Healthcare Fraud Analytics Market size is expected to reach USD 11.2 billion by 2030

 Healthcare Fraud Analytics Industry Overview

The global healthcare fraud analytics market size was valued at USD 1.63 billion in 2021 and is estimated to expand at a compound annual growth rate (CAGR) of 24.3% from 2022 to 2030.

The increasing penetration of health insurance, coupled with the rising number of fraud cases in the healthcare industry, are factors driving the market growth. Furthermore, the growing focus on curbing healthcare costs, as well as the technological advancements to launch advanced analytical techniques, are also expected to fuel the market growth.

Gather more insights about the market drivers, restrains and growth of the Global Healthcare Fraud Analytics Market

 

According to IBM Security’s X-Force Threat Intelligence Index, during the COVID-19 pandemic, the number of breached records and the severity of these breaches grew exponentially, despite an overall decline in the number of breach incidents across private and public sectors. This resulted in the adoption of healthcare fraud analytics software and services during the pandemic as well, hence supporting the market growth in 2020 and 2021.

As per the National Healthcare Anti-Fraud Association, every year payers spend nearly USD 68 billion due to fraud in the U.S. The risk of a nonexistent or unnecessary medical service owing to misrepresentation by providers or patients becomes an expensive investment.

Instead of investing in seeking out the bad areas, clinicians and medical consultants can focus on improving access to resources for chronic and urgent care, which can improve the quality of care by using data science, machine learning, and artificial intelligence-based solutions. Thus, the adoption of technologically advanced solutions drives the market growth.

According to an article published by Elsevier Inc., more than USD 700 billion are lost due to fraud, waste, or abuse in the healthcare system of the U.S. One of the most vulnerable targets for fraud in the past few years has been Medicaid. This is due to limited cross-program communication, a distributed management model, and a difficult-to-track patient population of low-income adults & their children. The use of effective fraud analytics solutions can help in curbing these high costs, thus boosting the market growth during the projection period.

Illegal medical billings with falsified claims, filing of multiple claims by different providers for the same patient, patient identity thefts & use for gaining reimbursement, and collusion between unprincipled providers & their patients, are some of the common healthcare fraud examples. According to a GAO report published in 2016, around 68% of all healthcare frauds are due to false billings and the providers are complicit in 62% of these cases, while patients are complicit in 14% of them. Such factors are expected to fuel the demand for advanced healthcare fraud analytics solutions.

Browse through Grand View Research's Healthcare IT Industry Research Reports

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Key Companies Profile

Some of the key players in the global healthcare fraud analytics market include:  

  • IBM
  • Optum, Inc.
  • Cotiviti, Inc
  • DXC Technology
  • SAS Institute, Inc.
  • EXL Service Holdings, Inc.
  • Wipro Limited
  • Conduent, Inc
  • HCL Technologies Limited
  • OSP Labs 

 

Order a free sample PDF of Healthcare Fraud Analytics Market Intelligence Study, published by Grand View Research. 

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