Major players in the healthcare fraud detection market are International Business Machines Corporation, Cotiviti Inc., Fair Isaac and Company, SAS Institute, CGI Inc., DXC Technology, RELX Group plc, EXL Service Holdings Inc., HCL Technologies, UnitedHealth Group Incorporated, Optum Inc., Conduent Inc., Change Healthcare, OSP Labs, and Codoxo.
The global healthcare fraud detection market is expected to grow from $2.16 billion in 2022 to $2.80 billion in 2023 at a compound annual growth rate (CAGR) of 29.5%. The Russia-Ukraine war disrupted the chances of global economic recovery from the COVID-19 pandemic, at least in the short term. The war between these two countries has led to economic sanctions on multiple countries, a surge in commodity prices, and supply chain disruptions, causing inflation across goods and services and affecting many markets across the globe. The healthcare fraud detection market is expected to reach $7.74 billion in 2027 at a CAGR of 28.9%.
The health fraud detection market includes revenues earned by entities by tracking secondary data, providing technology specialist.The market value includes the value of related goods sold by the service provider or included within the service offering.
Only goods and services traded between entities or sold to end consumers are included.
Healthcare fraud detection refers to a group of actions performed to stop someone from obtaining patient data or property under false pretences 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.
North America was the largest region in the healthcare fraud detection market in 2022. The regions covered in the healthcare fraud detection report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East and Africa.
The main type of healthcare fraud detection include descriptive analytics, predictive analytics and prescriptive analytics.The descriptive analytics are used to help with predictive and prescriptive analytics to manage medical imaging scans, clinical and outcomes data.
Descriptive analytics refers to the method of finding patterns and relationships by combining historical and present data to identify suspicious activities.The models includes on-premise delivery and on-demand delivery, which uses components such as services and software.
The application includes insurance claims review and payment integrity and are used by healthcare payers, government agencies and others.
The rise in fraudulent events in the healthcare industry is expected to propel the healthcare fraud detection market going forward.Fraudulent events in healthcare refer to the deliberate misrepresentation of patient data and insurance information in order to obtain an unfair or illegal gain or to deprive a user of a legal right.
For instance, in 2021, the Department of Justice (DOJ) opened 831 new criminal health care fraud investigations.Moreover, in 2021, DOJ opned 805 new civil health care fraud investigations.
According to data published by the United States Sentencing Commission, a US-based agency that articulates sentencing guidelines, in August 2022, 336 health care fraud offenders were identified in fiscal year 2021, making up 8.0% of total theft, property damage, and fraud charges. Therefore, the rise in fraudulent events in the healthcare industry is expected to drive the healthcare fraud detection market.
Adoption of advanced analytics tools is a key trend gaining popularity in the healthcare fraud detection market. Major players are concentrating their efforts on creating innovative technologies to sustain their position in the healthcare fraud detection market. For instance, in January 2022, Premier, Inc., a US-based healthcare technology company, launched "INSights" based on PINC AITM technology. Insights is a vendor-neutral analytics platform that has access to the risk-adjusted, standardised, and cleaned healthcare data from PINC AITM. Insights is designed for healthcare providers to lower the workload associated with data preparation and analytics development for quick gains in clinical, quality, and financial outcomes.
In 2021, Equifax, a global data, analytics and technology company acquired Appriss Insights for $1.825 billion. With the acquisition Equifax will expand its largest and fastest growing business-workforce solutions. Appriss Insights is a UK based provider of proprietary data and analytics solutions to address safety, fraud, risk and compliance issues effectively and efficiently for government and commercial enterprises including healthcare.
The countries covered in the healthcare fraud detection market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA.
The market value is defined as the revenues that enterprises gain from the sale of goods and/or services within the specified market and geography through sales, grants, or donations in terms of the currency (in USD, unless otherwise specified).
The revenues for a specified geography are consumption values that are revenues generated by organizations in the specified geography within the market, irrespective of where they are produced. It does not include revenues from resales along the supply chain, either further along the supply chain or as part of other products.
The healthcare fraud detection market research report is one of a series of new reports that provides healthcare fraud detection market statistics, including healthcare fraud detection industry global market size, regional shares, competitors with an healthcare fraud detection market share, detailed healthcare fraud detection market segments, market trends and opportunities, and any further data you may need to thrive in the healthcare fraud detection industry. This healthcare fraud detection market research report delivers a complete perspective of everything you need, with an in-depth analysis of the current and future scenario of the industry.