The large number of fraudulent activities in healthcare; increasing number of patients seeking health insurance; the prepayment review model; growing pressure of fraud, waste, and abuse on healthcare spending; and high returns on investment.

Market Size
The global Healthcare Fraud Detection market size is projected to reach USD 2,242.7 Million by 2022 from USD 631.0 Million in 2017, at a CAGR of 28.9%. 

IBM (US), Optum (US), SAS (US), McKesson (US), SCIO (US), Verscend (US), Wipro (India), Conduent (US), HCL (India), CGI (Canada), DXC (US), Northrop Grumman (US), LexisNexis (US), and Pondera (US) are some key players in this market. These companies are focusing on increasing their presence in the high-growth markets through both organic as well as inorganic growth strategies such as product launches, acquisitions, and expansions. 

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“IBM is a leading player in the healthcare fraud detection market”
The leading position of the company is attributed to its robust product portfolio. The company offers exhaustive healthcare fraud analytic solutions for application in healthcare. The company has a strong presence in the commercial and government healthcare payer markets. For instance, since 2005, the company has invested USD 24 billion in the development of its Big Data and Analytics software and services capabilities. For instance, in April 2016, IBM acquired Truven (US), a provider of cloud-based healthcare data, analytics, and insights. 

“McKesson held the second position in the market among the leading players in 2016”
The company has a strong presence in the US and Canadian markets. It has a strong customer base including more than 300 payer customers. The company focuses on inorganic growth strategies to strengthen its position in the market. In this regard, in February 2016, McKesson agreed with HealthQX (US) to help payers quickly design and scale complex bundled payment models and help ensure those innovative programs provide timely and accurate payment to providers. 

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The growth of the market is attributed to a large number of fraudulent activities in healthcare; increasing number of patients seeking health insurance; the prepayment review model; growing pressure of fraud, waste, and abuse on healthcare spending; and high returns on investment.

Market Size

The global Healthcare Fraud Detection Market is expected to grow from 2,242.7 million by 2022 from USD 504.4 million in 2016, at a CAGR of 28.9% from 2017 to 2022

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“The descriptive analytics segment is expected to dominate the market in 2017”

Based on type, the healthcare fraud detection market is segmented descriptive, predictive, and prescriptive analytics. In 2017, the descriptive analytics segment is expected to account for the largest share of the healthcare fraud detection market. Descriptive analytics forms the base for the effective application of predictive or prescriptive analytics.

“The insurance claims review segment is expected to dominate the market in 2017”

Based on application, the healthcare fraud detection market is segmented into insurance claims review, payment integrity, and other applications. The insurance claims review segment is expected to dominate the healthcare fraud detection market with a share in 2017. This segment is also expected to register the highest growth rate during the forecast period, primarily due to the increasing number of patients seeking health insurance, rising number of fraudulent claims, and growing adoption of the prepayment review model.

 Recent Developments

• In 2017, DXC Technology (CSC) entered into a collaboration with Virtual Clarity (UK) to offer clients’ next-generation IT solutions for their cloud environments.
• In 2016, IBM acquired Truven Health Analytics provider of cloud-based healthcare data, analytics, and insights. This acquisition strengthened IBM’s product portfolio for fraud, waste, and abuse detection and customer base.

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