醫療保健詐欺分析市場規模、佔有率、成長分析、按解決方案類型、按交付模式、按應用、按最終用戶、按地區 - 行業預測，2025 年至 2032 年

2023 年全球醫療保健詐欺分析市場規模價值 25 億美元，預計將從 2024 年的 31.1 億美元成長到 2032 年的 177.1 億美元，預測期內（2025-2032 年）的複合年成長率為 24.3%。

全球醫療保健詐欺分析市場正在經歷強勁成長，這得益於醫療保健提供者和保險公司將高級分析功能融入其詐欺預防策略的趨勢日益增強。這些解決方案利用資料分析、人工智慧和機器學習，可以有效識別不規則模式和可疑索賠，最大限度地減少財務損失，同時加強法規合規性。醫療保健詐欺事件的快速增加，加上嚴格的法規和對有效欺詐管理的迫切需求是推動市場擴張的主要因素。此外，醫療保健和技術部門之間持續的技術進步和策略聯盟預計將在未來幾年顯著推動市場發展，並改變行業詐欺檢測和預防的方法。

目錄

介紹

• 調查目的
• 研究範圍
• 定義

調查方法

• 資訊採購
• 次要和資料資料
• 市場規模預測
• 市場假設與限制

執行摘要

• 全球市場展望
• 供需趨勢分析
• 細分市場機會分析

市場動態及展望

• 市場概況
• 市場規模
• 市場動態
  • 促進因素和機遇
  • 限制與挑戰
• 波特的分析

主要市場考察

• 關鍵成功因素
• 競爭程度
• 主要投資機會
• 市場生態系統
• 市場吸引力指數（2024 年）
• PESTEL 分析
• 總體經濟指標
• 價值鏈分析
• 定價分析
• 監管格局
• 案例研究
• 技術進步

醫療詐欺分析市場規模（按解決方案類型）

• 市場概況
• 說明分析
• 預測分析
• 指示性分析

醫療詐欺分析市場規模（按模型）

• 市場概況
• 本地
• 一經請求

醫療詐欺分析市場規模（按應用）

• 市場概況
• 索賠審查
• 稍後付款審核
• 預付款審核
• 藥房帳單詐欺
• 付款誠信
• 其他

醫療詐欺分析市場規模（按最終用戶）

• 市場概況
• 公共和政府組織
• 商業付款人
• 第三方服務供應商
• 雇主
• 其他

醫療詐欺分析市場規模

• 北美洲
  • 美國
  • 加拿大
• 歐洲
  • 德國
  • 西班牙
  • 法國
  • 英國
  • 義大利
  • 其他歐洲國家
• 亞太地區
  • 中國
  • 印度
  • 日本
  • 韓國
  • 其他亞太地區
• 拉丁美洲
  • 巴西
  • 其他拉丁美洲國家
• 中東和非洲
  • 海灣合作理事會國家
  • 南非
  • 其他中東和非洲地區

競爭資訊

• 前 5 家公司對比
• 主要企業市場定位（2024年）
• 主要市場參與者所採用的策略
• 近期市場趨勢
• 公司市場佔有率分析（2024 年）
• 主要企業簡介
  • 公司簡介
  • 產品系列分析
  • 按細分市場分析市場佔有率
  • 收益與前一年同期比較（2022-2024 年）

主要企業簡介

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

結論和建議

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