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市場調查報告書
商品編碼
1897892
醫療保健詐騙分析市場規模、佔有率和成長分析（按解決方案類型、交付模式、應用、最終用戶和地區分類）—2026-2033年產業預測Health Care Fraud Analytics Market Size, Share, and Growth Analysis, By Solution Type (Descriptive Analytics, Predictive Analytics), By Delivery Model (On-premises, On-demand), By Application, By End User, By Region - Industry Forecast 2026-2033 |
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全球醫療保健詐騙分析市場規模預計在 2024 年達到 31.1 億美元，從 2025 年的 38.7 億美元成長到 2033 年的 220.3 億美元，在預測期（2026-2033 年）內複合年成長率為 24.3%。
醫療保健詐騙分析解決方案利用數據分析、人工智慧和機器學習技術，發現異常模式和可疑索賠，有效減少經濟損失並加強合規性。醫療保健詐騙案件的快速成長、嚴格的監管措施以及對有效詐騙管理的需求，正在推動市場擴張。此外，醫療產業和科技產業的持續技術創新與合作有望推動市場發展，增強產業整體的詐騙偵測和預防能力，並有助於建立更安全、更有效率的醫療保健生態系統。
全球醫療保健詐騙分析市場促進因素
醫療保健詐騙案件的激增，以及醫療服務提供者和保險公司擴大採用先進的分析工具來識別和防範詐欺活動，正在推動全球醫療保健詐騙分析市場的成長。隨著各機構日益認知到利用先進的數據分析技術來保護其營運和財務資源的重要性，對有效的詐欺檢測和預防解決方案的需求持續成長。這一趨勢凸顯了醫療保健行業在提高透明度和課責所做的努力，最終有助於整個行業的健康發展，並保護醫療服務提供者和患者免受欺詐活動的侵害。
全球醫療保健詐騙分析市場限制因素
全球醫療保健詐騙分析市場面臨阻礙其擴張的許多挑戰。主要因素包括部署高階分析解決方案的高昂成本，以及將這些技術無縫整合到現有醫療保健IT基礎設施中的複雜性。此外，對資料隱私和安全的擔憂進一步加劇了詐欺分析系統部署的困難。這些擔憂不僅延緩了系統的採用進程，也阻礙了潛在用戶建立信任，最終影響了市場在有效打擊醫療保健詐欺和保護敏感患者資訊方面的整體成長潛力。
全球醫療保健詐騙分析市場趨勢
全球醫療保健詐騙分析市場正經歷著向先進技術整合的重大轉變，尤其是在人工智慧和機器學習能力方面，這些能力能夠實現即時異常檢測和預測建模。這種發展提高了詐騙識別和理賠分析的準確性，同時，科技公司與醫療機構之間的合作也促進了創新解決方案的開發，以應對不斷變化的挑戰。對監管合規性和資料安全的重視推動了對全面詐欺預防系統的需求。此外，巨量資料分析驅動的演算法不斷改進，旨在增強詐欺偵測能力，最大限度地減少誤報，最終在確保高品質患者照護的同時，節省醫療資源。
目錄
介紹
- 調查目標
- 調查範圍
- 定義
調查方法
- 資訊收集
- 二手資料和一手資料方法
- 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
市場動態與展望
- 市場規模
- 市場動態
- 促進因素和機遇
- 限制與挑戰
- 波特分析
關鍵市場考察
- 關鍵成功因素
- 競爭程度
- 關鍵投資機會
- 市場生態系統
- 市場吸引力指數（2025）
- PESTEL 分析
- 總體經濟指標
- 價值鏈分析
- 定價分析
- 監管環境
- 案例研究
- 技術進步
全球醫療保健詐騙分析市場規模（按解決方案類型和複合年成長率分類）（2026-2033 年）
- 說明分析
- 預測分析
- 預測分析
全球醫療保健詐騙分析市場規模（按產品模式和複合年成長率分類）（2026-2033 年）
- 本地部署
- 一經請求
全球醫療保健詐騙分析市場規模（按應用領域及複合年成長率分類）（2026-2033 年）
- 保險理賠審查
- 付款後審核
- 預篩選
- 藥房帳單詐欺
- 支付適當性
- 其他
全球醫療保健詐騙分析市場規模（按最終用戶和複合年成長率分類）（2026-2033 年）
- 公共和政府機構
- 私人保險支付方
- 第三方服務供應商
- 雇主
- 其他
全球醫療保健詐騙分析市場規模及複合年成長率（2026-2033）
- 北美洲
- 美國
- 加拿大
- 歐洲
- 德國
- 西班牙
- 法國
- 英國
- 義大利
- 其他歐洲地區
- 亞太地區
- 中國
- 印度
- 日本
- 韓國
- 亞太其他地區
- 拉丁美洲
- 巴西
- 其他拉丁美洲地區
- 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
- 前五大公司對比
- 主要企業的市場定位（2025 年）
- 主要市場參與者所採取的策略
- 近期市場趨勢
- 公司市佔率分析（2025 年）
- 主要企業公司簡介
- 公司詳情
- 產品系列分析
- 依業務板塊進行公司股票分析
- 2023-2025年營收年比比較
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）
結論與建議
Global Health Care Fraud Analytics Market size was valued at USD 3.11 Billion in 2024 and is poised to grow from USD 3.87 Billion in 2025 to USD 22.03 Billion by 2033, growing at a CAGR of 24.3% during the forecast period (2026-2033).
