의료 부정 분석 시장 규모, 점유율, 성장 분석 : 솔루션 유형별, 제공 모델별, 용도별, 최종사용자별, 지역별 - 산업 예측(2025-2032년)

Global Health Care Fraud Analytics Market size was valued at USD 2.5 billion in 2023 and is poised to grow from USD 3.11 billion in 2024 to USD 17.71 billion by 2032, growing at a CAGR of 24.3% during the forecast period (2025-2032).

The global healthcare fraud analytics market is witnessing robust growth, propelled by healthcare providers and insurance firms increasingly integrating advanced analytics to combat fraud. Utilizing data analysis, AI, and machine learning, these solutions effectively identify irregular patterns and suspicious claims, minimizing financial losses while bolstering regulatory compliance. The surge in healthcare fraud incidents, coupled with stringent regulations and an urgent need for efficient fraud management, is a key driver of market expansion. Furthermore, ongoing technological advancements and strategic partnerships between healthcare and technology sectors are expected to significantly enhance the market's development in the coming years, transforming the approach to fraud detection and prevention within the industry.

Top-down and bottom-up approaches were used to estimate and validate the size of the Global Health Care Fraud Analytics market and to estimate the size of various other dependent submarkets. The research methodology used to estimate the market size includes the following details: The key players in the market were identified through secondary research, and their market shares in the respective regions were determined through primary and secondary research. This entire procedure includes the study of the annual and financial reports of the top market players and extensive interviews for key insights from industry leaders such as CEOs, VPs, directors, and marketing executives. All percentage shares split, and breakdowns were determined using secondary sources and verified through Primary sources. All possible parameters that affect the markets covered in this research study have been accounted for, viewed in extensive detail, verified through primary research, and analyzed to get the final quantitative and qualitative data.

Global Health Care Fraud Analytics Market Segmental Analysis

Global Health Care Fraud Analytics Market is segmented by Solution Type, Delivery Model, Application, End User and region. Based on Solution Type, the market is segmented into Descriptive Analytics, Predictive Analytics and Prescriptive Analytics. Based on Delivery Model, the market is segmented into On-premises and On-demand. Based on Application, the market is segmented into Insurance Claims Review, Postpayment Review, Prepayment Review, Pharmacy Billing Misuse, Payment Integrity and Others. Based on End User, the market is segmented into Public & Government Agencies, Private Insurance Payers, Third-party service providers, Employers and Others. Based on region, the market is segmented into North America, Europe, Asia Pacific, Latin America and Middle East & Africa.

Driver of the Global Health Care Fraud Analytics Market

The global healthcare fraud analytics market is being driven by a rising necessity to detect and prevent fraudulent activities within the healthcare system. As healthcare fraud becomes more prevalent, there is a significant push among healthcare providers and payers to adopt sophisticated analytics solutions. These advanced technologies enable organizations to closely monitor and identify potential fraudulent behavior, ensuring the integrity of healthcare services and protecting financial resources. This ongoing demand for efficient fraud detection mechanisms is fueling the growth of the healthcare fraud analytics market, ultimately promoting a more secure and trustworthy healthcare environment.

Restraints in the Global Health Care Fraud Analytics Market

The global healthcare fraud analytics market faces several significant restraints, primarily due to high implementation costs associated with deploying these systems. The complexity of seamlessly integrating analytics solutions into existing healthcare IT infrastructures further complicates adoption. Additionally, concerns regarding data privacy and security are critical factors that hinder market expansion. These challenges create reluctance among healthcare organizations to fully embrace fraud analytics, impacting the overall growth potential of the market. Addressing these issues will be crucial for enhancing the uptake of fraud detection and prevention technologies in the healthcare sector, thereby fostering a more secure and efficient healthcare system.

Market Trends of the Global Health Care Fraud Analytics Market

The global healthcare fraud analytics market is experiencing significant growth driven by the integration of advanced AI and machine learning technologies, which facilitate real-time anomaly detection and predictive modeling. Key developments include strategic collaborations between technology providers and healthcare organizations, leading to innovative fraud detection solutions. As regulatory compliance and data security remain critical, robust fraud prevention systems are increasingly adopted. Moreover, continuous algorithm refinement and the application of big data analytics enhance fraud detection accuracy while reducing false positives. These advancements not only safeguard healthcare resources but also ensure the delivery of high-quality patient care, positioning the market for sustained expansion.

