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Healthcare Fraud Detection Market: Global Industry Trends, Share, Size, Growth, Opportunity and Forecast 2022-2027

Market Overview:

The global healthcare fraud detection market reached a value of US$ 1.58 Billion in 2021. Looking forward, IMARC Group expects the market to reach a value of US$ 6.44 Billion by 2027, exhibiting a CAGR of 24.20% during 2022-2027. Keeping in mind the uncertainties of COVID-19, we are continuously tracking and evaluating the direct as well as the indirect influence of the pandemic on different end use sectors. These insights are included in the report as a major market contributor.

Healthcare fraud detection aids in detecting and preventing healthcare fraud, waste, and abuse at every stage of the claim process and reducing inappropriate payments. It connects existing payment integrity solutions and consolidates data from internal and external sources, such as claims systems, watch lists, third parties, and unstructured texts for efficient data management. It relies on various advanced analytic and artificial learning (AI) techniques, including modern statistical, machine learning (ML), deep learning, and text analytics algorithms. Apart from this, it uses a flexible process to assist operational, clinical, and investigative evaluations and store all relevant case information.

 

 
 

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Healthcare Fraud Detection Market Trends:

Due to an increase in the number of patients seeking health insurance, there is a rise in the demand for healthcare fraud detection solutions. This, along with the growing prepayment review model in the healthcare industry, represents one of the key factors driving the market. Moreover, the increasing number of pharmacy claims-related frauds across the globe is propelling the growth of the market. In addition, there is a rise in the demand for solutions that have biometric sensors to identify frauds. This, coupled with the growing adoption of healthcare fraud analytics, especially in developing countries, is positively influencing the market. Besides this, the increasing integration of artificial intelligence (AI) in healthcare fraud detection is offering lucrative growth opportunities to industry investors. Apart from this, governments of several countries are undertaking initiatives to review healthcare insurance claims and save money of consumers and nations. In line with this, the burgeoning healthcare industry is bolstering the growth of the market. Other growth-inducing factors are the increasing returns on investment (ROI), rising use of social media, and funding for the implementation of several information and technology (IT) platforms.

Key Market Segmentation:

IMARC Group provides an analysis of the key trends in each sub-segment of the global healthcare fraud detection market, along with forecasts at the global, regional and country level from 2022-2027. Our report has categorized the market based on component, type, delivery mode, application and end user.

Breakup by Component:

 

 
 

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  • Software
  • Services
     

Breakup by Type:

  • Descriptive Analytics
  • Predictive Analytics
  • Prescriptive Analytics
     

Breakup by Delivery Mode:

  • On-premises
  • On-demand
     

Breakup by Application:

  • Insurance Claims Review
  • Payment Integrity
     

Breakup by End User:

  • Private Insurance Payers
  • Government Agencies
  • Others
     

Breakup by Region:

 

 
 

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  • North America
    • United States
    • Canada
  • Asia-Pacific
    • China
    • Japan
    • India
    • South Korea
    • Australia
    • Indonesia
    • Others
  • Europe
    • Germany
    • France
    • United Kingdom
    • Italy
    • Spain
    • Russia
    • Others
  • Latin America
    • Brazil
    • Mexico
    • Others
  • Middle East and Africa
     

Competitive Landscape:

The competitive landscape of the industry has also been examined along with the profiles of the key players being CGI Inc., Conduent Inc., ExlService Holdings Inc., Fair Isaac Corporation, HCL Technologies Limited, International Business Machines Corporation, Northrop Grumman Corporation, RELX Group plc, SAS Institute Inc., UnitedHealth Group and Wipro Ltd.

Report Coverage:

Report Features Details
Base Year of the Analysis 2021
    Historical Period 2016-2021
Forecast Period 2022-2027
Units US$ Billion
Segment Coverage Component, Type, Delivery Mode, Application, End User, Region
Region Covered  Asia Pacific, Europe, North America, Latin America, Middle East and Africa
Countries Covered United States, Canada, Germany, France, United Kingdom, Italy, Spain, Russia, China, Japan, India, South Korea, Australia, Indonesia, Brazil, Mexico
Companies Covered CGI Inc., Conduent Inc., ExlService Holdings Inc., Fair Isaac Corporation, HCL Technologies Limited, International Business Machines Corporation, Northrop Grumman Corporation, RELX Group plc, SAS Institute Inc., UnitedHealth Group and Wipro Ltd.
Customization Scope 10% Free Customization
Report Price and Purchase Option Single User License: US$ 2499
Five User License: US$ 3499
Corporate License: US$ 4499
Post-Sale Analyst Support 10-12 Weeks
Delivery Format PDF and Excel through Email (We can also provide the editable version of the report in PPT/Word format on special request)

