Healthcare Fraud Detection Market Forecast: What to Expect by 2029

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What Are The Forecasted Market Size Estimates For The Healthcare Fraud Detection Market Between 2025 And 2029?

The healthcare fraud detection market size has experienced considerable expansion in recent years. It is projected to grow from $3.62 billion in 2024 to $4.66 billion in 2025, at a compound annual growth rate (CAGR) of 28.6%. The historical growth of this market is attributable to a rise in cyberthreats, patient identity verification, intense market competition, the identification of fraudulent claims, and increased awareness and training.

The healthcare fraud detection market size is projected to experience significant growth over the next few years. It is expected to expand to $13.66 billion by 2029, demonstrating a compound annual growth rate (CAGR) of 30.9%. This expansion during the forecast period is attributed to factors such as regulatory changes, increasing digitalization, the growing sophistication of fraud schemes, a heightened focus on insurance fraud, and enhancements in data security. Major trends anticipated in this period include the integration of advanced technology, real-time monitoring capabilities, the adoption of behavioral analytics, the use of blockchain for security, and improved patient identity verification.

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Which Industry Drivers Are Expected To Accelerate The Healthcare Fraud Detection Market From 2025 To 2029?

The increasing occurrence of deceitful activities within the healthcare sector is anticipated to boost the healthcare fraud detection market in the future. In healthcare, fraudulent incidents involve the intentional distortion of patient and insurance details, aimed at securing an unjust or unlawful advantage, or at denying an individual their legitimate entitlements. For example, reports from a UK-based financial body indicated that in 2022, the year saw 207,372 incidents of APP fraud, resulting in total losses of £485.2 million, which marked a 17 percent reduction from 2021. Consequently, the escalation of fraudulent occurrences within the healthcare industry is projected to fuel the expansion of the healthcare fraud detection market.

How Is The Healthcare Fraud Detection Market Classified Into Different Segments?

The healthcare fraud detectionmarket covered in this report is segmented –

1) By Type: Descriptive Analytics; Predictive Analytics; Prescriptive Analytics

2) By Model: On-Premise Delivery; On-Demand Delivery

3) By Component: Services; Software

4) By Application: Insurance Claims Review; Payment Integrity

5) By End User: Healthcare Payers; Government Agencies; Other End-Users

Subsegments:

1) By Descriptive Analytics: Data Mining; Reporting Tools; Historical Data Analysis

2) By Predictive Analytics: Risk Scoring Models; Machine Learning Algorithms; Trend Analysis

3) By Prescriptive Analytics: Decision Support Systems; Optimization Algorithms; Scenario Analysis And Simulations

Which Market Trends Are Creating New Opportunities In The Healthcare Fraud Detection Industry?

A significant trend gaining momentum in the healthcare fraud detection market is the adoption of advanced analytics tools. Major industry players are focusing their efforts on developing innovative technologies to maintain their competitive standing within this market. For instance, in January 2022, Premier, Inc., a US-based healthcare technology company, launched INSights, which is based on PINC AITM technology. INSights serves as a vendor-neutral analytics platform, providing access to risk-adjusted, standardized, and cleaned healthcare data from PINC AITM. The platform is designed to lessen the workload for healthcare providers in terms of data preparation and analytics development, thereby enabling quick improvements in clinical, quality, and financial outcomes.

Who Are The Major Companies Operating In The Healthcare Fraud Detection Market?

Major companies operating in the healthcare fraud detection market are International Business Machines Corporation, Cotiviti Inc., Fair Isaac Corporation, SAS Institute Inc., CGI Inc., DXC Technology Company, RELX Group PLC, EXL Service Holdings Inc., HCL Technologies Limited, UnitedHealth Group Incorporated, Conduent Incorporated, Change Healthcare LLC, OSP Labs LLC, Codoxo Inc., Wipro Limited, Qlarant Inc., Northrop Grumman Corporation, LexisNexis Risk Solutions Group, Healthcare Fraud Shield LLC, Sharecare Inc., FraudLens Inc., HMS Holdings Corp., H2O.ai Inc., Pondera Solutions Inc., FRISS B.V., MultiPlan Corporation, FraudScope Inc., McKesson Corporation, FraudGuard LLC, FraudCracker LLC

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How Is Healthcare Fraud Detection Market Demand Varying Across Different Regions?

North America was the largest region in the healthcare fraud detection market in 2024. The regions covered in the healthcare fraud detection market report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East, Africa.

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