraud

  • The increasing prevalence of healthcare fraud and the growing adoption of advanced analytics solutions by healthcare providers and payers to detect and prevent fraudulent activities are propelling the global healthcare fraud analytics market.

Health Care Fraud Analytics Market Restraints

High Cost

  • The high implementation costs, the complexity of integrating analytics systems into existing healthcare IT infrastructure, and concerns related to data privacy and security are restraining the growth of the global healthcare fraud analytics market.

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Health Care Fraud Analytics Market Competitive Landscape

The global healthcare fraud analytics market features intense competition among key players striving to enhance healthcare systems' integrity. Established companies like IBM, SAS, and Optum dominate with their advanced analytics solutions, leveraging AI and machine learning to detect and prevent fraudulent activities across medical claims, billing, and patient data. Meanwhile, innovative entrants such as Cotiviti and Pondera offer specialized tools that target evolving fraud schemes. The market's landscape is characterized by continuous technological advancements and collaborations with healthcare providers, as stakeholders increasingly prioritize robust fraud detection to ensure financial security and quality care delivery.

Health Care Fraud Analytics Market Top Player’s Company Profiles

  • IBM Corporation - United States
  • Optum, Inc. (A part of UnitedHealth Group) - United States
  • SAS Institute, Inc. - United States
  • Fair Isaac Corporation (FICO) - United States
  • Conduent, Inc. - United States
  • DXC Technology - United States
  • McKesson Corporation - United States
  • LexisNexis Group - United States
  • Pondera Solutions (Thomson Reuters) - United States
  • Cotiviti Corporation - United States
  • Wipro Limited - India
  • EXL Service Holdings, Inc. - United States
  • HCL Technologies Limited - India
  • McAfee, LLC - United States
  • SAP SE - Germany
  • FICO (Fair Isaac Corporation) - United States
  • BAE Systems Applied Intelligence - United Kingdom
  • SAS Institute Canada - Canada
  • Scio Health Analytics (an EXL Company) - United States
  • NTT Data Corporation - Japan

Health Care Fraud Analytics Market Recent Developments

  • In December 2021, Wipro Limited acquired LeanSwift. This acquisition has expanded the capabilities of Wipro FullStride Cloud Services.

Health Care Fraud Analytics Key Market Trends

  • In the global healthcare fraud analytics market, key developments include advanced AI and machine learning integration for real-time anomaly detection, predictive modeling, and claims analysis, enhancing fraud identification accuracy. Collaborations between technology providers and healthcare organizations are fostering innovative solutions. Regulatory compliance and data security remain focal points, driving the adoption of robust fraud prevention systems. Additionally, the market sees continuous refinement of algorithms, leveraging big data analytics to improve fraud detection and prevention while minimizing false positives, ultimately safeguarding healthcare resources, and ensuring quality patient care.

Health Care Fraud Analytics Market SkyQuest Analysis

SkyQuest’s ABIRAW (Advanced Business Intelligence, Research & Analysis Wing) is our Business Information Product types team that Collects, Collates, Co-relates, and Analyses the Data collected by means of Primary Exploratory Research backed by robust Secondary Desk research.

According to our analysis, the global healthcare fraud analytics market is poised for significant growth due to the escalating need for efficient detection and prevention of fraudulent activities in the healthcare sector. Leveraging advanced technologies like artificial intelligence and data analytics, the market is anticipated to expand as healthcare organizations increasingly prioritize safeguarding their finances and ensuring regulatory compliance. With a growing emphasis on optimizing operational efficiency and minimizing losses, the healthcare fraud analytics market is expected to experience sustained demand, offering innovative solutions to combat evolving fraudulent schemes and ultimately enhancing the overall integrity of healthcare systems worldwide.

Report Metric Details
Market size value in 2023 USD 1.63 billion
Market size value in 2031 USD 11.55 billion
Growth Rate 24.3%
Forecast period 2024-2031
Forecast Unit (Value) USD Billion
Segments covered
  • Application
    • Insurance claims, payment integrity, pharmacy billing, and others
  • Type
    • Predictive, prescriptive, and descriptive analytics
Regions covered North America (US, Canada), Europe (Germany, France, United Kingdom, Italy, Spain, Rest of Europe), Asia Pacific (China, India, Japan, Rest of Asia-Pacific), Latin America (Brazil, Rest of Latin America), Middle East & Africa (South Africa, GCC Countries, Rest of MEA)
Companies covered
  • IBM Corporation - United States
  • Optum, Inc. (A part of UnitedHealth Group) - United States
  • SAS Institute, Inc. - United States
  • Fair Isaac Corporation (FICO) - United States
  • Conduent, Inc. - United States
  • DXC Technology - United States
  • McKesson Corporation - United States
  • LexisNexis Group - United States
  • Pondera Solutions (Thomson Reuters) - United States
  • Cotiviti Corporation - United States
  • Wipro Limited - India
  • EXL Service Holdings, Inc. - United States
  • HCL Technologies Limited - India
  • McAfee, LLC - United States
  • SAP SE - Germany
  • FICO (Fair Isaac Corporation) - United States
  • BAE Systems Applied Intelligence - United Kingdom
  • SAS Institute Canada - Canada
  • Scio Health Analytics (an EXL Company) - United States
  • NTT Data Corporation - Japan
Customization scope

