Global Healthcare Fraud Detection Market Size

Healthcare Fraud Detection Market Analysis

The Global Healthcare Fraud Detection Market size is estimated at USD 2.32 billion in 2024, and is expected to reach USD 6.35 billion by 2029, growing at a CAGR of 22.26% during the forecast period (2024-2029).

Since the COVID-19 pandemic started, it has drastically affected the healthcare industry. While some markets in the industry have shown a downfall, some have shown increased growth. The healthcare industry has witnessed several fraud cases committed by patients, doctors, physicians, and other medical specialists. It was observed that many healthcare providers and specialists are engaged in fraudulent activities for profit. Many instances prove the increasing number of fraud cases during the pandemic. The Justice Department's False Claims Act Settlements and Judgments exceeded USD 5.6 billion in 2021, and it was the second-largest amount recorded since 2014, and of the amount settled, over USD 5 billion in matters related to the health care industry, which includes drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians, among others. Such factors boosted the adoption of healthcare fraud detection solutions, thereby driving the market's growth over the pandemic phase.

Furthermore, the major factors driving the growth of the market are the rising healthcare expenditure; the increasing number of patients opting for health insurance; growing pressure to increase operational efficiency and reduce healthcare spending, and surging fraudulent activities in the healthcare sector globally.

An increasing number of providers are billing and claiming federal health care programs for medically unnecessary services or services not rendered as billed. For instance, in May 2021, SavaSeniorCare LLC and its subsidiaries agreed to pay a settlement amount of USD 11.2 million for alleged false claims for rehabilitation therapy services that they provided because of aggressive corporate targets without respecting the patients' clinical needs. Likewise, Alere billed and caused others to charge for defective rapid point-of-care testing devices, which were used by Medicare beneficiaries to monitor blood coagulation when taking anticoagulant drugs, and for this, the company paid USD 38.75 million as a settlement as per the source mentioned above. These increasing fraudulent activities in the healthcare industry are increasing the demand for healthcare fraud detection services and solutions, which is positively affecting the growth of the market.

Additionally, in the upper-income countries, healthcare expenditure was observed to be equally distributed, resulting in the overall development of the healthcare system. On the contrary, people in the low- and middle-income countries have to pay from their own pockets due to less contribution from the governments toward healthcare expenditure which is resulting in more healthcare fraud, and this is proportionally increasing the demand for healthcare fraud detection solutions.

Thus, the market is expected to project growth over the forecast period. However, the lack of adoption of healthcare fraud analytics may hamper the growth of the market.