Growth Trend for Healthcare Fraud Analytics Market Anticipated at 23.5% Compound Annual Growth Rate (CAGR) from 2025 to 2033
The healthcare industry has seen a significant shift in the fight against fraudulent activities, with the Global Healthcare Fraud Analytics Market showing impressive growth in 2023.
According to recent reports, the application segment that dominated in 2023 was insurance claims review. This focus on claims analysis has proven crucial in identifying and preventing fraudulent activities.
Public and government agencies emerged as the leading end-users of healthcare fraud analytics in 2023. This heightened focus on detecting and preventing fraud in the public sector reflects the growing concern over the financial losses due to fraud and abuse.
The Healthcare Fraud Analytics market was valued at USD 2.5 billion in 2023, and it is projected to reach approximately USD 20.4 billion by 2033, growing at a CAGR of 23.5% during the forecast period from 2025 to 2033.
In the United States, the Centers for Medicare & Medicaid Services (CMS) had a notable success in 2025, preventing over US$ 4 billion from being paid in response to false or fraudulent claims. This was part of the U.S. fraud takedown, which saw 324 defendants charged, including 96 medical professionals, for fraud involving over US$ 14.6 billion in intended loss.
The U.S. Department of Health & Human Services (HHS) is also using advanced techniques to combat fraud. They are developing fraud, waste, and abuse (FWA) models that do not rely solely on past known schemes. These models use tree-based models and deep learning to assign weights to features in Medicare/Medicaid claims, allowing for the identification of new emerging fraud, waste, and abuse cases.
The HHS is also working on a "Unified Case Management" system. This centralised repository and workflow aims to coordinate investigations, with alerting of likely fraud schemes so investigators can prioritise their efforts.
However, the fight against fraud in the healthcare sector is not without challenges. Flaws in national Medicaid data create significant barriers to effective fraud detection within the public sector, according to findings by the U.S. Department of Health and Human Services in 2018. These shortcomings result in billions of dollars lost annually due to fraud and abuse, posing a restraint on the overall market growth.
In terms of delivery models, the on-premise segment led the market in 2023. Despite this, the market is expected to evolve as cloud-based solutions become more prevalent.
Notable players in the Healthcare Fraud Analytics Market include the International Business Machines Corporation (IBM), which plays a significant role in driving demand for advanced fraud detection solutions.
North America accounted for approximately 37.8% of the global healthcare fraud analytics market in 2023, making it the largest regional market. However, the exact market size of healthcare fraud analytics in North America in 2023 is not specified in the provided search results.
As the fight against fraud continues, it's clear that the healthcare industry is embracing advanced data science techniques to detect, prevent, and investigate fraudulent activities. This shift towards healthcare fraud analytics is not only crucial in safeguarding public funds but also in maintaining trust in the healthcare system.
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