1. Market Research
  2. > Healthcare Market Trends
Global Healthcare Fraud Analytics Market Size, Share & Industry Trends Analysis Report By Delivery Model, By Application, By End User, By Solution Type, By Regional Outlook and Forecast, 2022 – 2028

Global Healthcare Fraud Analytics Market Size, Share & Industry Trends Analysis Report By Delivery Model, By Application, By End User, By Solution Type, By Regional Outlook and Forecast, 2022 – 2028

  • May 2022
  • 269 pages
  • ID: 6289251
  • Format: PDF
  • KBV Research


Table of Contents

The Global Healthcare Fraud Analytics Market size is expected to reach $6.6 Billion by 2028, rising at a market growth of 23.0% CAGR during the forecast period.

Health-care fraud is characterized as illegal deception aimed at gaining financial benefit in the areas of medication manufacture, product quality, medical practice, and healthcare insurance. The practice of healthcare fraud includes cheating government-sponsored healthcare schemes, as well as defrauding insurance companies, businesses, and consumers. Leading life sciences companies are currently using a variety of data mining techniques to combat these fraudulent operations. These data mining techniques entail scouring databases for new information, such as healthcare insurance data, fraud strategies, and healthcare information systems, among other things.

In the coming years, the healthcare fraud detection market is expected to be driven by a rise in the number of fraudulent events in health care, an uptick in the frequency of patients going to opt for health care insurance, and an increase in the pressure to keep a record of fraud and abuse in health care spending. Other factors include a growth in the frequency of health care BPO and fraud identity management software, quick acceptance of cloud-based analytical solutions, increased influence of social media on the health care industry, and the efficiency of artificial intelligence in healthcare services & solutions.

With a unique visualization interface that allows users to go over individual and account views to evaluate all relevant activities and relationships at a network dimension, users may discover linkages within apparently unrelated claims. With social network diagrams and extensive data mining skills, organizations may gain an improved understanding of new dangers and prevent large losses before they happen. Additionally, by constantly developing models and modifying the system, organizations can keep in front of variations in payment and cost-cutting trends.

COVID-19 Impact Analysis

The healthcare fraud analytics industry is confronted with numerous obstacles. Business dynamics are being impacted by travel restrictions and quarantines, shuts down in outdoor/indoor activities, temporary business outages, supply-demand fluctuations, stock market volatility, diminishing business confidence, and a myriad of other worries. In the healthcare industry, doctors, patients, physicians, and other medical experts have all been engaged in fraud situations. Many healthcare professionals and experts have been discovered scamming patients for monetary gain. Patients’ fraudulent acts in the healthcare sector include fraudulently obtaining sickness certificates, prescription fraud, and evasion of medical payments.

Market Growth Factors

Growth In Frequency Of People Looking For Health Insurance

The number of people who have benefited from various healthcare initiatives has increased dramatically over time. The increase in the ageing population, growth in healthcare costs, and rising illness load are all factors leading to the expansion of the health insurance market. The number of people without health insurance in the United States has declined dramatically, from the year 2010 to the year 2016. During the 2017 open enrollment period, multiple millions of people signed up for or renewed their health insurance, as per National Center for Health Statistics.

Social Media’s Emergence And Influence On The Healthcare Business

The healthcare business is evolving at a breakneck pace, and one of the primary factors driving this evolution is the increasing influence of healthcare communication via social media. Not only has social media grown in popularity as a source of health information, but it also allows for dual-way public communication among patients, other third parties, and providers. This contributes to the creation of a big forum for comprehensive health discussions.

Market Restraining Factors

Time-Consuming Deployment And The Need For Frequent Upgrades

The execution of fraud analytics solutions consumes a huge time. Developing new databases, user interfaces, and predictive models; assessing and implementing models; and tracking their efficacy are all part of the process. During this step, data analysts execute algorithms till they find the best accurate forecasting model. The eave-droppers are very clever to notice that which organization is lacking regular upgrades & updates and is the deployment process time-consuming and accordingly plan & execute the unauthorized interference.