The global healthcare fraud analytics market is witnessing substantial growth as providers and insurers increasingly implement advanced analytics to combat fraud. These solutions utilize data analysis, artificial intelligence, and machine learning to uncover irregular patterns and suspicious claims, effectively reducing financial losses and bolstering regulatory adherence. Factors such as the surge in healthcare fraud incidents, rigorous regulatory measures, and the demand for effective fraud management are propelling market expansion. Furthermore, ongoing technological innovations and partnerships between healthcare and technology industries are expected to drive the market's progress, enhancing the capabilities of fraud detection and prevention efforts across the sector, ultimately contributing to a more secure and efficient healthcare ecosystem.
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 Segments 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 surge in healthcare fraud incidents, coupled with the rising implementation of sophisticated analytics tools by healthcare providers and insurers to identify and mitigate fraudulent practices, is driving the expansion of the global healthcare fraud analytics market. As organizations increasingly recognize the importance of utilizing advanced data analysis techniques to safeguard their operations and financial resources, the demand for effective fraud detection and prevention solutions continues to grow. This trend highlights a broader commitment within the healthcare sector to enhance transparency and accountability, ultimately contributing to the overall health of the industry and protecting both providers and patients from fraudulent activities.
Restraints in the Global Health Care Fraud Analytics Market
The global healthcare fraud analytics market faces significant challenges that hinder its expansion. Key factors include the exorbitant costs associated with implementing sophisticated analytics solutions, coupled with the complexity of seamlessly integrating these technologies into existing healthcare IT infrastructures. Additionally, apprehensions regarding data privacy and security further complicate the adoption of fraud analytics systems. These concerns not only slow down the implementation process but also create barriers to trust among potential users, ultimately affecting the overall growth potential of the market in addressing healthcare fraud effectively while ensuring the protection of sensitive patient information.
Market Trends of the Global Health Care Fraud Analytics Market
The global healthcare fraud analytics market is experiencing a significant shift towards advanced technological integration, particularly with AI and machine learning capabilities that enable real-time anomaly detection and predictive modeling. This evolution enhances the accuracy of fraud identification and claims analysis, while partnerships between tech firms and healthcare organizations promote innovative solutions tailored to evolving challenges. Strong emphasis on regulatory compliance and data security is fueling the demand for comprehensive fraud prevention systems. Moreover, continuous improvements in algorithms, backed by big data analytics, aim to bolster fraud detection efforts, minimize false positives, and ultimately protect healthcare resources while ensuring quality patient care.
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, 2025
- 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 (2026-2033)
- Market Overview
- Descriptive Analytics
- Predictive Analytics
- Prescriptive Analytics
Global Health Care Fraud Analytics Market Size by Delivery Model & CAGR (2026-2033)
- Market Overview
- On-premises
- On-demand
Global Health Care Fraud Analytics Market Size by Application & CAGR (2026-2033)
- 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 (2026-2033)
- Market Overview
- Public & Government Agencies
- Private Insurance Payers
- Third-party service providers
- Employers
- Others
Global Health Care Fraud Analytics Market Size & CAGR (2026-2033)
- 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, 2025
- Strategies Adopted by Key Market Players
- Recent Developments in the Market
- Company Market Share Analysis, 2025
- Company Profiles of All Key Players
- Company Details
- Product Portfolio Analysis
- Company's Segmental Share Analysis
- Revenue Y-O-Y Comparison (2023-2025)
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
