Healthcare Fraud Analytics Market Size, Share & Trends by 2027

The healthcare fraud analytics market was valued at US$ 1,331.09 million in 2019 and it is projected to reach US$ 8,707.73 million in 2027; it is expected to grow at a CAGR of 27.0% from 2020 to 2027.

Healthcare fraud is a kind of white-collar crime that includes the filing of dishonest health care claims to turn a profit. The majority of health care fraud is committed by organized crime groups and a small minority of fraudulent health care providers. The most common types of health care fraud include billing for more expensive services or procedures, misrepresenting non-covered treatments, insurance frauds, and others. The growth of the global healthcare fraud analytics market is attributed to the increasing number of fraud cases across all industries, and growing health insurance industry in the US. However, concerns regarding healthcare fraud analytics is the major factor hindering the market growth.

The global healthcare fraud analytics market is expected to witness substantial growth post-pandemic. The COVID-19 has affected economies and industries in various countries due to lockdowns, travel bans, and business shutdowns. The COVID-19 crisis has overburdened public health systems in many countries and highlighted the strong need for sustainable investment in health systems. As the COVID-19 pandemic progresses, the healthcare industry is expected to see a drop in growth. The life sciences segment thrives due to increased demand for invitro diagnostic products and rising research and development activities worldwide. However, the medical technologies and imaging segment is witnessing drop in sales due to a smaller number of surgeries being carried out and delayed or prolonged equipment procurement. Additionally, virtual consultations by healthcare professionals are expected to become the mainstream care delivery model post-pandemic. With telehealth transforming care delivery, digital health will continue to thrive in coming years. In addition, disrupted clinical trials and the subsequent delay in drug launches is also expected to pave the way for entirely virtual trials in the future. New technologies such as mRNA is expected to emerge and shift the pharmaceutical industry and market is also expected to witness more vertical integration and joint ventures in coming years.

Lucrative Regions for Global Healthcare Fraud Analytics Market

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Market Insights

Growing Health Insurance Industry in the US to Drive Global Healthcare Fraud Analytics Market Growth

Health insurance fraud is a deliberate deception committed against an insurance company or agent to achieve financial gain. Frauds are committed at different transaction points by the applicants, policyholders, third-party claimants, or healthcare professionals who offer services to claimants. Sometimes insurance agents, as well as company employees, may also commit insurance fraud. Common health insurance frauds include padding that is manipulating the legitimate claims, exaggerating the facts on an insurance application, submitting claims for diseases or injuries that never occurred, and staging accidents.

In the United States, there are more than 900 health insurance companies that offer medical coverage. Moreover, the number of people with health insurance coverage in the United States is high. As per the report Health Insurance Coverage in the United States: 2018, in the year 2018, approximately 91.5% of the population has health insurance. The report also mentioned that, in 2018, private health insurance coverage was more prevalent in the US than public coverage, about 67.3% of the population had private health insurance coverage and 34.4% had public coverage. Among the subtypes, employer-based insurance was the most common health insurance coverage accounting for 55.1 % of the population.

Owing to the growing health insurance industry and the rising number of health insurance frauds, the demand for healthcare fraud analytics solutions is expected to increase during the forecast period.

Solution - Based Insights

In terms of solution, the global healthcare fraud analytics market is segmented into predictive analytics, descriptive analytics, and prescriptive analytics. In 2019, the predictive analytics segment held largest share of the market. Moreover, the same segment is estimated to register the highest CAGR during the forecast period.

Global Healthcare Fraud Analytics Market, by Solution – 2019 and 2027

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Mode of Delivery-Based Insights

Based on mode of delivery, the global healthcare fraud analytics market is segmented into on-premise delivery models, and cloud-based delivery models. The on-premise delivery models segment held the largest market share in 2019. However, cloud based delivery models segment is estimated to register the highest CAGR during the forecast period.

Application-Based Insights

Based on application, the global healthcare fraud analytics market is segmented into insurance claims review, pharmacy billing misuse, payment integrity, medical identity theft and other applications. The insurance claims segment held the largest market share in 2019. Also, the same segment is estimated to register the highest CAGR during the forecast period.

End User-Based Insights

In terms of end user, the global healthcare fraud analytics market is segmented into government agencies, private insurance payers, third-party service providers, and employers. The government agencies segment held the largest share of the market in 2019, and the same segment is estimated to register the highest CAGR during the forecast period.

Strategic Insights

The global healthcare fraud analytics market players are adopting the product launch and expansion strategies to cater to changing customer demands worldwide, which also allows them to maintain their brand name globally.

Global Healthcare Fraud Analytics Market – by Solution

• Predictive Analytics
• Descriptive Analytics

• Prescriptive Analytics

Global Healthcare Fraud Analytics Market – by Mode of Delivery

• On-Premise Delivery Models

• Cloud Based Delivery Models

Global Healthcare Fraud Analytics Market – by Application

• Insurance Claims Review
• Pharmacy Billing Misuse
• Payment Integrity
• Medical Identity Theft

• Other Applications  

Global Healthcare Fraud Analytics Market – by End- User

• Government Agencies
• Private Insurance Payers
• Third-party Service Providers

• Employers

Global Healthcare Fraud Analytics Market – by Geography

• North America

  • US
  • Canada
  • Mexico

• Europe

  • France
  • Germany
  • Italy
  • UK
  • Spain
  • Rest of Europe

• Asia Pacific (APAC)

  • China
  • India
  • South Korea
  • Japan
  • Australia
  • Rest of APAC

• Middle East & Africa (MEA)

  • South Africa
  • Saudi Arabia
  • UAE
  • Rest of MEA

• South America and Central America (SCAM)

  • Brazil
  • Argentina
  • Rest of SCAM

Company Profiles

• Conduent Inc.
• DXC Technology
• Scioinspire, Corp.
• Optum, Inc.
• SAS Institute
• Pondera Solutions
• Lexisnexis Risk Solutions
• Fair, Isaac and Company(FICO)
• Cotiviti, Inc.
• Whitehatai