Delivery Model Outlook

Based on delivery model, the healthcare fraud analytics market is bifurcated into On-premises and Cloud-based. The On-premises segment acquired the highest revenue share in the healthcare fraud analytics market in 2021. The simplicity of access to data being on-site, i.e., hospitals, etc., results in better record management and data monitoring, among other things. Current systems in small businesses are functional, but when scaled up, data management can become complicated and cumbersome, especially if the company is dealing with a large data set. This could imply a significant financial investment in data storage and security.

Application Outlook

Based on Application, the healthcare fraud analytics market is divided into Insurance Claim Review, Pharmacy billing Issues, Payment Integrity, and Others. The pharmacy billing issue segment garnered a significant revenue share in the healthcare fraud analytics market in 2021. The increased frequency of medical billing fraud is happening in pharmacies.. The objective of pharmacy billing is to reduce expenses from the admin side.

End- Use Outlook

Based on end-use, the healthcare fraud analytics market is classified into Public & Government Agencies, Private Insurance Payers, Third-party Service Providers, and Employers. The Public & Government Agencies segment acquired the highest revenue share in the healthcare fraud analytics market in 2021. A greater amount of patients in government hospitals, as well as the increased vulnerability of government organizations to fraudulent operations because of a lack of technologically updated infrastructure, specifically in developing countries, are two significant factors leading to the big percentage.

Solution type Outlook

Based on solution type, the healthcare fraud analytics market is segmented into Descriptive Analytics, Prescriptive Analytics, and Predictive Analytics. The descriptive analytics segment acquired the highest revenue share in the healthcare fraud analytics market in 2021. For the purpose of identifying patterns and linkages, it uses both current and historical data. This aids in the more accurate detection of potential scams. It also serves as a foundation for implementing predictive and prescriptive analytics effectively. This contributes to the segment’s continued expansion.

Regional Outlook

Based on Region, the healthcare fraud analytics market is analyzed across North America, Europe, Asia Pacific, and LAMEA. North America emerged as the leading region in the healthcare fraud analytics market with the largest revenue share in 2021. This is due to rising healthcare spending, increased adoption of healthcare IT, and an increase in the number of fraud instances. As per the National Health Care Anti-Fraud Association, the United States spends several trillions on health care each year (NHCAA). NHCAA believes that health care fraud costs tens of billions of dollars out of that total. There is the availability of various advanced solutions and services associated with healthcare fraud detection, as well as strategic steps taken by big players present in the country.

The market research report covers the analysis of key stake holders of the market. Key companies profiled in the report include Wipro Limited, IBM Corporation, DXC Technology Company, SAS Institute, Inc., Conduent, Incorporated, HCL Technologies Ltd., UnitedHealth Group, Inc. (Optum, Inc.), OSP Labs, Cotiviti, Inc., and ExlService Holdings, Inc.

Strategies Deployed in Healthcare Fraud Analytics Market

Oct-2021: ExlService Holding joined hands with GEOX, a leader in supplying geospatial data to insurers. This collaboration aimed to provide unified image analytics offering to insurance carriers. Further, this partnership aimed to improve assist carriers in attaining enhanced underwriting assessment, smart roof condition assessment, more accurate property renewal assessment, and improved claim processing assistance.

Apr-2021: Wipro entered into an agreement to acquire Ampion, an Australia-located provider of cyber security, quality engineering services, and DevOps. This acquisition aimed to bring scale and market flexibility and speed to respond to the increasing demands of customers.

Feb-2021: IBM Corporation came into partnership with Watson Health and Humana, a not-for-profit American health insurance company located in Louisville, Kentucky. This partnership aimed to aid deliver an improved member experience while giving higher transparency and clarity on advantages and other associated matters for Humana Employer Group members.

Sep-2020: HCL Technologies extended its partnership with Google Cloud. This partnership aimed for customers to have real-time valuable information from the operational data at a significantly lower total cost of ownership. Further, this partnership aimed to bring HCL’S Actian portfolio, beginning with Actian Avalanche, to Google Cloud. Action Avalanche is a high-performance hybrid cloud data warehouse created to support enterprises highly demanding operational analytics workloads.

