헬스케어 부정 탐지 시장 보고서 : 컴포넌트, 유형, 제공 모드, 용도, 최종사용자, 지역별(2024-2032년)

The global healthcare fraud detection market size reached US$ 2.5 Billion in 2023. Looking forward, IMARC Group expects the market to reach US$ 14.0 Billion by 2032, exhibiting a growth rate (CAGR) of 20.7% during 2024-2032.

Healthcare fraud detection aids in detecting and preventing healthcare fraud, waste, and abuse at every stage of the claim process and reducing inappropriate payments. It connects existing payment integrity solutions and consolidates data from internal and external sources, such as claims systems, watch lists, third parties, and unstructured texts for efficient data management. It relies on various advanced analytic and artificial learning (AI) techniques, including modern statistical, machine learning (ML), deep learning, and text analytics algorithms. Apart from this, it uses a flexible process to assist operational, clinical, and investigative evaluations and store all relevant case information.

Healthcare Fraud Detection Market Trends:

Due to an increase in the number of patients seeking health insurance, there is a rise in the demand for healthcare fraud detection solutions. This, along with the growing prepayment review model in the healthcare industry, represents one of the key factors driving the market. Moreover, the increasing number of pharmacy claims-related frauds across the globe is propelling the growth of the market. In addition, there is a rise in the demand for solutions that have biometric sensors to identify frauds. This, coupled with the growing adoption of healthcare fraud analytics, especially in developing countries, is positively influencing the market. Besides this, the increasing integration of artificial intelligence (AI) in healthcare fraud detection is offering lucrative growth opportunities to industry investors. Apart from this, governments of several countries are undertaking initiatives to review healthcare insurance claims and save money of consumers and nations. In line with this, the burgeoning healthcare industry is bolstering the growth of the market. Other growth-inducing factors are the increasing returns on investment (ROI), rising use of social media, and funding for the implementation of several information and technology (IT) platforms.

Key Market Segmentation:

IMARC Group provides an analysis of the key trends in each sub-segment of the global healthcare fraud detection market report, along with forecasts at the global, regional and country level from 2024-2032. Our report has categorized the market based on component, type, delivery mode, application and end user.

Breakup by Component:

Software

Services

Breakup by Type:

Descriptive Analytics

Predictive Analytics

Prescriptive Analytics

Breakup by Delivery Mode:

On-premises

On-demand

Breakup by Application:

Insurance Claims Review

Payment Integrity

Breakup by End User:

Private Insurance Payers

Government Agencies

Others

Breakup by Region:

North America

United States

Canada

Asia-Pacific

China

Japan

India

South Korea

Australia

Indonesia

Others

Europe

Germany

France

United Kingdom

Italy

Spain

Russia

Others

Latin America

Brazil

Mexico

Others

Middle East and Africa

Competitive Landscape:

The competitive landscape of the industry has also been examined along with the profiles of the key players being CGI Inc., Conduent Inc., ExlService Holdings Inc., Fair Isaac Corporation, HCL Technologies Limited, International Business Machines Corporation, Northrop Grumman Corporation, RELX Group plc, SAS Institute Inc., UnitedHealth Group and Wipro Ltd.

Key Questions Answered in This Report:

• How has the global healthcare fraud detection market performed so far and how will it perform in the coming years?
• What has been the impact of COVID-19 on the global healthcare fraud detection market?
• What are the key regional markets?
• What is the breakup of the market based on the component?
• What is the breakup of the market based on the type?
• What is the breakup of the market based on the delivery mode?
• What is the breakup of the market based on the application?
• What is the breakup of the market based on the end user?
• What are the various stages in the value chain of the industry?
• What are the key driving factors and challenges in the industry?
• What is the structure of the global healthcare fraud detection market and who are the key players?
• What is the degree of competition in the industry?

Table of Contents

1 Preface

2 Scope and Methodology

• 2.1 Objectives of the Study
• 2.2 Stakeholders
• 2.3 Data Sources
  • 2.3.1 Primary Sources
  • 2.3.2 Secondary Sources
• 2.4 Market Estimation
  • 2.4.1 Bottom-Up Approach
  • 2.4.2 Top-Down Approach
• 2.5 Forecasting Methodology

3 Executive Summary

4 Introduction

• 4.1 Overview
• 4.2 Key Industry Trends

5 Global Healthcare Fraud Detection Market

• 5.1 Market Overview
• 5.2 Market Performance
• 5.3 Impact of COVID-19
• 5.4 Market Forecast

6 Market Breakup by Component

• 6.1 Software
  • 6.1.1 Market Trends
  • 6.1.2 Market Forecast
• 6.2 Services
  • 6.2.1 Market Trends
  • 6.2.2 Market Forecast

7 Market Breakup by Type

• 7.1 Descriptive Analytics
  • 7.1.1 Market Trends
  • 7.1.2 Market Forecast
• 7.2 Predictive Analytics
  • 7.2.1 Market Trends
  • 7.2.2 Market Forecast
• 7.3 Prescriptive Analytics
  • 7.3.1 Market Trends
  • 7.3.2 Market Forecast

8 Market Breakup by Delivery Mode

• 8.1 On-premises
  • 8.1.1 Market Trends
  • 8.1.2 Market Forecast
• 8.2 On-demand
  • 8.2.1 Market Trends
  • 8.2.2 Market Forecast

9 Market Breakup by Application

• 9.1 Insurance Claims Review
  • 9.1.1 Market Trends
  • 9.1.2 Market Forecast
• 9.2 Payment Integrity
  • 9.2.1 Market Trends
  • 9.2.2 Market Forecast