 

Key Questions Answered in This Report:

  • How has the global healthcare fraud detection market performed so far and how will it perform in the coming years?
  • What has been the impact of COVID-19 on the global healthcare fraud detection market?
  • What are the key regional markets?
  • What is the breakup of the market based on the component?
  • What is the breakup of the market based on the type?
  • What is the breakup of the market based on the delivery mode?
  • What is the breakup of the market based on the application?
  • What is the breakup of the market based on the end user?
  • What are the various stages in the value chain of the industry?
  • What are the key driving factors and challenges in the industry?
  • What is the structure of the global healthcare fraud detection market and who are the key players?
  • What is the degree of competition in the industry?

1    Preface
2    Scope and Methodology

    2.1    Objectives of the Study
    2.2    Stakeholders
    2.3    Data Sources
        2.3.1    Primary Sources
        2.3.2    Secondary Sources
    2.4    Market Estimation
        2.4.1    Bottom-Up Approach
        2.4.2    Top-Down Approach
    2.5    Forecasting Methodology
3    Executive Summary
4    Introduction

    4.1    Overview
    4.2    Key Industry Trends
5    Global Healthcare Fraud Detection Market
    5.1    Market Overview
    5.2    Market Performance
    5.3    Impact of COVID-19
    5.4    Market Forecast
6    Market Breakup by Component
    6.1    Software
        6.1.1 Market Trends
        6.1.2 Market Forecast
    6.2    Services 
        6.2.1 Market Trends
        6.2.2 Market Forecast
7    Market Breakup by Type
    7.1    Descriptive Analytics
        7.1.1 Market Trends
        7.1.2 Market Forecast
    7.2    Predictive Analytics
        7.2.1 Market Trends
        7.2.2 Market Forecast
    7.3    Prescriptive Analytics 
        7.3.1 Market Trends
        7.3.2 Market Forecast
8    Market Breakup by Delivery Mode
    8.1    On-premises
        8.1.1 Market Trends
        8.1.2 Market Forecast
    8.2    On-demand
        8.2.1 Market Trends
        8.2.2 Market Forecast
9    Market Breakup by Application
    9.1    Insurance Claims Review
        9.1.1 Market Trends
        9.1.2 Market Forecast
    9.2    Payment Integrity
        9.2.1 Market Trends
        9.2.2 Market Forecast
10    Market Breakup by End User
    10.1    Private Insurance Payers
        10.1.1 Market Trends
        10.1.2 Market Forecast
    10.2    Government Agencies
        10.2.1 Market Trends
        10.2.2 Market Forecast
    10.3    Others
        10.3.1 Market Trends
        10.3.2 Market Forecast
11    Market Breakup by Region
    11.1    North America
        11.1.1 United States
           11.1.1.1 Market Trends
           11.1.1.2 Market Forecast
        11.1.2 Canada
           11.1.2.1 Market Trends
           11.1.2.2 Market Forecast
    11.2    Asia-Pacific
        11.2.1 China
           11.2.1.1 Market Trends
           11.2.1.2 Market Forecast
        11.2.2 Japan
           11.2.2.1 Market Trends
           11.2.2.2 Market Forecast
        11.2.3 India
           11.2.3.1 Market Trends
           11.2.3.2 Market Forecast
        11.2.4 South Korea
           11.2.4.1 Market Trends
           11.2.4.2 Market Forecast
        11.2.5 Australia
           11.2.5.1 Market Trends
           11.2.5.2 Market Forecast
        11.2.6 Indonesia
           11.2.6.1 Market Trends
           11.2.6.2 Market Forecast
        11.2.7 Others
           11.2.7.1 Market Trends
           11.2.7.2 Market Forecast
    11.3    Europe
        11.3.1 Germany
           11.3.1.1 Market Trends
           11.3.1.2 Market Forecast
        11.3.2 France
           11.3.2.1 Market Trends
           11.3.2.2 Market Forecast
        11.3.3 United Kingdom
           11.3.3.1 Market Trends
           11.3.3.2 Market Forecast
        11.3.4 Italy
           11.3.4.1 Market Trends
           11.3.4.2 Market Forecast
        11.3.5 Spain
           11.3.5.1 Market Trends
           11.3.5.2 Market Forecast
        11.3.6 Russia
           11.3.6.1 Market Trends
           11.3.6.2 Market Forecast
        11.3.7 Others
           11.3.7.1 Market Trends
           11.3.7.2 Market Forecast
    11.4    Latin America
        11.4.1 Brazil
           11.4.1.1 Market Trends
           11.4.1.2 Market Forecast
        11.4.2 Mexico
           11.4.2.1 Market Trends
           11.4.2.2 Market Forecast
        11.4.3 Others
           11.4.3.1 Market Trends
           11.4.3.2 Market Forecast
    11.5    Middle East and Africa
        11.5.1 Market Trends
        11.5.2 Market Breakup by Country
        11.5.3 Market Forecast
12    SWOT Analysis
    12.1    Overview
    12.2    Strengths
    12.3    Weaknesses
    12.4    Opportunities
    12.5    Threats
13    Value Chain Analysis
14    Porters Five Forces Analysis

