A report by Global Market Studies has shown a CAGR of 27.8% for the Healthcare Fraud Detection Market which is expected to expand to a value of USD 18.3 billion by 2028.
The healthcare fraud detection market is usually split into post-payment fraud detection, insurance claim fraud detection and pre-payment fraud detection. The healthcare fraud detection market can be divided into software and services. The software part is made up of different software tools for detecting fraud and the services are made up of consulting, implementation and support services. By end user, the healthcare fraud detection market is divided into private healthcare providers, public healthcare providers and insurance payers.
One of the main factors is that healthcare fraud is becoming more common, which has cost healthcare organizations and insurance payers a lot of money due to which there is an increasing need for healthcare fraud detection solutions that can help organizations find and stop fraud.
The growing use of electronic health records (EHRs) and other digital healthcare systems creates a lot of data that can be analyzed with advanced analytics tools. This has made it possible for healthcare organizations to use data analytics to look for patterns of fraud.
Based on the different market segments, there are also many methods for the healthcare fraud detection market to grow. For example, the post-payment fraud detection segment is expected to grow a lot thanks to more and more people using techniques like retrospective analysis to find fraud.
There is expected growth in the insurance claim fraud detection market as more people are using machine learning and artificial intelligence (AI) techniques to look at claims data and find fraudulent activity. Meanwhile, the private healthcare providers segment is estimated to grow because private hospitals and clinics are getting multiple healthcare fraud detection solutions such as the cloud-based delivery model.
The high cost of healthcare fraud detection technologies is a common issue. Many healthcare firms do not have the financial means to invest in solutions like advanced analytics tools and other fraud detection systems.
The absence of standardized data in the healthcare sector presents another difficulty because it might be challenging to examine and spot trends of fraudulent conduct. In order to prevent it, healthcare fraudsters are continuously developing new strategies to avoid detection and becoming more sophisticated.
Due to the requirement for real-time data analysis, the pre-payment fraud detection component of the program provides a specific challenge. Real-time data processing capabilities and advanced analytics tools are necessary and their implementation can be challenging and costly.
Detecting healthcare fraud may also be subject to regulatory and legal issues, especially those relating to data privacy and protection laws. By enacting fraud detection technologies, healthcare organizations must ensure that they comply with all applicable rules and regulations.
- In March 2022, Veriff released a new suite of biometric authentication solutions designed specifically for the healthcare industry. According to the company, the new product will utilize artificial intelligence and facial recognition technology to perform user identification.
- In February 2022, the Canadian Life and Health Insurance Association (CLHIA) launched an industry initiative to pool claims data and use advanced artificial intelligence tools to enhance the detection and investigation of benefit fraud.
CGI Inc., DXC Technology Company, ExlService Holdings Inc., Scio Health Analytics, International Business Machines Corporation (IBM), McKesson Corporation, Northrop Grumman, OSP Labs, SAS Institute Inc., RELX Group plc, UnitedHealth Group, Optum Inc.
Frequently Asked Questions
1) What is the projected market value of the Healthcare Fraud Detection Market?
– The Healthcare Fraud Detection Market is expected to reach a value of USD 18.3 billion by 2028
2) What is the estimated CAGR of the Healthcare Fraud Detection Market over the 2023 to 2028 forecast period?
– The Healthcare Fraud Detection Market is expected to grow at a CAGR of approximately 27.8% from 2023 to 2028.
3) Who are the key players in the Healthcare Fraud Detection Market?
– CGI Inc., DXC Technology Company, ExlService Holdings Inc., Scio Health Analytics, International Business Machines Corporation (IBM), McKesson Corporation, Northrop Grumman, OSP Labs, SAS Institute Inc., RELX Group plc, UnitedHealth Group, Optum Inc.
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