Dublin, March 12, 2024 (GLOBE NEWSWIRE) -- The "Healthcare Fraud Detection Global Market Report 2024" report has been added to ResearchAndMarkets.com's offering.
The global healthcare fraud detection market has grown exponentially in recent years. It will grow from $2.78 billion in 2023 to $3.6 billion in 2024 at a compound annual growth rate (CAGR) of 29.3%. During the historical period, growth can be credited to the rise in cyber threats, enhanced patient identity verification, intensified market competition, improved detection of fraudulent claims, and heightened awareness and training efforts.
The global healthcare fraud detection market is expected to see exponential growth in the next few years. It will grow to $10.35 billion in 2028 at a compound annual growth rate (CAGR) of 30.2%. During the projected period, growth is expected due to regulatory shifts, heightened digital adoption, more complex fraud tactics, a concentrated effort on combating insurance fraud, and improvements in data security. Key trends anticipated during this period encompass the integration of advanced technology, real-time monitoring capabilities, the use of behavioral analytics, leveraging blockchain for security purposes, and enhancing patient identity verification.
The anticipated surge in fraudulent activities within the healthcare sector is poised to be a driving force behind the healthcare fraud detection market. In 2021 alone, the Department of Justice (DOJ) initiated 831 new criminal health care fraud investigations and 805 new civil health care fraud investigations. In fiscal year 2021, 336 health care fraud offenders, constituting 8% of total theft, property damage, and fraud charges, were identified according to data from the United States Sentencing Commission in August 2022. Consequently, the uptick in fraudulent activities within the healthcare industry is set to fuel growth in the healthcare fraud detection market.
The ongoing digital revolution in healthcare is projected to be a significant driver of growth in the healthcare fraud detection domain. For example, in 2021, nearly all non-federal acute care hospitals (96%) and about 78% of office-based physicians in the United States embraced certified EHR systems, as per HealthIT.gov. Consequently, the escalating digital revolution in healthcare propels the expansion of the healthcare fraud detection market.
The adoption of advanced analytics tools emerges as a significant trend gaining traction within the healthcare fraud detection landscape. Key industry players are channeling efforts into crafting innovative technologies to maintain their foothold in the healthcare fraud detection sphere. For instance, in January 2022, Premier, Inc., a US-based healthcare technology company, introduced 'INSights' built upon PINC AITM technology. INSights stand as a vendor-neutral analytics platform harnessing risk-adjusted, standardized, and cleansed healthcare data from PINC AITM. Tailored for healthcare providers, INSights aim to alleviate the burden associated with data preparation and analytics development, enabling rapid improvements in clinical, quality, and financial outcomes.
Leading companies within the healthcare fraud detection arena are innovating new insurance fraud detection solutions to gain a competitive edge. For example, in June 2023, Verisk Analytics, Inc., a US-based analytics company, collaborated with Kyndryl Holdings, Inc. to introduce an advanced technology suite targeting insurance fraud prevention in Israel's compulsory insurance market. Leveraging Kyndryl's robust computing resources and Verisk's domain expertise, this solution fortified the anti-fraud engine for real-time monitoring of auto claims concerning bodily injury. Supported by round-the-clock managed services and advanced analytics, the system verified applicant details against databases and government sources, facilitating comprehensive data investigations for insurance claim adjusters. This collaboration aimed to streamline claims processes, detect potential fraud, and meet evolving consumer expectations in the digitized insurance landscape.
In January 2021, Cedar Gate Technologies, a US-based company specializing in prescriptive analytics and healthcare performance management, successfully acquired Enli Health Intelligence. This strategic acquisition, completed for an undisclosed sum, bolstered Cedar Gate's enterprise value-based care platform by integrating Enli's population, cohort, and patient management technologies. This incorporation aimed to enhance outcomes and long-term financial performance by introducing critical features such as risk and quality measurement, identification of care gaps, and opportunities for patient outreach.
North America was the largest region in the healthcare fraud detection market in 2023. The regions covered in the healthcare fraud detection market report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East, Africa. The countries covered in the healthcare fraud detection market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA, Canada, Italy, Spain.
Report Scope
Markets Covered:
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
Key Companies Mentioned: International Business Machines Corporation; Cotiviti Inc.; Fair Isaac Corporation; SAS Institute Inc.; CGI Inc
Time Series: Five years historic and ten years forecast
Data: Ratios of market size and growth to related markets, GDP proportions, expenditure per capita
Data Segmentation: Country and regional historic and forecast data, market share of competitors, market segments
A selection of companies mentioned in this report includes:
- 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
For more information about this report visit https://www.researchandmarkets.com/r/d5mzue
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