Healthcare Fraud Detection Market Research Report - Global Forecast till 2027

Global Healthcare Fraud Detection Market: Information By Type (Descriptive Analytics, Predictive Analytics and Prescriptive Analytics), By Component (Services and Software), By Delivery Model (On-Premise and Cloud-Based), By Application (Insurance Claims Review and Payment Integrity), By End User (Private Insurance Payers, Public/Government Agencies and Third Party Service Providers) - Forecast till 2027

ID: MRFR/HCIT/4215-CR | September 2019 | Region: Global | 160 pages

Market Overview

Market Research Future (MRFR) evaluates that the Global Healthcare Fraud Detection Market can attain a strong valuation of USD 3,787.68 Million by 2024.

COVID-19 Analysis

Following the COVID-19 outbreak, healthcare IT has been at the epicentre of a host of challenges posed by the pandemic worldwide. Virtual care and data technologies along with healthcare IT systems such as digitalization, analytical technologies and more have backed the healthcare IT market during the novel coronavirus outbreak. Healthcare fraud detection solutions have been observing a higher demand since the lockdown, given the rising need for solutions that have biometric sensors to identify frauds. The alarming surge in unauthorized payments and other threats following the SARS-CoV-2 pandemic has also bolstered the demand for healthcare fraud detection services and solutions.

Market Dynamics


Expanding Patient Pool Opting for Healthcare Insurance to Benefit the Market

Burgeoning patient pool opting for health care insurance, alarming rise in fraudulent events in the healthcare industry, and the rising pressure to track abuse and fraud in healthcare are some of the top growth boosters in the global market.

A few other encouraging factors include the growing number of healthcare BPO, introduction of cutting edge fraud identity management software, rising adoption of cloud-based analytical solutions and social media’s significant influence on the healthcare industry. The surging integration of artificial intelligence (AI) in healthcare solutions and services could also work in the favor of the global healthcare fraud detection market.


Developing Countries to Provide Attractive Opportunities

Supportive initiatives taken up by governments to bolster the healthcare IT industry could be an attractive opportunity for healthcare fraud detection firms in the coming years. The surge in funding for the implementation of several IT platforms in the healthcare industry will create a host of growth avenues for the leading vendors during the evaluation period.


Low Awareness Level in Emerging Countries to be a Restraint

Lower awareness level regarding healthcare fraud analytics solutions in emerging countries is expected to restrain the market growth in the near future.


Reluctance among Companies to Challenge Market Growth

Dearth of skilled professionals to deal with the healthcare fraud detection technology, and the companies unwilling to adopt new technologies could be key challenges surrounding the global industry.

Cumulative Growth Analysis

Market Share Set to Thrive at a Strong Rate

MRFR believes that the Healthcare Fraud Detection Market can soar at a significant rate of 28.83% during the forecast period from 2019 to 2024, in view of the surge in fraudulent events within the healthcare industry and the expanding pool of patients taking up healthcare insurance.

Segment Overview

Descriptive Analytics Type Captures the Highest Share

Various types of healthcare fraud detection solutions in the market are predictive analytics, prescriptive analytics and descriptive analytics. Between these, the descriptive analytics segment owns the biggest share in the global market as these types facilitate efficient application of prescriptive or predictive analytics.

Software Segment to be in the Lead

Key components covered in the report are software and services. The healthcare fraud detection software market is growing at a stable rate thanks to the emergence of technically advanced software and the resultant surge in their demand.

Insurance Claims Review Segment Seizes the Biggest Share

The main applications of healthcare fraud detection solutions are insurance claims review as well as payment integrity. In the lead is the insurance claims review segment, with the biggest share in the healthcare fraud analytics market due to the soaring number of people opting for health insurance, surge in fraudulent claims, and the escalating uptake of prepayment review model among patients.

Public/Government Agencies Segment to Secure the Lead

Public/government agencies, third-party service providers and private insurance payers are the key end-users listed in the report. Public/government agencies are expected to be the top market end-users in the coming years.

Regional Analysis

America to Emerge as the Most Lucrative Market

The Americas, 2018, took the lead with the biggest share of 49.97% in the global industry. Americas has emerged as a lucrative market, in view of the rising use of technically innovative products, supportive reimbursement policies, and the rising spending on healthcare analytical services. An expansive pool of world-renowned players that offer an extensive range of healthcare fraud detection solutions also bolsters the market share in the region.

Europe Secures the Second Position

Europe has landed the second spot in the medical fraud detection management system market, thanks to the surging adoption of cloud-based analytic solutions, social media’s rising influence on the healthcare sector, and the growing integration of artificial intelligence in various healthcare solutions and services.

