医療不正分析市場規模、シェア、成長分析、ソリューションタイプ別、提供モデル別、用途別、エンドユーザー別、地域別 - 産業予測、2025-2032年

医療不正分析の世界市場規模は、2023年に25億米ドルと評価され、2024年の31億1,000万米ドルから2032年には177億1,000万米ドルに成長し、予測期間（2025-2032年）のCAGRは24.3％で成長する見通しです。

ヘルスケア不正アナリティクスの世界市場は、医療提供者や保険会社が不正対策に高度なアナリティクスを統合する傾向が強まっていることを背景に、力強い成長を遂げています。データ分析、AI、機械学習を活用したこれらのソリューションは、不規則なパターンや疑わしい請求を効果的に特定し、規制遵守を強化しながら金銭的損失を最小限に抑えます。ヘルスケア不正インシデントの急増は、厳格な規制や効率的な不正管理の緊急ニーズと相まって、市場拡大の主な要因となっています。さらに、現在進行中の技術的進歩やヘルスケア部門とテクノロジー部門との戦略的提携は、今後数年間で市場の開拓を大きく促進し、業界内の不正検知・防止へのアプローチを変革すると予想されます。

目次

イントロダクション

• 調査の目的
• 調査範囲
• 定義

調査手法

• 情報調達
• 二次データと一次データの方法
• 市場規模予測
• 市場の前提条件と制限

エグゼクティブサマリー

• 世界市場の見通し
• 供給と需要の動向分析
• セグメント別機会分析

市場力学と見通し

• 市場概要
• 市場規模
• 市場力学
  • 促進要因と機会
  • 抑制要因と課題
• ポーターの分析

主な市場の考察

• 重要成功要因
• 競合の程度
• 主な投資機会
• 市場エコシステム
• 市場の魅力指数（2024年）
• PESTEL分析
• マクロ経済指標
• バリューチェーン分析
• 価格分析
• 規制情勢
• ケーススタディ
• 技術の進歩

医療不正分析市場規模：ソリューションタイプ別

• 市場概要
• 記述的分析
• 予測的分析
• 処方的分析

医療不正分析市場規模：提供モデル別

• 市場概要
• オンプレミス
• オンデマンド

医療不正分析市場規模：用途別

• 市場概要
• 保険金請求の審査
• 後払いレビュー
• 前払いの見直し
• 薬局請求書の不正使用
• 支払いの整合性
• その他

医療不正分析市場規模：エンドユーザー別

• 市場概要
• 公共機関および政府機関
• 民間保険支払者
• サードパーティのサービスプロバイダー
• 雇用主
• その他

医療不正分析市場規模

• 北米
  • 米国
  • カナダ
• 欧州
  • ドイツ
  • スペイン
  • フランス
  • 英国
  • イタリア
  • その他欧州地域
• アジア太平洋地域
  • 中国
  • インド
  • 日本
  • 韓国
  • その他アジア太平洋地域
• ラテンアメリカ
  • ブラジル
  • その他ラテンアメリカ地域
• 中東・アフリカ
  • GCC諸国
  • 南アフリカ
  • その他中東・アフリカ

競合情報

• 上位5社の比較
• 主要企業の市場ポジショニング（2024年）
• 主な市場企業が採用した戦略
• 市場の最近の動向
• 企業の市場シェア分析（2024年）
• 主要企業の企業プロファイル
  • 会社概要
  • 製品ポートフォリオ分析
  • セグメント別シェア分析
  • 収益の前年比比較（2022-2024）

主要企業プロファイル

• 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 B.V.（Netherlands）
• MultiPlan Inc.（USA）

結論と推奨事項

Global Health Care Fraud Analytics Market size was valued at USD 2.5 billion in 2023 and is poised to grow from USD 3.11 billion in 2024 to USD 17.71 billion by 2032, growing at a CAGR of 24.3% during the forecast period (2025-2032).

The global healthcare fraud analytics market is witnessing robust growth, propelled by healthcare providers and insurance firms increasingly integrating advanced analytics to combat fraud. Utilizing data analysis, AI, and machine learning, these solutions effectively identify irregular patterns and suspicious claims, minimizing financial losses while bolstering regulatory compliance. The surge in healthcare fraud incidents, coupled with stringent regulations and an urgent need for efficient fraud management, is a key driver of market expansion. Furthermore, ongoing technological advancements and strategic partnerships between healthcare and technology sectors are expected to significantly enhance the market's development in the coming years, transforming the approach to fraud detection and prevention within the industry.

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 Segmental 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 global healthcare fraud analytics market is being driven by a rising necessity to detect and prevent fraudulent activities within the healthcare system. As healthcare fraud becomes more prevalent, there is a significant push among healthcare providers and payers to adopt sophisticated analytics solutions. These advanced technologies enable organizations to closely monitor and identify potential fraudulent behavior, ensuring the integrity of healthcare services and protecting financial resources. This ongoing demand for efficient fraud detection mechanisms is fueling the growth of the healthcare fraud analytics market, ultimately promoting a more secure and trustworthy healthcare environment.

Restraints in the Global Health Care Fraud Analytics Market

The global healthcare fraud analytics market faces several significant restraints, primarily due to high implementation costs associated with deploying these systems. The complexity of seamlessly integrating analytics solutions into existing healthcare IT infrastructures further complicates adoption. Additionally, concerns regarding data privacy and security are critical factors that hinder market expansion. These challenges create reluctance among healthcare organizations to fully embrace fraud analytics, impacting the overall growth potential of the market. Addressing these issues will be crucial for enhancing the uptake of fraud detection and prevention technologies in the healthcare sector, thereby fostering a more secure and efficient healthcare system.

Market Trends of the Global Health Care Fraud Analytics Market

The global healthcare fraud analytics market is experiencing significant growth driven by the integration of advanced AI and machine learning technologies, which facilitate real-time anomaly detection and predictive modeling. Key developments include strategic collaborations between technology providers and healthcare organizations, leading to innovative fraud detection solutions. As regulatory compliance and data security remain critical, robust fraud prevention systems are increasingly adopted. Moreover, continuous algorithm refinement and the application of big data analytics enhance fraud detection accuracy while reducing false positives. These advancements not only safeguard healthcare resources but also ensure the delivery of high-quality patient care, positioning the market for sustained expansion.

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, 2024
• 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 (2025-2032)

• Market Overview
• Descriptive Analytics
• Predictive Analytics
• Prescriptive Analytics

Global Health Care Fraud Analytics Market Size by Delivery Model & CAGR (2025-2032)

• Market Overview
• On-premises
• On-demand

Global Health Care Fraud Analytics Market Size by Application & CAGR (2025-2032)

• 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 (2025-2032)

• Market Overview
• Public & Government Agencies
• Private Insurance Payers
• Third-party service providers
• Employers
• Others

Global Health Care Fraud Analytics Market Size & CAGR (2025-2032)

• 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, 2024
• Strategies Adopted by Key Market Players
• Recent Developments in the Market
• Company Market Share Analysis, 2024
• Company Profiles of All Key Players
  • Company Details
  • Product Portfolio Analysis
  • Company's Segmental Share Analysis
  • Revenue Y-O-Y Comparison (2022-2024)

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