Healthcare fraud detection Market Expected to Reach $3.6 Billion by 2031—Allied Market Research

According to a new report published by Allied Market Research, titled, “Healthcare Fraud Detection Market," The Healthcare fraud detection market was valued at $1.1 billion in 2021, and is estimated to reach $3.6 billion by 2031, growing at a CAGR of 12.6% from 2022 to 2031.

The misrepresentation or making false statements about the medical bills, healthcare funds, or the nature of the medical treatment or service provided in a way that could lead to the payment of unlawful amounts, is considered as healthcare or medical fraud. Some cases of medical fraud are misleading the person providing the service, billing for services with inadequate documentation, falsifying the quality of service offered and submitting invoices for goods and services that have not been delivered. The fraud detection traditionally was done by the manual ways; however, this strategy becomes time-consuming and ineffective with a huge data collection. Progression in machine learning and data mining tools draw attention to automated fraud detection systems. Moreover, the global healthcare fraud detection market is expanding due to increased fraud in healthcare domain, increase in pressure of abuse and fraud, and rise in patient benefiting by health insurance. The segment descriptive analysis is a sort of data analysis that aids in accurately describing, displaying, or summarizing data points so that patterns may appear that satisfy all of the data's requirements.

Descriptive analysis segment is expanding as it offering various tools such as variance calculator, percentile calculator and scatter plot chart maker, with line of best fit. A subcategory of advanced analytics called predictive analytics uses historical data along with statistical modelling, data mining, and machine learning to forecast future results. The predictive analytics segment is expanding due to new advances technology of artificial intelligence and data miming tools, SAS Advanced Analytics and SAP Analytics Cloud is the top tool used in fraud detection.

The technique of using data to decide on the best course of action is known as prescriptive analytics. The growth of global healthcare fraud detection is expanding as various new techniques are developing.

The introduction of cutting-edge fraud identity management software is expected to boost the market growth. Massive amounts of data can be examined by machine learning to help create rules. This helps propel the market growth. Account auditing and investigation by a detective can help in healthcare fund misuse detection. The market for global healthcare fraud detection will grow rapidly, as the various new software based on data mining and artificial intelligence are being used by the healthcare industry. Furthermore, healthcare fraud detection market will also advance due to the expansion of analysis, services, insurance claim reviews and by maintaining payment integrity.

On the other hand, data security concern in healthcare industry may restrain the expansion of the global healthcare fraud detection market. The need for healthcare fraud detection significantly decreased after the COVID-19 pandemic. The focus of medical professionals, governments, and the general public has moved towards the virus's spread as a result of the fatal virus's quick expansion. It consequently decreased the need for fraud management detection. As a result, the COVID-19 pandemic caused severe disruptions in the market of the healthcare fraud detection.

By type, the descriptive analytics segment dominated the market in 2021. The factors responsible for the product segment growth are new tools developed in recent years. Furthermore, the introduction of Enblick data computing platform for data sorting in minimum time. Increased demand and approval of new tools supported the segment growth during forecast period.

By component, the software segment dominated market in 2021 and is expected to remain dominant during the forecast period. The use of numerous software contribute toward the market growth of healthcare fraud detection. The newly developed software namely SEON and LexisNexis also used widely in management of fraud detection.

By application, the insurance claims review segment dominated the market in 2021. The fraudulence in this segment is at the peak hence this segment dominated the in the global healthcare fraud detection market.

By end user, the healthcare payer segment dominated the market in 2021 and is expected to remain dominant during the forecast period. The market growth of this segment driven by the increased fraudulence in the public and private payers. The highest fraudulence cases in healthcare insurance and claims responsible for the market growth of healthcare payer

Region wise, North America has the highest market share during the forecast period. North America advances due to availability of newly developed software and high investigational cases of medical fraudulence in the U.S and Mexico.

Key findings of the study

• On the basis of type, the descriptive analytics segment dominated the market in 2021.
• On the basis of component, the software segment dominated the market in 2021.
• On the basis of application, the insurance claim review segment dominated the market in 2021.
• On the basis of end user, the healthcare payer segment dominated the market in 2021.
• On the basis of region, North America dominated the market in 2021.