APAC to Procure a Significant Growth Rate

The Asia Pacific healthcare fraud detection market size is expanding on the back of the soaring number of government anti-fraud initiatives, growing need to cut down healthcare costs, technological advances, and increasing service and product availability. Rising threats in the region, especially in India and China, has boosted the focus of major companies on developing advanced healthcare fraud prevention services, which helps foster market growth. Moreover, growing popularity of medical tourism and rising demand in the pharmaceutical industry can emerge as key healthcare fraud detection market trends in the region.

Competitive Landscape

Competition Rises as Major Companies Focus on Technical Advances

Technological innovations and launch of new solutions and services are some of the major parameters leading to intense competition in the fraud in healthcare industry. Many of the companies are focused on bolstering their portfolio of medical fraud prevention solutions, while also adopting strategies like partnerships, acquisitions, and mergers to stay competitive.

Optum is a well-renowned brand in the healthcare fraud detection software market, with its Optum Program Integrity Solutions delivering insightful intelligence. The system helps generate information that assists end-users in preventing inappropriate payments, identify suspicious activity, and boost recoveries. The company has made a huge name in the healthcare fraud analytics market, offering advanced solutions that are designed primarily for Medicaid in the US.

List of Key Companies Covered in this Report

  • DXC Technology Company


  • SAS Institute Inc.


  • EXLSERVICE Holdings Inc.

  • International Business Machines Corporation (IBM)


  • McKesson Corporation


  • FAIR ISAAC Corporation and LEXISNEXIS

Recent Developments

  • October 2020 – Fiserv has launched an intelligent fraud detection system, Advance Defense that caters to card issuers for reducing losses while bolstering cardholder spend for a complete set of card types.

  • November 2020 – LexisNexis Risk Solutions released LexisNexis Emailage, an innovative fraud risk scoring service backed by email intelligence, which enables companies deliver a smooth user experience with extensive fraud detection as well as prevention capacity. The solution helps address these issues by letting organizations effectively analyze risks, facilitate faster transactions and efficiently tackle quickly evolving fraud tactics during digital transactions.

Report Overview

Scope of the Report

Healthcare fraud detection software market, healthcare fraud detection market trends, healthcare fraud detection market size, healthcare and fraud solutions, healthcare fraud detection solutions, medical fraud detection management system market are some of the top parameters considered in the scope of the report. MRFR report extensively covers the global healthcare fraud detection market, with respect to type, component, delivery model, application and regions.               

Segmentation Table

By Type

  • Descriptive Analytics

  • Predictive Analytics

  • Prescriptive Analytics

Global Healthcare Fraud Detection Market, By Component         

  • Services

  • Software

Global Healthcare Fraud Detection Market, By Delivery Model

  • On-Premise

  • Cloud-Based

Global Healthcare Fraud Detection Market, By Application

  • Insurance Claims Review

  • Payment Integrity

Global Healthcare Fraud Detection Market, By End User

  • Private Insurance Payers

  • Public/Government Agencies

  • Third-Party Service Providers

Report Scope:
Report Attribute/Metric Details
  Market Size   USD 3,787.68 Million
  CAGR   28.83%
  Base Year   2016
  Forecast Period   2027
  Historical Data   2015
  Forecast Units   Value (USD Million)
  Report Coverage   Revenue Forecast, Competitive Landscape, Growth Factors, and Trends
  Segments Covered   Type, Component, Delivery Model, Application, End User
  Geographies Covered   North America, Europe, Asia-Pacific, and Rest of the World (RoW)
  Key Vendors   DXC Technology Company, UNITEDHEALTH group, SAS Institute Inc., WIPRO LIMITED, EXLSERVICE Holdings Inc., International Business Machines Corporation (IBM), COTIVITI INC., McKesson Corporation, CGI INC, FAIR ISAAC Corporation and LEXISNEXIS
  Key Market Opportunities

  • Supportive initiatives taken up by governments
  • Surge in funding for the implementation of several IT platforms
  •   Key Market Drivers

  • Healthcare Insurance
  • Rise in fraudulent events in healthcare industry
  • Rising adoption of cloud-based analytical solutions

  • Frequently Asked Questions (FAQ) :

    Healthcare Fraud Detection Market is predicted to touch USD 3,787.68 million by 2024.

    Healthcare Fraud Detection Market is projected to grow at a 28.83% CAGR between 2016-2024.

    Americas is projected to dominate in the Healthcare Fraud Detection Market.

    It finds extensive applications in Payment Integrity and Insurance Claims Review.

    Unwillingness of various end users to use Healthcare Fraud analytics systems may deter market growth.