Top Growth Trends in the Healthcare Fraud Detection Market: Key Insights and Opportunities for 2025-2034
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How has the healthcare fraud detection market size evolved in recent years?
The market for healthcare fraud detection has experienced tremendous expansion in the past few years. The market size is projected to increase from $3.62 billion in 2024 to $4.67 billion in 2025, reflecting a compound annual growth rate (CAGR) of 28.9%. This significant growth during the historical period has been driven by a surge in cyber threats, patient identity verification, competitive market climates, the identification of fraudulent claims, and an overall increase in awareness and training.
What are the predictions for the healthcare fraud detection market size in the coming years?
The size of the healthcare fraud detection market is predicted to experience substantial expansion in the forthcoming years, with expectations of reaching $13.77 billion in 2029, at a Compound Annual Growth Rate (CAGR) of 31.1%. Contributing factors to this surge during the forecast period include alterations in regulations, enhanced digitalization, progression of fraud systems, emphasis on insurance fraud, and improvements in data security. Forecasts for this period also highlight incorporating advanced technologies, real-time surveillance, behavioral analytics, the use of blockchain for increased security, and patient identity confirmation as key trends.
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What key factors are fueling the growth of the healthcare fraud detection market?
The upward trend in deceitful incidents in the medical sector is anticipated to fuel the growth of the healthcare fraud detection market. Such deceitful incidents refer to the intentional distortion of patient health records and insurance details with the primary intention to unfairly or unlawfully benefit or deprive a user of a lawful entitlement. For example, a UK-based financial institute reported in 2022 that there were 207,372 instances of APP fraud in the same year, causing a gross loss of £485.2 million, marking a decline of 17 percent in comparison to 2021. Consequently, the escalating incidents of deceit in the healthcare sector are projected to stimulate the expansion of the healthcare fraud detection market.
How is the global healthcare fraud detection market divided into key segments?
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
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Who are the key firms paving the way for growth 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
Which trends are expected to transform the healthcare fraud detection market?
The rising use of sophisticated analytics tools is a major trend gaining traction in the healthcare fraud detection market. Prominent companies are focusing their resources on developing inventive technologies to maintain their standing in this market. For example, Premier, Inc., a healthcare technology company from the US, introduced a product called INSights, based on PINC AITM technology, in January 2022. INSights is a universal analytics platform that uses risk-adjusted, standardised, and sanitised healthcare data from PINC AITM. It is aimed at enabling healthcare providers to reduce the tasks related to data preparation and analytics creation for immediate improvements in clinical, quality, and financial outcomes.
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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.
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