    14.1    Overview
    14.2    Bargaining Power of Buyers
    14.3    Bargaining Power of Suppliers
    14.4    Degree of Competition
    14.5    Threat of New Entrants
    14.6    Threat of Substitutes
15    Price Analysis
16    Competitive Landscape

    16.1    Market Structure
    16.2    Key Players
    16.3    Profiles of Key Players
        16.3.1    CGI Inc.
           16.3.1.1 Company Overview
           16.3.1.2 Product Portfolio
           16.3.1.3 Financials
           16.3.1.4 SWOT Analysis
        16.3.2    Conduent Inc.
           16.3.2.1 Company Overview
           16.3.2.2 Product Portfolio
           16.3.2.3 Financials
           16.3.2.4 SWOT Analysis
        16.3.3    ExlService Holdings Inc.
           16.3.3.1 Company Overview
           16.3.3.2 Product Portfolio
           16.3.3.3 Financials
        16.3.4    Fair Isaac Corporation
           16.3.4.1 Company Overview
           16.3.4.2 Product Portfolio
           16.3.4.3 Financials
           16.3.4.4 SWOT Analysis
        16.3.5    HCL Technologies Limited
           16.3.5.1 Company Overview
           16.3.5.2 Product Portfolio
           16.3.5.3 Financials
           16.3.5.4 SWOT Analysis
        16.3.6    International Business Machines Corporation
           16.3.6.1 Company Overview
           16.3.6.2 Product Portfolio
           16.3.6.3 Financials
        16.3.7    Northrop Grumman Corporation
           16.3.7.1 Company Overview
           16.3.7.2 Product Portfolio
           16.3.7.3 Financials
           16.3.7.4 SWOT Analysis
        16.3.8    RELX Group plc
           16.3.8.1 Company Overview
           16.3.8.2 Product Portfolio
           16.3.8.3 Financials
           16.3.8.4 SWOT Analysis
        16.3.9    SAS Institute Inc.
           16.3.9.1 Company Overview
           16.3.9.2 Product Portfolio
           16.3.9.3 SWOT Analysis
        16.3.10    UnitedHealth Group
           16.3.10.1 Company Overview
           16.3.10.2 Product Portfolio
           16.3.10.3 Financials
           16.3.10.4 SWOT Analysis
        16.3.11    Wipro Ltd.
           16.3.11.1 Company Overview
           16.3.11.2 Product Portfolio
           16.3.11.3 Financials