10 Market Breakup by End User

• 10.1 Private Insurance Payers
  • 10.1.1 Market Trends
  • 10.1.2 Market Forecast
• 10.2 Government Agencies
  • 10.2.1 Market Trends
  • 10.2.2 Market Forecast
• 10.3 Others
  • 10.3.1 Market Trends
  • 10.3.2 Market Forecast

11 Market Breakup by Region

• 11.1 North America
  • 11.1.1 United States
    • 11.1.1.1 Market Trends
    • 11.1.1.2 Market Forecast
  • 11.1.2 Canada
    • 11.1.2.1 Market Trends
    • 11.1.2.2 Market Forecast
• 11.2 Asia-Pacific
  • 11.2.1 China
    • 11.2.1.1 Market Trends
    • 11.2.1.2 Market Forecast
  • 11.2.2 Japan
    • 11.2.2.1 Market Trends
    • 11.2.2.2 Market Forecast
  • 11.2.3 India
    • 11.2.3.1 Market Trends
    • 11.2.3.2 Market Forecast
  • 11.2.4 South Korea
    • 11.2.4.1 Market Trends
    • 11.2.4.2 Market Forecast
  • 11.2.5 Australia
    • 11.2.5.1 Market Trends
    • 11.2.5.2 Market Forecast
  • 11.2.6 Indonesia
    • 11.2.6.1 Market Trends
    • 11.2.6.2 Market Forecast
  • 11.2.7 Others
    • 11.2.7.1 Market Trends
    • 11.2.7.2 Market Forecast
• 11.3 Europe
  • 11.3.1 Germany
    • 11.3.1.1 Market Trends
    • 11.3.1.2 Market Forecast
  • 11.3.2 France
    • 11.3.2.1 Market Trends
    • 11.3.2.2 Market Forecast
  • 11.3.3 United Kingdom
    • 11.3.3.1 Market Trends
    • 11.3.3.2 Market Forecast
  • 11.3.4 Italy
    • 11.3.4.1 Market Trends
    • 11.3.4.2 Market Forecast
  • 11.3.5 Spain
    • 11.3.5.1 Market Trends
    • 11.3.5.2 Market Forecast
  • 11.3.6 Russia
    • 11.3.6.1 Market Trends
    • 11.3.6.2 Market Forecast
  • 11.3.7 Others
    • 11.3.7.1 Market Trends
    • 11.3.7.2 Market Forecast
• 11.4 Latin America
  • 11.4.1 Brazil
    • 11.4.1.1 Market Trends
    • 11.4.1.2 Market Forecast
  • 11.4.2 Mexico
    • 11.4.2.1 Market Trends
    • 11.4.2.2 Market Forecast
  • 11.4.3 Others
    • 11.4.3.1 Market Trends
    • 11.4.3.2 Market Forecast
• 11.5 Middle East and Africa
  • 11.5.1 Market Trends
  • 11.5.2 Market Breakup by Country
  • 11.5.3 Market Forecast

12 SWOT Analysis

• 12.1 Overview
• 12.2 Strengths
• 12.3 Weaknesses
• 12.4 Opportunities
• 12.5 Threats

13 Value Chain Analysis

14 Porters Five Forces Analysis

• 14.1 Overview
• 14.2 Bargaining Power of Buyers
• 14.3 Bargaining Power of Suppliers
• 14.4 Degree of Competition
• 14.5 Threat of New Entrants
• 14.6 Threat of Substitutes

15 Price Analysis

16 Competitive Landscape

• 16.1 Market Structure
• 16.2 Key Players
• 16.3 Profiles of Key Players
  • 16.3.1 CGI Inc.
    • 16.3.1.1 Company Overview
    • 16.3.1.2 Product Portfolio
    • 16.3.1.3 Financials
    • 16.3.1.4 SWOT Analysis
  • 16.3.2 Conduent Inc.
    • 16.3.2.1 Company Overview
    • 16.3.2.2 Product Portfolio
    • 16.3.2.3 Financials
    • 16.3.2.4 SWOT Analysis
  • 16.3.3 ExlService Holdings Inc.
    • 16.3.3.1 Company Overview
    • 16.3.3.2 Product Portfolio
    • 16.3.3.3 Financials
  • 16.3.4 Fair Isaac Corporation
    • 16.3.4.1 Company Overview
    • 16.3.4.2 Product Portfolio
    • 16.3.4.3 Financials
    • 16.3.4.4 SWOT Analysis
  • 16.3.5 HCL Technologies Limited
    • 16.3.5.1 Company Overview
    • 16.3.5.2 Product Portfolio
    • 16.3.5.3 Financials
    • 16.3.5.4 SWOT Analysis
  • 16.3.6 International Business Machines Corporation
    • 16.3.6.1 Company Overview
    • 16.3.6.2 Product Portfolio
    • 16.3.6.3 Financials
  • 16.3.7 Northrop Grumman Corporation
    • 16.3.7.1 Company Overview
    • 16.3.7.2 Product Portfolio
    • 16.3.7.3 Financials
    • 16.3.7.4 SWOT Analysis
  • 16.3.8 RELX Group plc
    • 16.3.8.1 Company Overview
    • 16.3.8.2 Product Portfolio
    • 16.3.8.3 Financials
    • 16.3.8.4 SWOT Analysis
  • 16.3.9 SAS Institute Inc.
    • 16.3.9.1 Company Overview
    • 16.3.9.2 Product Portfolio
    • 16.3.9.3 SWOT Analysis
  • 16.3.10 UnitedHealth Group
    • 16.3.10.1 Company Overview
    • 16.3.10.2 Product Portfolio
    • 16.3.10.3 Financials
    • 16.3.10.4 SWOT Analysis
  • 16.3.11 Wipro Ltd.
    • 16.3.11.1 Company Overview
    • 16.3.11.2 Product Portfolio
    • 16.3.11.3 Financials