医疗保健诈欺分析市场规模、份额、成长分析、按解决方案类型、按交付模式、按应用、按最终用户、按地区 - 行业预测，2025 年至 2032 年

2023 年全球医疗保健诈欺分析市场规模价值 25 亿美元，预计将从 2024 年的 31.1 亿美元成长到 2032 年的 177.1 亿美元，预测期内（2025-2032 年）的复合年增长率为 24.3%。

全球医疗保健诈欺分析市场正在经历强劲增长，这得益于医疗保健提供者和保险公司将高级分析功能融入其诈欺预防策略的趋势日益增强。这些解决方案利用资料分析、人工智慧和机器学习，可以有效识别不规则模式和可疑索赔，最大限度地减少财务损失，同时加强法规合规性。医疗保健诈欺事件的快速增加，加上严格的法规和对有效欺诈管理的迫切需求是推动市场扩张的主要因素。此外，医疗保健和技术部门之间持续的技术进步和策略联盟预计将在未来几年显着推动市场发展，并改变行业诈欺检测和预防的方法。

目录

介绍

• 调查目的
• 研究范围
• 定义

调查方法

• 资讯采购
• 次要和资料资料
• 市场规模预测
• 市场假设与限制

执行摘要

• 全球市场展望
• 供需趋势分析
• 细分市场机会分析

市场动态及展望

• 市场概况
• 市场规模
• 市场动态
  • 驱动因素和机会
  • 限制与挑战
• 波特的分析

主要市场考察

• 关键成功因素
• 竞争程度
• 主要投资机会
• 市场生态系统
• 市场吸引力指数（2024 年）
• PESTEL 分析
• 总体经济指标
• 价值链分析
• 定价分析
• 监管格局
• 案例研究
• 技术进步

医疗诈欺分析市场规模（按解决方案类型）

• 市场概况
• 说明分析
• 预测分析
• 指示性分析

医疗诈欺分析市场规模（按模型）

• 市场概况
• 本地
• 一经请求

医疗诈欺分析市场规模（按应用）

• 市场概况
• 索赔审查
• 稍后付款审核
• 预付款审核
• 药房帐单诈欺
• 付款诚信
• 其他的

医疗诈欺分析市场规模（按最终用户）

• 市场概况
• 公共和政府组织
• 商业付款人
• 第三方服务供应商
• 雇主
• 其他的

医疗诈欺分析市场规模

• 北美洲
  • 美国
  • 加拿大
• 欧洲
  • 德国
  • 西班牙
  • 法国
  • 英国
  • 义大利
  • 其他欧洲国家
• 亚太地区
  • 中国
  • 印度
  • 日本
  • 韩国
  • 其他亚太地区
• 拉丁美洲
  • 巴西
  • 其他拉丁美洲国家
• 中东和非洲
  • 海湾合作委员会国家
  • 南非
  • 其他中东和非洲地区

竞争资讯

• 前 5 家公司对比
• 主要企业市场定位（2024年）
• 主要市场参与者所采用的策略
• 近期市场趋势
• 公司市场占有率分析（2024 年）
• 主要企业简介
  • 公司简介
  • 产品系列分析
  • 按细分市场分析市场份额
  • 收益与前一年同期比较（2022-2024 年）

主要企业简介

• 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）

结论和建议

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