Increasing Global Demand For Healthcare Fraud Analytics Market With Rising CAGR Forecast Till 2030

Posted by Mrudula Anil Karmarkar on October 19th, 2022

The global healthcare fraud analytics market size is expected to reach USD 11.2 billion by 2030, according to a new report by Grand View Research, Inc. The market is projected to advance at a CAGR of 24.3% from 2022 to 2030. The rising incidence of fraudulent activities in the healthcare sector, increasing number of patients seeking health insurance, high returns on investment, and the increasing number of pharmacy claims-related frauds are the major drivers propelling the market growth.

The COVID-19 pandemic has drastically affected the healthcare industry. The healthcare industry has observed various fraud cases on the part of doctors, patients, physicians, and other healthcare specialists. It is observed that many medical specialists and healthcare providers are engaged in fraudulent activities for profit gains. Many instances prove the increasing number of fraud cases during the COVID-19 pandemic.

The adoption of software used for fraud detection by insurance companies is increasing due to the rising availability of the same in developed regions. For instance, in February 2022, The Canadian Life and Health Insurance Association (CLHIA) launched an industry initiative to pool claims data and use advanced artificial intelligence tools which enhance the investigation and detection of benefits fraud. Moreover, in June 2021, Artivatic launched the Alfred- AI Health Claims platform. This platform automates end-to-end health claims, and the abuse & fraud detection capacity is almost 30% or more. Moreover, it enables users to self-learn and develop a system for decision-making, risk assessment, and fraud detection. This growth in the availability of the software is because of increasing healthcare expenditure, which triggers the companies to come up with a product or service to meet the market demand.

The rising incidence of fraudulent activities in the healthcare sector drives the market globally. For example, according to data published by the National Library of Medicine, the fraudulent activities count raised from 30 in 2022 to 52 in the year 2021. The market is highly competitive and consists of several major players. With the rising adoption of healthcare IT solutions and the increasing number of fraud cases, smaller or private players are anticipated to enter the market in the coming years. Initiatives like collaborations or partnerships with local players, acquisitions, or new product launches by market players contribute to the market growth. For example, in April 2022, HCL Technologies Limited launched the CyberSecurity Fusion Center in Texas, U.S., and expanded its U.S. operations with the CyberSecurity Center.

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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.

Healthcare Fraud Analytics Market Report Highlights

• In terms of revenue, the descriptive analytics segment dominated the solution type segment with a share of around 40.5% in 2021, owing to its high penetration
• Based on the delivery model, the on-premise segment is expected to show lucrative growth during the forecast period, owing to its higher deployment as compared to the cloud-based delivery model
• Insurance claims review dominated the application segment with a share of around 35% as of 2021. The growth can be attributed to the rising adoption of health insurance
• The employers' segment is expected to show the fastest growth during the forecast period, owing to the increasing demand for healthcare fraud analytics software by employers for better cost management
• The North American region accounted for the largest market share of around 38% in 2021, owing to the presence of major market players in the region 

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.

List of Key Players in the Healthcare Fraud Analytics Market

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