Global Healthcare Fraud Detection Market – Industry Trends - Forecast to 2026

  • Medical Devices
  • Upcoming Report
  • May 2019
  • Global
  • 350 Pages
  • No of Tables: 60
  • No of Figures: 220

Global Healthcare Fraud Detection Market By Component (Services, Software), Delivery Mode (On-Premise Delivery Models, On-Demand Delivery Models), Type (Descriptive Analytics, Predictive Analytics, Prescriptive Analytics), Application (Insurance Claims Review, Payment Integrity, Other Application), End-User (Private Insurance Payers, Public/Government Agencies, Third-Party Service Providers, Employers), Geography (North America, South America, Europe, Asia-Pacific, Middle East and Africa) – Industry Trends & Forecast to 2026

Market Analysis: Global Healthcare Fraud Detection Market

Global Healthcare Fraud Detection Market is expected to rise from its initial estimated value of USD 840.39 million to an estimated value of USD 6432.7 million by 2026, registering a CAGR of 28.97% in the forecast period of 2019-2026. Rising fraudulent activities is the major factor for the growth of this market.

Market Definition: Global Healthcare Fraud Detection Market

Healthcare fraud detection is specially designed to prevent healthcare frauds, abuse and waste so that any unauthorized payment and benefits can be avoided. They are usually used to avoid misrepresenting dates, falsification of data by physicians, submitting claims for services not provided etc. Increasing fraudulent activities in healthcare is the major factor fueling the growth of this market.

Market Drivers

  • Rising population adapting health insurance is driving the growth of this market
  • Increasing fraud and abuse on healthcare spending is another factor driving the market

Market Restraints

  • Less adoption of Healthcare Fraud Analytics is restraining the growth of this market.
  • Lack of skilled and trained profession is another factor restraining market

Segmentation: Global Healthcare Fraud Detection Market

By Component

  •  Services
  •  Software

By Delivery Mode

  •  On-Premise Delivery Models
  •  On-Demand Delivery Models

By Type

  •  Descriptive Analytics
  •  Predictive Analytics
  •  Prescriptive Analytics

By Application

  •  Insurance Claims Review

    • Post payment Review
    • Prepayment Review

  •  Payment Integrity
  •  Other Application

By End- User

  •  Private Insurance Payers
  •  Public/Government Agencies
  •  Third-Party Service Providers
  •  Employers

By Geography

  • North America

    • US.
    • Canada
    • Mexico

  • South America

    • Brazil
    • Argentina
    • Rest of South America

  • Europe

    • Germany
    • France
    • United Kingdom
    • Italy
    • Spain
    • Russia
    • Turkey
    • Belgium
    • Netherlands
    • Switzerland
    • Rest of Europe

  • Asia-Pacific

    • Japan
    • China
    • South Korea
    • India
    • Australia
    • Singapore
    • Thailand
    • Malaysia
    • Indonesia
    • Philippines
    • Rest of Asia-Pacific

  • Middle East & Africa

    • South Africa
    • Egypt
    • Saudi Arabia
    • United Arab Emirates
    • Israel
    • Rest of Middle East & Africa

Key Developments in the Market:

  • In February 2018, DOJs Healthcare fraud unit announced the launch of their new data analytics team so that they can manage the health care frauds. The main aim is to see address and manage the new frauds trends in the country.
  • In June 2018, Wipro Limited announced the launch of their end-to-end solution to address the issue of fraud, waste, and abuse in healthcare insurance which will also have Opera Solutions’ powerful AI and machine. This new solution examines the audits, recovery follow up, payment posting and adjustments. The main aim of the launch is to reduce the number of false risk rates and improve the high- risk claims.

Competitive Analysis:

Global healthcare fraud detection market is highly fragmented and the major players have used various strategies such as new product launches, expansions, agreements, joint ventures, partnerships, acquisitions, and others to increase their footprints in this market. The report includes market shares of healthcare fraud detection market for global, Europe, North America, Asia-Pacific, South America and Middle East & Africa.

Key Market Competitors:

Few of the major competitors currently working in the healthcare fraud detection market are IBM Corporation, Optum, Inc., COTIVITI, INC., McKesson Corporation, Fair Isaac Corporation, SAS Institute Inc., SCIOInspire, Corp., Conduent, Inc., HCL Technologies Limited, CGI Inc.,  DXC Technology Company, Northrop Grumman, LexisNexis, Pondera Solutions, Wipro.

Research Methodology: Global Healthcare Fraud Detection Market

Data collection and base year analysis is done using data collection modules with large sample sizes. The market data is analysed and forecasted using market statistical and coherent models. Also market share analysis and key trend analysis are the major success factors in the market report. To know more please Request an Analyst Call or can drop down your inquiry.

The key research methodology used by DBMR Research team is data triangulation which involves data mining, analysis of the impact of data variables on the market, and primary (industry expert) validation. Apart from this, other data models include Vendor Positioning Grid, Market Time Line Analysis, Market Overview and Guide, Company Positioning Grid, Company Market Share Analysis, Standards of Measurement, Top to Bottom Analysis and Vendor Share Analysis. To know more about the research methodology, drop in an inquiry to speak to our industry experts.

Primary Respondents

Demand Side: Doctors, Surgeons, Medical Consultants, Nurses, Hospital Buyers, Group Purchasing Organizations, Associations, Insurers, Medical Payers, Healthcare Authorities, Universities, Technological Writers, Scientists, Promoters, and Investors among others.

Supply Side: Product Managers, Marketing Managers, C-Level Executives, Distributors, Market Intelligence, and Regulatory Affairs Managers among others.

Reasons to Purchase this Report

  • Current and future of global healthcare fraud detection market outlook in the developed and emerging markets
  • The segment that is expected to dominate the market as well as the segment which holds highest CAGR in the forecast period
  • Regions/Countries that are expected to witness the fastest growth rates during the forecast period
  • The latest developments, market shares, and strategies that are employed by the major market players

Customization of the Report:

  • All segmentation provided above in this report is represented at country level
  • All products covered in the market, product volume and average selling prices will be included as customizable options which may incur no or minimal additional cost (depends on customization)


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