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What CAGR is Anticipated for the Healthcare Fraud Detection Market During the Forecast Period, and Why?

In recent times, the size of the healthcare fraud detection market has witnessed a remarkable expansion. It is forecasted to escalate from $3.62 billion in 2024, culminating in $4.67 billion in 2025, maintaining a compound annual growth rate (CAGR) of 28.9%. The reasons behind the substantial growth throughout this historic era include mounting cyberthreats, enhanced patient identity verification, intensified market competition, better detection of fraudulent claims, as well as an upsurge in awareness and training.

In the upcoming years, significant expansion is forecasted for the healthcare fraud detection marketplace, and it is projected to reach $13.77 billion by 2029, with a CAGR of 31.1%. Several reasons behind this growth during the prediction period include regulatory transformations, the rise in digitalization, advances in fraud schemes, emphasis on insurance fraud, and the improvement of data security. Key trends during this period of expansion are the incorporation of cutting-edge technology, instantaneous monitoring, behavioral analysis, usage of blockchain for security, and verification of patient identities.

What Drivers Are Shaping the Growth of the healthcare fraud detection Market?

The growth of the healthcare fraud detection market is anticipated to be driven by an increase in fraudulent activities in the healthcare sector. These unlawful occurrences involve the intentional distortion of patient records and insurance details to secure illicit or undue advantage, or to rob a person of a rightful entitlement. For example, from a report released by a UK-centric financial conglomerate in 2022, it revealed 207,372 cases of APP fraud in the same year, with an aggregate loss amounting to £485.2 million, a 17 percent decrease from 2021. Consequently, the ascending trend in health-related fraud cases is predicted to fuel the expansion of the healthcare fraud detection market.

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Which Companies Are Poised to Shape the Future of the Healthcare Fraud Detection Market?

Major companies operating in the healthcare fraud detection market are:

• International Business Machines Corporation_x000D_

• Cotiviti Inc._x000D_

• Fair Isaac Corporation_x000D_

• SAS Institute Inc._x000D_

• CGI Inc._x000D_

What Are the Latest Innovations and Trends Influencing the Healthcare Fraud Detection Market?

The emergence of sophisticated analytic tools represents a prominent trend in the healthcare fraud detection market. Leading companies are focusing their energy on the development of groundbreaking technologies to maintain their market dominance. For instance, in January 2022, Premier, Inc., a healthcare tech firm based in the US, rolled out INSights utilizing PINC AITM technology. INSights is a vendor-agnostic analytic platform that is granted entry to risk-adjusted, standardized, and cleansed healthcare data from PINC AITM. It aims to assist healthcare providers in reducing the effort required in data preparation and analytics creation for rapid improvements in clinical, quality, and financial results.

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What Are the Strategic Segments Comprising the Healthcare Fraud Detection Market and Their Growth Contributions?

The healthcare fraud detection market 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

What Regions Are Contributing Significantly to the Growth of the Healthcare Fraud Detection Market?

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.

What Key Elements Shape the Definition of the Healthcare Fraud Detection Market?

Healthcare fraud detection refers to a group of actions performed to stop someone from obtaining patient data or property under false pretenses and involves account auditing and detective investigation. It is used to promote transparency and accountability, risk assessment by identifying data usage, detection, prevention, and management of suspicious fraud, waste, and abuse, and reduce leakage of sensitive information such as patient medical records and other credentials.

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