Free report customization with purchase. Customization includes:-

  • Segments by type, application, etc
  • Company profile
  • Market dynamics & outlook
  • Region

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Table Of Content

Executive Summary

Market overview

  • Exhibit: Executive Summary – Chart on Market Overview
  • Exhibit: Executive Summary – Data Table on Market Overview
  • Exhibit: Executive Summary – Chart on Health Care Fraud Analytics Market Characteristics
  • Exhibit: Executive Summary – Chart on Market by Geography
  • Exhibit: Executive Summary – Chart on Market Segmentation
  • Exhibit: Executive Summary – Chart on Incremental Growth
  • Exhibit: Executive Summary – Data Table on Incremental Growth
  • Exhibit: Executive Summary – Chart on Vendor Market Positioning

Parent Market Analysis

Market overview

Market size

  • Market Dynamics
    • Exhibit: Impact analysis of DROC, 2021
      • Drivers
      • Opportunities
      • Restraints
      • Challenges
  • SWOT Analysis

KEY MARKET INSIGHTS

  • Technology Analysis
    • (Exhibit: Data Table: Name of technology and details)
  • Pricing Analysis
    • (Exhibit: Data Table: Name of technology and pricing details)
  • Supply Chain Analysis
    • (Exhibit: Detailed Supply Chain Presentation)
  • Value Chain Analysis
    • (Exhibit: Detailed Value Chain Presentation)
  • Ecosystem Of the Market
    • Exhibit: Parent Market Ecosystem Market Analysis
    • Exhibit: Market Characteristics of Parent Market
  • IP Analysis
    • (Exhibit: Data Table: Name of product/technology, patents filed, inventor/company name, acquiring firm)
  • Trade Analysis
    • (Exhibit: Data Table: Import and Export data details)
  • Startup Analysis
    • (Exhibit: Data Table: Emerging startups details)
  • Raw Material Analysis
    • (Exhibit: Data Table: Mapping of key raw materials)
  • Innovation Matrix
    • (Exhibit: Positioning Matrix: Mapping of new and existing technologies)
  • Pipeline product Analysis
    • (Exhibit: Data Table: Name of companies and pipeline products, regional mapping)
  • Macroeconomic Indicators

COVID IMPACT

  • Introduction
  • Impact On Economy—scenario Assessment
    • Exhibit: Data on GDP - Year-over-year growth 2016-2022 (%)
  • Revised Market Size
    • Exhibit: Data Table on Health Care Fraud Analytics Market size and forecast 2021-2027 ($ million)
  • Impact Of COVID On Key Segments
    • Exhibit: Data Table on Segment Market size and forecast 2021-2027 ($ million)
  • COVID Strategies By Company
    • Exhibit: Analysis on key strategies adopted by companies

MARKET DYNAMICS & OUTLOOK

  • Market Dynamics
    • Exhibit: Impact analysis of DROC, 2021
      • Drivers
      • Opportunities
      • Restraints
      • Challenges
  • Regulatory Landscape
    • Exhibit: Data Table on regulation from different region
  • SWOT Analysis
  • Porters Analysis
    • Competitive rivalry
      • Exhibit: Competitive rivalry Impact of key factors, 2021
    • Threat of substitute products
      • Exhibit: Threat of Substitute Products Impact of key factors, 2021
    • Bargaining power of buyers
      • Exhibit: buyers bargaining power Impact of key factors, 2021
    • Threat of new entrants
      • Exhibit: Threat of new entrants Impact of key factors, 2021
    • Bargaining power of suppliers
      • Exhibit: Threat of suppliers bargaining power Impact of key factors, 2021
  • Skyquest special insights on future disruptions
    • Political Impact
    • Economic impact
    • Social Impact
    • Technical Impact
    • Environmental Impact
    • Legal Impact

Market Size by Region

  • Chart on Market share by geography 2021-2027 (%)
  • Data Table on Market share by geography 2021-2027(%)
  • North America
    • Chart on Market share by country 2021-2027 (%)
    • Data Table on Market share by country 2021-2027(%)
    • USA
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Canada
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
  • Europe
    • Chart on Market share by country 2021-2027 (%)
    • Data Table on Market share by country 2021-2027(%)
    • Germany
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Spain
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • France
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • UK
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Rest of Europe
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
  • Asia Pacific
    • Chart on Market share by country 2021-2027 (%)
    • Data Table on Market share by country 2021-2027(%)
    • China
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • India
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Japan
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • South Korea
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Rest of Asia Pacific
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
  • Latin America
    • Chart on Market share by country 2021-2027 (%)
    • Data Table on Market share by country 2021-2027(%)
    • Brazil
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Rest of South America
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
  • Middle East & Africa (MEA)
    • Chart on Market share by country 2021-2027 (%)
    • Data Table on Market share by country 2021-2027(%)
    • GCC Countries
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • South Africa
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)
    • Rest of MEA
      • Exhibit: Chart on Market share 2021-2027 (%)
      • Exhibit: Market size and forecast 2021-2027 ($ million)

