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市场调查报告书
商品编码
1897892
医疗保健诈骗分析市场规模、份额和成长分析（按解决方案类型、交付模式、应用、最终用户和地区划分）—2026-2033年产业预测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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全球医疗保健诈骗分析市场规模预计在 2024 年达到 31.1 亿美元，从 2025 年的 38.7 亿美元增长到 2033 年的 220.3 亿美元，在预测期（2026-2033 年）内复合年增长率为 24.3%。
医疗保健诈骗分析解决方案利用数据分析、人工智慧和机器学习技术，发现异常模式和可疑索赔，有效减少经济损失并加强合规性。医疗保健诈骗案件的快速增长、严格的监管措施以及对有效诈骗管理的需求，正在推动市场扩张。此外，医疗产业和科技产业的持续技术创新与合作有望推动市场发展，增强产业整体的诈骗侦测和预防能力，并有助于建立更安全、更有效率的医疗保健生态系统。
全球医疗保健诈骗分析市场驱动因素
医疗保健诈骗案件的激增，以及医疗服务提供者和保险公司越来越多地采用先进的分析工具来识别和防范诈欺活动，正在推动全球医疗保健诈骗分析市场的成长。随着各机构日益认识到利用先进的数据分析技术来保护其营运和财务资源的重要性，对有效的诈欺检测和预防解决方案的需求持续增长。这一趋势凸显了医疗保健行业在提高透明度和课责所做的努力，最终有助于整个行业的健康发展，并保护医疗服务提供者和患者免受欺诈活动的侵害。
全球医疗保健诈骗分析市场限制因素
全球医疗保健诈骗分析市场面临阻碍其扩张的许多挑战。主要因素包括部署高阶分析解决方案的高昂成本，以及将这些技术无缝整合到现有医疗保健IT基础设施中的复杂性。此外，对资料隐私和安全的担忧进一步加剧了诈欺分析系统部署的困难。这些担忧不仅延缓了系统的采用进程，也阻碍了潜在用户建立信任，最终影响了市场在有效打击医疗保健诈欺和保护敏感患者资讯方面的整体成长潜力。
全球医疗保健诈骗分析市场趋势
全球医疗保健诈骗分析市场正经历着向先进技术整合的重大转变，尤其是在人工智慧和机器学习能力方面，这些能力能够实现即时异常检测和预测建模。这种发展提高了诈骗识别和理赔分析的准确性，同时，科技公司与医疗机构之间的合作也促进了创新解决方案的开发，以应对不断变化的挑战。对监管合规性和资料安全的重视推动了对全面诈欺预防系统的需求。此外，巨量资料分析驱动的演算法不断改进，旨在增强诈欺侦测能力，最大限度地减少误报，最终在确保高品质患者照护的同时，节省医疗资源。
目录
介绍
- 调查目标
- 调查范围
- 定义
调查方法
- 资讯收集
- 二手资料和一手资料方法
- 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
市场动态与展望
- 市场规模
- 市场动态
- 驱动因素和机会
- 限制与挑战
- 波特分析
关键市场考察
- 关键成功因素
- 竞争程度
- 关键投资机会
- 市场生态系统
- 市场吸引力指数（2025）
- PESTEL 分析
- 总体经济指标
- 价值链分析
- 定价分析
- 监管环境
- 案例研究
- 技术进步
全球医疗保健诈骗分析市场规模（按解决方案类型和复合年增长率划分）（2026-2033 年）
- 说明分析
- 预测分析
- 预测分析
全球医疗保健诈骗分析市场规模（按产品模式和复合年增长率划分）（2026-2033 年）
- 本地部署
- 一经请求
全球医疗保健诈骗分析市场规模（按应用领域及复合年增长率划分）（2026-2033 年）
- 保险理赔审查
- 付款后审核
- 预筛选
- 药房帐单诈欺
- 支付适当性
- 其他的
全球医疗保健诈骗分析市场规模（按最终用户和复合年增长率划分）（2026-2033 年）
- 公共和政府机构
- 私人保险支付方
- 第三方服务供应商
- 雇主
- 其他的
全球医疗保健诈骗分析市场规模及复合年增长率（2026-2033）
- 北美洲
- 美国
- 加拿大
- 欧洲
- 德国
- 西班牙
- 法国
- 英国
- 义大利
- 其他欧洲地区
- 亚太地区
- 中国
- 印度
- 日本
- 韩国
- 亚太其他地区
- 拉丁美洲
- 巴西
- 其他拉丁美洲地区
- 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
- 前五大公司对比
- 主要企业的市场定位（2025 年）
- 主要市场参与者所采取的策略
- 近期市场趋势
- 公司市占率分析（2025 年）
- 主要企业公司简介
- 公司详情
- 产品系列分析
- 依业务板块进行公司股票分析
- 2023-2025年营收年比比较
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）
结论与建议
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