Table of Contents

Introduction

• Objectives of the Study
• Scope of the Report
• Definitions

Research Methodology

• Information Procurement
• Secondary & Primary Data Methods
• Market Size Estimation
• Market Assumptions & Limitations

Executive Summary

• Global Market Outlook
• Supply & Demand Trend Analysis
• Segmental Opportunity Analysis

Market Dynamics & Outlook

• Market Overview
• Market Size
• Market Dynamics
  • Drivers & Opportunities
  • Restraints & Challenges
• Porters Analysis
  • Competitive rivalry
  • Threat of substitute
  • Bargaining power of buyers
  • Threat of new entrants
  • Bargaining power of suppliers

Key Market Insights

• Key Success Factors
• Degree of Competition
• Top Investment Pockets
• Market Ecosystem
• Market Attractiveness Index, 2024
• PESTEL Analysis
• Macro-Economic Indicators
• Value Chain Analysis
• Pricing Analysis
• Regulatory Landscape
• Case Studies
• Technological Advancement

Global Health Care Fraud Analytics Market Size by Solution Type & CAGR (2025-2032)

• Market Overview
• Descriptive Analytics
• Predictive Analytics
• Prescriptive Analytics

Global Health Care Fraud Analytics Market Size by Delivery Model & CAGR (2025-2032)

• Market Overview
• On-premises
• On-demand

Global Health Care Fraud Analytics Market Size by Application & CAGR (2025-2032)

• Market Overview
• Insurance Claims Review
• Postpayment Review
• Prepayment Review
• Pharmacy Billing Misuse
• Payment Integrity
• Others

Global Health Care Fraud Analytics Market Size by End User & CAGR (2025-2032)

• Market Overview
• Public & Government Agencies
• Private Insurance Payers
• Third-party service providers
• Employers
• Others

Global Health Care Fraud Analytics Market Size & CAGR (2025-2032)

• North America (Solution Type, Delivery Model, Application, End User)
  • US
  • Canada
• Europe (Solution Type, Delivery Model, Application, End User)
  • Germany
  • Spain
  • France
  • UK
  • Italy
  • Rest of Europe
• Asia Pacific (Solution Type, Delivery Model, Application, End User)
  • China
  • India
  • Japan
  • South Korea
  • Rest of Asia-Pacific
• Latin America (Solution Type, Delivery Model, Application, End User)
  • Brazil
  • Rest of Latin America
• Middle East & Africa (Solution Type, Delivery Model, Application, End User)
  • GCC Countries
  • South Africa
  • Rest of Middle East & Africa

Competitive Intelligence

• Top 5 Player Comparison
• Market Positioning of Key Players, 2024
• Strategies Adopted by Key Market Players
• Recent Developments in the Market
• Company Market Share Analysis, 2024
• Company Profiles of All Key Players
  • Company Details
  • Product Portfolio Analysis
  • Company's Segmental Share Analysis
  • Revenue Y-O-Y Comparison (2022-2024)

Key Company Profiles

• IBM Corporation (USA)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Optum Inc. (USA)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• SAS Institute Inc. (USA)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• DXC Technology Company (USA)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Conduent Incorporated (USA)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• HCL Technologies Ltd. (India)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Wipro Limited (India)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Cotiviti Inc. (USA)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• EXL Service Holdings Inc. (USA)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• OSP Labs (USA)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• McKesson Corporation (USA)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Northrop Grumman Corporation (USA)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• RELX Group PLC (LexisNexis) (UK)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Healthcare Fraud Shield (USA)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Sharecare Inc. (USA)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• FraudLens Inc. (USA)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• HMS Holding Corp. (USA)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• Codoxo (USA)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• FRISS International B.V. (Netherlands)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments
• MultiPlan Inc. (USA)
  • Company Overview
  • Business Segment Overview
  • Financial Updates
  • Key Developments

Conclusion & Recommendations