Jul-2020: SAS Institute formed a partnership with National Health Authority (NHA), NHA is responsible for implementing India’s flagship public health insurance/assurance scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana. This partnership aimed to aid check abuse and fraud in the execution structure of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojna (AB PM-JAY) scheme. In addition, SAS would deliver an end-to-end framework to ensure claim processing with notable elements for alert management, fraud detection, and case-handling for NHA.

Jun-2020: SAS Institute came into a partnership with Microsoft Corporation. This partnership aimed to allow customers to simply run the SAS workload in the cloud, expanding the business solutions and unlocking vital value from the digital transformation initiatives. Under this partnership, the companies would aid the customers to fasten their growth and discover new methods to boost innovation with a wide set of SAS Analytics offerings on Microsoft Azure.

Jun-2018: Wipro came into a partnership with Opera Solutions, a global leader in applied Big Data analytics and artificial intelligence (AI). This partnership aimed to integrate Opera Solutions’ powerful AI and machine learning based Fraud, Waste, and Abuse (FWA) detection engine with Wipro’s extensive full-service claim processing capabilities in claims review, which comprises the forensic examination of questionable audits, claims, negotiations, adjustments recovery follow-up and payment posting. Further, this partnership aimed to solve the concerns of waste, fraud, and abuse in healthcare insurance claims in the United States.

Scope of the Study

Market Segments covered in the Report:

By Delivery Model

• On-premise

• Cloud

By Application

• Insurance Claim Review

• Pharmacy billing Issue

• Payment Integrity

• Others

By End User

• Public & Government Agencies

• Private Insurance Payers

• Third-party Service Providers

• Employers

By Solution Type

• Descriptive Analytics

• Predictive Analytics

• Prescriptive Analytics

By Geography

• North America

o US

o Canada

o Mexico

o Rest of North America

• Europe

o Germany

o UK

o France

o Russia

o Spain

o Italy

o Rest of Europe

• Asia Pacific

o China

o Japan

o India

o South Korea

o Singapore

o Malaysia

o Rest of Asia Pacific


o Brazil

o Argentina


o Saudi Arabia

o South Africa

o Nigeria

o Rest of LAMEA

Companies Profiled

• Wipro Limited

• IBM Corporation

• DXC Technology Company

• SAS Institute, Inc.

• Conduent, Incorporated

• HCL Technologies Ltd.

• UnitedHealth Group, Inc. (Optum, Inc.)

• OSP Labs

• Cotiviti, Inc.

• ExlService Holdings, Inc.

Unique Offerings

• Exhaustive coverage

• Highest number of market tables and figures

• Subscription based model available

• Guaranteed best price

• Assured post sales research support with 10% customization free

Get Industry Insights. Simply.

  • Latest reports & slideshows with insights from top research analysts
  • 150+ Million searchable statistics with tables, figures & datasets
  • More than 25,000 trusted sources
  • Single User License — provides access to the report by one individual.
  • Department License — allows you to share the report with up to 5 users
  • Site License — allows the report to be shared amongst all employees in a defined country
  • Corporate License — allows for complete access, globally.

ReportLinker may already be registered as a supplier with your company. If you want to Order by PO, check with us first and we'll let you know if we are a registered supplier and what the vendor number is. Otherwise, we'll provide you with the necessary information to register ReportLinker as a vendor.

Grace helps you find the right report:

The research specialist advised us on the best content for our needs and provided a great report and follow-up, thanks very much we shall look at ReportLinker in the future.

Kate Merrick

Global Marketing Manager at
Eurotherm by Schneider Electric

We were impressed with the support that ReportLinker’s research specialists’ team provided. The report we purchased was useful and provided exactly what we want.

Category Manager at

ReportLinker gave access to reliable and useful data while avoiding dispersing resources and spending too much time on unnecessary research.

Executive Director at
PwC Advisory

The customer service was fast, responsive, and 100% professional in all my dealings (...) If we have more research needs, I'll certainly prioritize working with ReportLinker!

