Healthcare Fraud Detection Market: Current Analysis and Forecast (2021-2027)

Healthcare fraud has led to a significant addition of expenses in the healthcare system. As per GAO (General Accounting Office), 'federal spending on major health care programs to grow from 5.9% of GDP in the fiscal year 2020 to 8.0% of GDP in the fiscal year 2050'. The enormous volume of money involved in the healthcare sector and its size make it an attractive fraud target.

The demand for healthcare fraud detection is increasing on account of rising patients number applying for health insurance, an increase in the number of frauds in pharmacy bills etc. Social media influence on the healthcare industry, speedy acceptance of cloud-based analytical solutions, AI effects in the healthcare services, and increase in the number of fraud identity management software propel the market growth. However, some of the restraints in the market include lack of skilled personnel, reluctance to adopt healthcare fraud analytics paired with high upfront cost of deployment.

Based on components, the market is fragmented into Services and Software. The healthcare fraud detection market is expected to record the high growth owing to advancements in software technology, a high adoption rate of fraud detection software by insurance companies, rise in software availability in the developed regions, among others. For instance, healthcare cloud has launched patient analytics software for the tracking of patient outcomes and utilizes extensive database and proprietary analytics to recommend procedures based on patient comorbidities. The software segment generated revenue of USD XX million in 2020 and is expected to grow at a CAGR of XX% during the forecast period to reach a market valuation of USD XX million by 2027F.

Based on delivery models, the market is bifurcated into on-premises and on-demand delivery model. On-premises delivery model is expected to record highest growth owing to high flexibility, pay-as-you-go pricing, and the lack of upfront capital investments for hardware. The On-premises delivery model generated revenue of USD XX million in 2020 and is expected to grow at a CAGR of XX% during the forecast period to reach a market valuation of USD XX million by 2027F.

Based on solutions type, the market is divided into descriptive analytics, predictive analytics, and prescriptive analytics. Descriptive analytics holds the major share owing to its high assistance in predictive and prescriptive analytics. For instance, Vidence and NTT DATA announced a partnership to deliver predictive analytics in oncology. This collaboration will make use of a combination of medical imaging scans, clinical and outcomes data to build a predictive model that will improve treatment regimens.

Based on applications, the market is segmented into insurance claims, payment integrity, pharmacy bill and others. The review of insurance claims holds the largest share owing to a high number of people seeking health insurance, an increase in the uptake of the prepayment review model amongst the patients, an increase in fraud activities, and the rising need to control these frauds. For instance, Care Shield insurance announced the launch of Care Shield, which will cover numerous medical expenses and the protection of No Claim Bonus (NCB) benefit from lapsing.

Based on end-user, the market is fragmented into private insurance payers, government agencies, third-party service providers, and others. Government agencies dominates the market on account of rising fraudulent activities coupled with emerging need for data security. For instance, Criminal Division, Fraud Section's Health Care Fraud (HCF) Unit is comprised of more than 70 prosecutors whose core mission is to prosecute health care fraud-related cases involving patient harm and huge financial loss.

For a better understanding of the adoption of Healthcare Fraud Analytics, the market is analyzed based region/ countries including North America (US, Canada, and the Rest of North America), Europe (Germany, France, Italy, Spain, UK, and Rest of Europe), Asia-Pacific (China, Japan, India, Australia, and Rest of APAC), and Rest of World. North America dominates the healthcare fraud analytics market in 2020, on account of the rising number of people seeking health insurance, rising fraudulent activities, and rise in government anti-fraud initiatives and advancements in technology. As per the National Healthcare Anti-Fraud Association (NHCAA), health care fraud costs the U.S. nearly USD 68 billion every year.

Some of the major players operating in the market include IBM Corporation, Optum, Inc., COTIVITI, INC., McKesson Corporation, Fair Isaac Corporation, SAS Institute Inc., SCIO Inspire, Corp., Conduent, Inc., HCL Technologies Limited, CGI Inc., DXC Technology Company, and Northrop Grumman, etc. Several M&As along with partnerships have been undertaken by these players to boost their presence in different regions.

Global Healthcare Fraud Detection Market was valued at USD XX million in 2020 and is projected to expand significantly with a CAGR of XX% from 2021F to 2027F. The Global Healthcare Fraud Detection Market is expected to witness a boost on account of rising patients number applying for health insurance, an increase in the number of frauds in pharmacy, healthcare, and high returns on investment.