의료 부정 적발 시장 보고서 : 구성요소, 유형, 제공 모드, 용도, 최종사용자, 지역별(2025-2033년)

The global healthcare fraud detection market size reached USD 3.0 Billion in 2024. Looking forward, IMARC Group expects the market to reach USD 16.4 Billion by 2033, exhibiting a growth rate (CAGR) of 19.66% during 2025-2033. The rising incidence of healthcare fraud, ongoing technological advancements, healthcare digitalization, and adoption of cloud-based solutions are primarily driving the market's growth.

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:

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

• 1.How big is the healthcare fraud detection market?
• 2.What is the future outlook of healthcare fraud detection market?
• 3.What are the key factors driving the healthcare fraud detection market?
• 4.Which region accounts for the largest healthcare fraud detection market share?
• 5.Which are the leading companies in the global healthcare fraud detection market?

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