The global healthcare fraud analytics market size is expected to be USD 11,909 million by 2030, rising at 25.50% CAGR between 2022 and 2030. One of the main drivers for the market is the rising healthcare costs across the world, which leads people toward medical insurance, coupled with the increasing number of fraud cases in the medical industry. Moreover, with the advancements in the IT sector, the detection of fraudulent activity is becoming easy, in part, driven by the initiatives for the launch of advanced analytical techniques.
Some of the most-prevalent frauds in the medical industry are illegal medical billings with false claims, different care providers filing of claims for the same patient, and theft of patient identity and its illegal usage to gain reimbursement. According to a statement published by the National Healthcare Anti-Fraud Association, payers spend approximately USD 68 billion due to fraud in the U.S. each year. Hence, the utilization of analytics software for healthcare frauds, for cutting down this added expense, drives the market.
Additionally, the IBM Security X-Force Threat Intelligence Index says that healthcare is the sixth-most-attacked industry by fraudsters and that during the COVID-19 epidemic, the number of breached records and the severity of these breaches grew exponentially. This has been driving the acceptance of such scam analytics software and services, in turn, supporting the growth of market in the future as well.
The public & government agencies category dominated the end user segment, with a share of 42%, in 2022, and it will occupy the top position throughout this decade. This is owing to the rising expenditure on the setup of new hospitals, high patient count in government hospitals, and the high risk of fraud government agencies are at due to their usage of technologically primitive infrastructure, particularly in the developing nations. However, owing to the high financial losses public and government healthcare bodies suffer due to fraud, their focus on screening for such incidents before processing claims is propelling the market in the current scenario.
Moreover, the private insurance payers category is expected to grow at the highest CAGR during the projection period, as a result of employers’ rising adoption of healthcare fraud analytics for better cost management.
Geographically, the Asia-Pacific region is expected to see the quickest advance over this decade. This is credited to the surging investment by overseas and domestic medical insurance firms, a large patient base, and a shift in government policies in favor of reducing medical frauds. Moreover, the substantial number of people with health coverage raises the chances of healthcare fraud with an objective of getting the lump sum insurance amount.
Moreover, medical regulatory authorities in this region are taking strategic initiatives to tackle such wrongdoing, but it is not enough, as the healthcare fraud analytics systems need to be incorporated into a rather expansive and dispersed medical infrastructure, to methodically put an end to such fraud by both patients and healthcare authorities.
Some of the major solution providers in the global healthcare fraud analytics market are International Business Machines Corporation, Optum Inc., COTIVITI INC., EXL Service Holdings Inc., SAS Institute Inc., Wipro Limited, Conduent Inc., Healthcare Fraud Shield, CGI Inc., and FraudLens Inc.