Scott Griffith

Vice President Marketing at
Maurice Sporting Goods

The research specialist provided prompt, helpful instructions for accessing ReportLinker's product. He also followed up to make sure everything went smoothly and to ensure an easy transition to the next stage of my research

Jessica P Huffman

Research Associate at
American Transportation Research Institute

Excellent customer service. Very responsive and fast.

Director, Corporate Strategy at

I reached out to ReportLinker for a detailed market study on the Air Treatment industry. The quality of the report, the research specialist’s willingness to solve my queries exceeded my expectations. I would definitely recommend ReportLinker for in-depth industry information.

Mariana Mendoza

Global Platform Senior Manager at
Whirlpool Corporation

Thanks! I like what you've provided and will certainly come back if I need to do further research works.

Bee Hin Png

CEO at
LDR Pte Ltd

The research specialist advised us on the best content for our needs and provided a great report and follow-up, thanks very much we shall look at ReportLinker in the future.

Kate Merrick

Global Marketing Manager at
Eurotherm by Schneider Electric

  • How we can help
    • I am not sure if the report I am interested in will fulfill my needs. Can you help me?
    • Yes, of course. You can call us at +33(0) 4 37 65 17 03 or drop us an email at [email protected] to let us know more about your requirements.
    • We buy reports often - can ReportLinker get me any benefits?
    • Yes. Set up a call with a Senior Research Advisor to learn more - [email protected] or +33(0) 4 37 65 17 03.
    • I have had negative experiences with market research reports before. How can you avoid this from happening again?
    • We advise all clients to read the TOC and Summary and list your questions so that we can get more insight for you before you make any purchase decision. A research advisor will accompany you so that you can compare samples and reports from different sources, and choose the study that is right for you.

  • Report Delivery
    • How and when I will receive my Report?
    • Most reports are delivered right away in a pdf format, while others are accessed via a secure link and access codes. Do note that sometimes reports are sent within a 12 hour period, depending on the time zones. However, you can contact us to escalate this. Should you need a hard copy, you can check if this option is offered for the particular report, and pay the related fees.
  • Payment conditions
    • What payment methods do you accept?
      1. Credit card : VISA, American Express, Mastercard, or
      2. You can download an invoice to pay by wire transfer, check, or via a Purchase Order from your company, or
      3. You can pay via a Check made out in US Dollars, Euros, or British Pounds for the full amount made payable to ReportLinker
    • What are ReportLinker’s Payment Terms?
    • All payments must normally be submitted within 30 days. However, you can let us know if you need extended time.
    • Are Taxes and duties included?
    • All companies based in France must pay a 20% tax per report. The same applies to all individuals based in the EU. All EU companies must supply their VAT number when purchasing to avoid this charge.
    • I’m not satisfied. Can I be refunded?
    • No. Once your order has been processed and the publisher has received a notification to send you the report, we cannot issue any refund or cancel any order. As these are not ‘traditional’ products that can be returned, reports that are dispatched are considered to be ‘consumed’.
  • User license
    • The license that you should acquire depends on the number of persons that need to access the report. This can range from Single User (only one person will have the right to read or access the report), or Department License (up to 5 persons), to Site License (a group of persons based in the same company location), or Corporate License (the entire company personnel based worldwide). However, as publishers have different terms and conditions, we can look into this for you.
Purchase Reports From Reputable Market Research Publishers

Fraud Detection & Prevention Market By Component, By Organization Size, By Deployment Model, By Industry Vertical : Global Opportunity Analysis and Industry Forecast, 2021-2031

  • $ 3840
  • May 2022
  • 287 pages

Fraud Detection & Prevention Market By Component (Solution, Services), By Organization Size (Large Enteprises, Small and Medium-sized Enteprises), By Deployment Model (On-Premises, Cloud), By Industry ...

  • World
  • Big Data
  • Data Analytics
  • Industry analysis
  • Paid Claims


Reportlinker.com © Copyright 2022. All rights reserved.

ReportLinker simplifies how Analysts and Decision Makers get industry data for their business.

Make sure you don’t miss any news and follow us on