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PUBLISHER: IMARC | PRODUCT CODE: 1722532
PUBLISHER: IMARC | PRODUCT CODE: 1722532
Healthcare Fraud Detection Market Report by Component, Type, Delivery Mode, Application, End User, and Region 2025-2033
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PAGES: 135 Pages
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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?
Product Code: SR112025A5536
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
- 11.1.1 United States
- 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
- 11.2.1 China
- 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
- 11.3.1 Germany
- 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
- 11.4.1 Brazil
- 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
- 16.3.1 CGI Inc.
Product Code: SR112025A5536
List of Figures
- Figure 1: Global: Healthcare Fraud Detection Market: Major Drivers and Challenges
- Figure 2: Global: Healthcare Fraud Detection Market: Sales Value (in Billion USD), 2019-2024
- Figure 3: Global: Healthcare Fraud Detection Market Forecast: Sales Value (in Billion USD), 2025-2033
- Figure 4: Global: Healthcare Fraud Detection Market: Breakup by Component (in %), 2024
- Figure 5: Global: Healthcare Fraud Detection Market: Breakup by Type (in %), 2024
- Figure 6: Global: Healthcare Fraud Detection Market: Breakup by Delivery Mode (in %), 2024
- Figure 7: Global: Healthcare Fraud Detection Market: Breakup by Application (in %), 2024
- Figure 8: Global: Healthcare Fraud Detection Market: Breakup by End User (in %), 2024
- Figure 9: Global: Healthcare Fraud Detection Market: Breakup by Region (in %), 2024
- Figure 10: Global: Healthcare Fraud Detection (Software) Market: Sales Value (in Million USD), 2019 & 2024
- Figure 11: Global: Healthcare Fraud Detection (Software) Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 12: Global: Healthcare Fraud Detection (Services) Market: Sales Value (in Million USD), 2019 & 2024
- Figure 13: Global: Healthcare Fraud Detection (Services) Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 14: Global: Healthcare Fraud Detection (Descriptive Analytics) Market: Sales Value (in Million USD), 2019 & 2024
- Figure 15: Global: Healthcare Fraud Detection (Descriptive Analytics) Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 16: Global: Healthcare Fraud Detection (Predictive Analytics) Market: Sales Value (in Million USD), 2019 & 2024
- Figure 17: Global: Healthcare Fraud Detection (Predictive Analytics) Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 18: Global: Healthcare Fraud Detection (Prescriptive Analytics) Market: Sales Value (in Million USD), 2019 & 2024
- Figure 19: Global: Healthcare Fraud Detection (Prescriptive Analytics) Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 20: Global: Healthcare Fraud Detection (On-premises) Market: Sales Value (in Million USD), 2019 & 2024
- Figure 21: Global: Healthcare Fraud Detection (On-premises) Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 22: Global: Healthcare Fraud Detection (On-demand) Market: Sales Value (in Million USD), 2019 & 2024
- Figure 23: Global: Healthcare Fraud Detection (On-demand) Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 24: Global: Healthcare Fraud Detection (Insurance Claims Review) Market: Sales Value (in Million USD), 2019 & 2024
- Figure 25: Global: Healthcare Fraud Detection (Insurance Claims Review) Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 26: Global: Healthcare Fraud Detection (Payment Integrity) Market: Sales Value (in Million USD), 2019 & 2024
- Figure 27: Global: Healthcare Fraud Detection (Payment Integrity) Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 28: Global: Healthcare Fraud Detection (Private Insurance Payers) Market: Sales Value (in Million USD), 2019 & 2024
- Figure 29: Global: Healthcare Fraud Detection (Private Insurance Payers) Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 30: Global: Healthcare Fraud Detection (Government Agencies) Market: Sales Value (in Million USD), 2019 & 2024
- Figure 31: Global: Healthcare Fraud Detection (Government Agencies) Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 32: Global: Healthcare Fraud Detection (Other End Users) Market: Sales Value (in Million USD), 2019 & 2024
- Figure 33: Global: Healthcare Fraud Detection (Other End Users) Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 34: North America: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 35: North America: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 36: United States: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 37: United States: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 38: Canada: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 39: Canada: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 40: Asia-Pacific: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 41: Asia-Pacific: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 42: China: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 43: China: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 44: Japan: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 45: Japan: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 46: India: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 47: India: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 48: South Korea: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 49: South Korea: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 50: Australia: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 51: Australia: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 52: Indonesia: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 53: Indonesia: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 54: Others: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 55: Others: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 56: Europe: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 57: Europe: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 58: Germany: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 59: Germany: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 60: France: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 61: France: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 62: United Kingdom: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 63: United Kingdom: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 64: Italy: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 65: Italy: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 66: Spain: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 67: Spain: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 68: Russia: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 69: Russia: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 70: Others: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 71: Others: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 72: Latin America: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 73: Latin America: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 74: Brazil: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 75: Brazil: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 76: Mexico: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 77: Mexico: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 78: Others: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 79: Others: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 80: Middle East and Africa: Healthcare Fraud Detection Market: Sales Value (in Million USD), 2019 & 2024
- Figure 81: Middle East and Africa: Healthcare Fraud Detection Market: Breakup by Country (in %), 2024
- Figure 82: Middle East and Africa: Healthcare Fraud Detection Market Forecast: Sales Value (in Million USD), 2025-2033
- Figure 83: Global: Healthcare Fraud Detection Industry: SWOT Analysis
- Figure 84: Global: Healthcare Fraud Detection Industry: Value Chain Analysis
- Figure 85: Global: Healthcare Fraud Detection Industry: Porter's Five Forces Analysis
List of Tables
- Table 1: Global: Healthcare Fraud Detection Market: Key Industry Highlights, 2024 and 2033
- Table 2: Global: Healthcare Fraud Detection Market Forecast: Breakup by Component (in Million USD), 2025-2033
- Table 3: Global: Healthcare Fraud Detection Market Forecast: Breakup by Type (in Million USD), 2025-2033
- Table 4: Global: Healthcare Fraud Detection Market Forecast: Breakup by Delivery Mode (in Million USD), 2025-2033
- Table 5: Global: Healthcare Fraud Detection Market Forecast: Breakup by Application (in Million USD), 2025-2033
- Table 6: Global: Healthcare Fraud Detection Market Forecast: Breakup by End User (in Million USD), 2025-2033
- Table 7: Global: Healthcare Fraud Detection Market Forecast: Breakup by Region (in Million USD), 2025-2033
- Table 8: Global: Healthcare Fraud Detection Market: Competitive Structure
- Table 9: Global: Healthcare Fraud Detection Market: Key Players
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