The healthcare fraud analytics market is poised for robust growth over the next several years, according to a new report from MarketsandMarkets. The market was valued at $1.5 billion in 2021 and is expected to reach $5 billion by 2026, reflecting a compound annual growth rate of 26.7%.
Several key factors are driving growth in the healthcare fraud analytics sector. These include an increasing number of fraudulent activities in healthcare, a rising number of patients obtaining health insurance, high returns on investment for fraud analytics solutions, and a growing number of pharmacy claims-related frauds.
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The growth in health insurance coverage globally is providing significant momentum. In the U.S. alone, the number of uninsured citizens dropped from 48 million in 2010 to just 28.6 million in 2016. Emerging markets like Asia are also seeing surges in health insurance sign-ups thanks to government initiatives, rising incomes, and increased affordability.
As more patients obtain insurance, the opportunity for fraudulent claims also increases. Healthcare fraud analytics provides payers, government agencies, and employers with descriptive, predictive and prescriptive tools to detect and prevent fraudulent claims and billing activity. The high rate of return delivered by these analytics solutions makes investment in fraud prevention attractive.
The report cited insurance claims review as the largest application segment for healthcare fraud analytics currently, representing claims submitted by providers to insurers. As claims volumes rise with increased insurance coverage, payers are leveraging analytics to identify duplicate claims, upcoding, and other suspicious billing patterns during pre-payment, post-payment or retrospective reviews.
North America leads the global market currently and is expected to maintain a commanding market share through 2026. Widespread insurance coverage, advanced data analytics capabilities and other industry dynamics contribute to the region’s dominance in healthcare fraud prevention adopting.
While the benefits and return on investment delivered by healthcare fraud analytics are substantial, barriers to faster adoption exist as well. These include difficulties capturing comprehensive Medicaid data, the time-intensive and complex nature of analytics model development, and the constant need to upgrade systems to keep pace with the evolving tactics of fraudsters.
Nevertheless, the overarching market drivers point to strong growth trajectories continuing in healthcare fraud analytics globally. The proliferation of digital healthcare data from electronic health records, wearables and social media provides a wealth of data to layer into fraud analytics systems. This big data foundation coupled with advanced AI and machine learning will enable payers and program overseers to achieve new levels of predictive insights to stamp out fraudulent activities and waste in healthcare.
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The MarketsandMarkets report provides a comprehensive overview of the healthcare fraud analytics market with detailed segmentation by solution type, delivery model, application, end user and region. It profiles key players in the market such as IBM, Optum, SAS Institute and Change Healthcare among others. The study serves as an essential guide for companies operating in the healthcare industry focused on improving operational efficiency and eliminating fraud.