List of Figures

Figure 1: Global: Healthcare Fraud Detection Market: Major Drivers and Challenges
Figure 2: Global: Healthcare Fraud Detection Market: Sales Value (in Billion US$), 2016-2021
Figure 3: Global: Healthcare Fraud Detection Market Forecast: Sales Value (in Billion US$), 2022-2027
Figure 4: Global: Healthcare Fraud Detection Market: Breakup by Component (in %), 2021
Figure 5: Global: Healthcare Fraud Detection Market: Breakup by Type (in %), 2021
Figure 6: Global: Healthcare Fraud Detection Market: Breakup by Delivery Mode (in %), 2021
Figure 7: Global: Healthcare Fraud Detection Market: Breakup by Application (in %), 2021
Figure 8: Global: Healthcare Fraud Detection Market: Breakup by End User (in %), 2021
Figure 9: Global: Healthcare Fraud Detection Market: Breakup by Region (in %), 2021
Figure 10: Global: Healthcare Fraud Detection (Software) Market: Sales Value (in Million US$), 2016 & 2021
Figure 11: Global: Healthcare Fraud Detection (Software) Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 12: Global: Healthcare Fraud Detection (Services) Market: Sales Value (in Million US$), 2016 & 2021
Figure 13: Global: Healthcare Fraud Detection (Services) Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 14: Global: Healthcare Fraud Detection (Descriptive Analytics) Market: Sales Value (in Million US$), 2016 & 2021
Figure 15: Global: Healthcare Fraud Detection (Descriptive Analytics) Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 16: Global: Healthcare Fraud Detection (Predictive Analytics) Market: Sales Value (in Million US$), 2016 & 2021
Figure 17: Global: Healthcare Fraud Detection (Predictive Analytics) Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 18: Global: Healthcare Fraud Detection (Prescriptive Analytics) Market: Sales Value (in Million US$), 2016 & 2021
Figure 19: Global: Healthcare Fraud Detection (Prescriptive Analytics) Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 20: Global: Healthcare Fraud Detection (On-premises) Market: Sales Value (in Million US$), 2016 & 2021
Figure 21: Global: Healthcare Fraud Detection (On-premises) Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 22: Global: Healthcare Fraud Detection (On-demand) Market: Sales Value (in Million US$), 2016 & 2021
Figure 23: Global: Healthcare Fraud Detection (On-demand) Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 24: Global: Healthcare Fraud Detection (Insurance Claims Review) Market: Sales Value (in Million US$), 2016 & 2021
Figure 25: Global: Healthcare Fraud Detection (Insurance Claims Review) Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 26: Global: Healthcare Fraud Detection (Payment Integrity) Market: Sales Value (in Million US$), 2016 & 2021
Figure 27: Global: Healthcare Fraud Detection (Payment Integrity) Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 28: Global: Healthcare Fraud Detection (Private Insurance Payers) Market: Sales Value (in Million US$), 2016 & 2021
Figure 29: Global: Healthcare Fraud Detection (Private Insurance Payers) Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 30: Global: Healthcare Fraud Detection (Government Agencies) Market: Sales Value (in Million US$), 2016 & 2021
Figure 31: Global: Healthcare Fraud Detection (Government Agencies) Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 32: Global: Healthcare Fraud Detection (Other End Users) Market: Sales Value (in Million US$), 2016 & 2021
Figure 33: Global: Healthcare Fraud Detection (Other End Users) Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 34: North America: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 35: North America: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 36: United States: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 37: United States: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 38: Canada: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 39: Canada: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 40: Asia-Pacific: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 41: Asia-Pacific: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 42: China: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 43: China: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 44: Japan: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 45: Japan: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 46: India: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 47: India: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 48: South Korea: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 49: South Korea: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 50: Australia: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 51: Australia: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 52: Indonesia: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 53: Indonesia: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 54: Others: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 55: Others: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 56: Europe: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 57: Europe: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 58: Germany: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 59: Germany: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 60: France: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 61: France: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 62: United Kingdom: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 63: United Kingdom: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 64: Italy: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 65: Italy: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 66: Spain: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 67: Spain: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 68: Russia: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 69: Russia: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 70: Others: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 71: Others: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 72: Latin America: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 73: Latin America: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 74: Brazil: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 75: Brazil: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 76: Mexico: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 77: Mexico: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 78: Others: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 79: Others: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 80: Middle East and Africa: Healthcare Fraud Detection Market: Sales Value (in Million US$), 2016 & 2021
Figure 81: Middle East and Africa: Healthcare Fraud Detection Market: Breakup by Country (in %), 2021
Figure 82: Middle East and Africa: Healthcare Fraud Detection Market Forecast: Sales Value (in Million US$), 2022-2027
Figure 83: Global: Healthcare Fraud Detection Industry: SWOT Analysis
Figure 84: Global: Healthcare Fraud Detection Industry: Value Chain Analysis
Figure 85: Global: Healthcare Fraud Detection Industry: Porter's Five Forces Analysis

List of Tables

Table 1: Global: Healthcare Fraud Detection Market: Key Industry Highlights, 2021 and 2027
Table 2: Global: Healthcare Fraud Detection Market Forecast: Breakup by Component (in Million US$), 2022-2027
Table 3: Global: Healthcare Fraud Detection Market Forecast: Breakup by Type (in Million US$), 2022-2027
Table 4: Global: Healthcare Fraud Detection Market Forecast: Breakup by Delivery Mode (in Million US$), 2022-2027
Table 5: Global: Healthcare Fraud Detection Market Forecast: Breakup by Application (in Million US$), 2022-2027
Table 6: Global: Healthcare Fraud Detection Market Forecast: Breakup by End User (in Million US$), 2022-2027
Table 7: Global: Healthcare Fraud Detection Market Forecast: Breakup by Region (in Million US$), 2022-2027
Table 8: Global: Healthcare Fraud Detection Market: Competitive Structure
Table 9: Global: Healthcare Fraud Detection Market: Key Players


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