Healthcare Fraud Analytics Market by Solution Type (Descriptive Analytics, Predictive Analytics, Prescriptive Analytics), Delivery Model (On-Demand, On-Premise), Application, End-User - Global Forecast 2024-2030

Healthcare Fraud Analytics Market by Solution Type (Descriptive Analytics, Predictive Analytics, Prescriptive Analytics), Delivery Model (On-Demand, On-Premise), Application, End-User - Global Forecast 2024-2030

The Healthcare Fraud Analytics Market size was estimated at USD 6.92 billion in 2023 and expected to reach USD 8.18 billion in 2024, at a CAGR 19.61% to reach USD 24.27 billion by 2030.The healthcare sector is facing an unprecedented surge in fraudulent activities with increasing numbers of errors in claim submission forms and repetition of claims. Thus, the healthcare sector widely adopts healthcare fraud analytics to track financial fraud efficiently. The increasing numbers of healthcare frauds and rising concerns regarding health insurance have proliferated the need for healthcare fraud analytics solutions. According to the U.S. Sentencing Commission, in the fiscal year 2021, around 57287 healthcare frauds were reported in the United States. Recently, machine learning and data mining techniques have been used for automatically detecting healthcare frauds by quickly analyzing large amounts of data in real-time to detect suspicious activity faster than manual methods. Moreover, the emergence of Business Process Outsourcing (BPO), and fraud identity management software are expected to create growth opportunities for the healthcare fraud analytics market.Regional InsightsAmericas represents a highly developing and innovative landscape for the global healthcare fraud analytics market characterized by increasing healthcare spending, rising healthcare IT adoption, and the growing number of fraud cases in the healthcare industry. According to the National Healthcare Anti-Fraud Association, payers spend nearly USD 68 billion yearly due to the increasing healthcare fraud in the U.S. According to National Health Care Anti-Fraud Association (NHCAA), the United States spends over USD 2.27 trillion on healthcare every year, and NHCAA estimates that tens of billions of dollars from the total amount are being spent over healthcare fraud. Thus, owing to the availability of numerous advanced services and solutions related to healthcare fraud detection, and strategic steps taken by major players present in the country, it is expected to drive the growth of the studied market in the American region during the projection period. Additionally, in June 2021, Artivatic launched the ALFRED-AI HEALTH CLAIMS platform for automating end-to-end health claims, and its fraud and abuse detection capacity is 30% or more. Thus, owing to the availability of numerous advanced services and solutions related to healthcare fraud detection and strategic steps taken by major players in the country, the market for healthcare fraud detection is expected to bolster within the North American region. Asia Pacific region is witnessing the fastest growth rate, owing to the increasing adoption of technologically advanced solutions and rising government spending on healthcare infrastructure.

FPNV Positioning Matrix

The FPNV Positioning Matrix is pivotal in evaluating the Healthcare Fraud Analytics Market. It offers a comprehensive assessment of vendors, examining key metrics related to Business Strategy and Product Satisfaction. This in-depth analysis empowers users to make well-informed decisions aligned with their requirements. Based on the evaluation, the vendors are then categorized into four distinct quadrants representing varying levels of success: Forefront (F), Pathfinder (P), Niche (N), or Vital (V).

Market Share Analysis

The Market Share Analysis is a comprehensive tool that provides an insightful and in-depth examination of the current state of vendors in the Healthcare Fraud Analytics Market. By meticulously comparing and analyzing vendor contributions in terms of overall revenue, customer base, and other key metrics, we can offer companies a greater understanding of their performance and the challenges they face when competing for market share. Additionally, this analysis provides valuable insights into the competitive nature of the sector, including factors such as accumulation, fragmentation dominance, and amalgamation traits observed over the base year period studied. With this expanded level of detail, vendors can make more informed decisions and devise effective strategies to gain a competitive edge in the market.

Key Company Profiles

The report delves into recent significant developments in the Healthcare Fraud Analytics Market, highlighting leading vendors and their innovative profiles. These include Atos SE, CGI Inc., Change Healthcare Inc., Claroty Ltd., Codoxo, Inc., Conduent, Inc., Coviti, Inc., DXC Technology Company, ExlService Holdings, Inc., Fair Isaac Corporation, Fortified Health Security, FraudLens Inc., FRISS, H2O.ai, Inc., HCL Technologies Ltd., Healthcare fraud Shield, Hewlett Packard Enterprise Development LP, Imperva, Inc., Intel Corporation, International Business Machines Corporation, LexisNexis Risk Solutions Group, Mckesson Corporation, Multuplan Corporaton, Northrop Grumman Corporation, OneSpan Inc., OSP Labs, Pondera Solutions, Qlarant Inc., RELX Group Plc, SAS Institute Inc., Sharecare, Inc., United Health Group Incorporated, and Wipro Limited.

Market Segmentation & Coverage



This research report categorizes the Healthcare Fraud Analytics Market to forecast the revenues and analyze trends in each of the following sub-markets:

Solution Type
Descriptive Analytics
Predictive Analytics
Prescriptive Analytics
Delivery Model
On-Demand
On-Premise
Application
Insurance Claims Review
Post payment Review

Prepayment Review
Payment Integrity
Pharmacy Billing Misuse
End-User
Employers
Private Insurance Payers
Public & Government Agencies
Third-party service providers
Region
Americas
Argentina

Brazil

Canada

Mexico

United States
California

Florida

Illinois

New York

Ohio

Pennsylvania

Texas
Asia-Pacific
Australia

China

India

Indonesia

Japan

Malaysia

Philippines

Singapore

South Korea

Taiwan

Thailand

Vietnam
Europe, Middle East & Africa
Denmark

Egypt

Finland

France

Germany

Israel

Italy

Netherlands

Nigeria

Norway

Poland

Qatar

Russia

Saudi Arabia

South Africa

Spain

Sweden

Switzerland

Turkey

United Arab Emirates

United Kingdom

The report offers valuable insights on the following aspects:

1. Market Penetration: It presents comprehensive information on the market provided by key players.
2. Market Development: It delves deep into lucrative emerging markets and analyzes the penetration across mature market segments.
3. Market Diversification: It provides detailed information on new product launches, untapped geographic regions, recent developments, and investments.
4. Competitive Assessment & Intelligence: It conducts an exhaustive assessment of market shares, strategies, products, certifications, regulatory approvals, patent landscape, and manufacturing capabilities of the leading players.
5. Product Development & Innovation: It offers intelligent insights on future technologies, R&D activities, and breakthrough product developments.

The report addresses key questions such as:

1. What is the market size and forecast of the Healthcare Fraud Analytics Market?
2. Which products, segments, applications, and areas should one consider investing in over the forecast period in the Healthcare Fraud Analytics Market?
3. What are the technology trends and regulatory frameworks in the Healthcare Fraud Analytics Market?
4. What is the market share of the leading vendors in the Healthcare Fraud Analytics Market?
5. Which modes and strategic moves are suitable for entering the Healthcare Fraud Analytics Market?

Note: PDF & Excel + Online Access - 1 Year