KEY COMPANY PROFILES

  • Competitive Landscape
    • Total number of companies covered
      • Exhibit: companies covered in the report, 2021
    • Top companies market positioning
      • Exhibit: company positioning matrix, 2021
    • Top companies market Share
      • Exhibit: Pie chart analysis on company market share, 2021(%)

Methodology

For the Health Care Fraud Analytics Market, our research methodology involved a mixture of primary and secondary data sources. Key steps involved in the research process are listed below:

1. Information Procurement: This stage involved the procurement of Market data or related information via primary and secondary sources. The various secondary sources used included various company websites, annual reports, trade databases, and paid databases such as Hoover's, Bloomberg Business, Factiva, and Avention. Our team did 45 primary interactions Globally which included several stakeholders such as manufacturers, customers, key opinion leaders, etc. Overall, information procurement was one of the most extensive stages in our research process.

2. Information Analysis: This step involved triangulation of data through bottom-up and top-down approaches to estimate and validate the total size and future estimate of the Health Care Fraud Analytics Market.

3. Report Formulation: The final step entailed the placement of data points in appropriate Market spaces in an attempt to deduce viable conclusions.

4. Validation & Publishing: Validation is the most important step in the process. Validation & re-validation via an intricately designed process helped us finalize data points to be used for final calculations. The final Market estimates and forecasts were then aligned and sent to our panel of industry experts for validation of data. Once the validation was done the report was sent to our Quality Assurance team to ensure adherence to style guides, consistency & design.

Analyst Support

Customization Options

With the given market data, our dedicated team of analysts can offer you the following customization options are available for the Health Care Fraud Analytics Market:

Product Analysis: Product matrix, which offers a detailed comparison of the product portfolio of companies.

Regional Analysis: Further analysis of the Health Care Fraud Analytics Market for additional countries.

Competitive Analysis: Detailed analysis and profiling of additional Market players & comparative analysis of competitive products.

Go to Market Strategy: Find the high-growth channels to invest your marketing efforts and increase your customer base.

Innovation Mapping: Identify racial solutions and innovation, connected to deep ecosystems of innovators, start-ups, academics, and strategic partners.

Category Intelligence: Customized intelligence that is relevant to their supply Markets will enable them to make smarter sourcing decisions and improve their category management.

Public Company Transcript Analysis: To improve the investment performance by generating new alpha and making better-informed decisions.

Social Media Listening: To analyze the conversations and trends happening not just around your brand, but around your industry as a whole, and use those insights to make better Marketing decisions.

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FAQs

Health Care Fraud Analytics Market size was valued at USD 1.63 billion in 2021 and is poised to grow from USD 2.52 billion in 2023 to USD 11.55 billion by 2030, at a CAGR of 24.3% during the forecast period (2023-2030).

The healthcare fraud analytics market features intense competition among key players striving to enhance healthcare systems' integrity. Established companies like IBM, SAS, and Optum dominate with their advanced analytics solutions, leveraging AI and machine learning to detect and prevent fraudulent activities across medical claims, billing, and patient data. Meanwhile, innovative entrants such as Cotiviti and Pondera offer specialized tools that target evolving fraud schemes. The market's landscape is characterized by continuous technological advancements and collaborations with healthcare providers, as stakeholders increasingly prioritize robust fraud detection to ensure financial security and quality care delivery. 'IBM Corporation - United States', 'Optum, Inc. (A part of UnitedHealth Group) - United States', 'SAS Institute, Inc. - United States', 'Fair Isaac Corporation (FICO) - United States', 'Conduent, Inc. - United States', 'DXC Technology - United States', 'McKesson Corporation - United States', 'LexisNexis Group - United States', 'Pondera Solutions (Thomson Reuters) - United States', 'Cotiviti Corporation - United States', 'Wipro Limited - India', 'EXL Service Holdings, Inc. - United States', 'HCL Technologies Limited - India', 'McAfee, LLC - United States', 'SAP SE - Germany', 'FICO (Fair Isaac Corporation) - United States', 'BAE Systems Applied Intelligence - United Kingdom', 'SAS Institute Canada - Canada', 'Scio Health Analytics (an EXL Company) - United States', 'NTT Data Corporation - Japan'

The increasing prevalence of healthcare fraud and the growing adoption of advanced analytics solutions by healthcare providers and payers to detect and prevent fraudulent activities are propelling the healthcare fraud analytics market.

In the healthcare fraud analytics market, key developments include advanced AI and machine learning integration for real-time anomaly detection, predictive modeling, and claims analysis, enhancing fraud identification accuracy. Collaborations between technology providers and healthcare organizations are fostering innovative solutions. Regulatory compliance and data security remain focal points, driving the adoption of robust fraud prevention systems. Additionally, the market sees continuous refinement of algorithms, leveraging big data analytics to improve fraud detection and prevention while minimizing false positives, ultimately safeguarding healthcare resources, and ensuring quality patient care.

The largest market for healthcare fraud analytics has traditionally been North America, particularly the United States. The region's extensive healthcare system, high healthcare spending, and strict regulatory environment have driven the adoption of advanced fraud detection technologies.

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