A quick way to see what we are going to deal with as providers down the road is to look into what the healthcare fraud industry’s latest advances. Insight partners has released a report on the future of the fraud detection industry in their report, “Healthcare Fraud Detection Market Size and Key Trends in terms of Volume and Value 2015 – 2025.” Let’s look at teh summary here. They key takeaway that we should focus on is the automation of fraud detection.


Healthcare fraud detection markets generally go unnoticed, therefore detection of such fraudulent claims is necessary, as they increase burden on the society. The use of fraud detection solution enable healthcare firms in accounting, and auditing by predictive data methodologies. Careful account auditing can reveal suspicious providers and policy holders and detect potential fraudulent cases before it occurs.

Large number of fraudulent activities in healthcare, rising number of patients opting health insurance, prepayment review model, increasing pressure of fraud and abuse on healthcare spending is expected to drive the growth of the market. Moreover, increasing adoption of cloud-based analytics, emergence of social media and its impact on the healthcare industry, artificial intelligence (AI) in healthcare fraud detection is expected to provide opportunity for the growth of healthcare fraud detection market during the forecast period.

The report provides a detailed overview on the industry including both qualitative and quantitative information. It provides overview and forecast of the global healthcare fraud detection market based on delivery model, component, type, application, and end user. It also provides market size and forecast till 2025 for overall healthcare fraud detection market with respect to five major regions, namely; North America, Europe, Asia-Pacific (APAC), Middle East and Africa (MEA) and South & Central America. The market by each region is later sub-segmented by respective countries and segments. The report covers analysis and forecast of 13 countries globally along with current trend and opportunities prevailing in the region.

The healthcare fraud detection market is segmented based on delivery model as, on-premise delivery models and on-premise delivery models. On the basis of component healthcare fraud detection market is segmented into services and software. Based on type, healthcare fraud detection market is segmented into predictive analytics, prescriptive analytics and descriptive analytics. On the basis of application, healthcare fraud detection market is segmented into insurance claims review, payment integrity and other applications. Based on the end user the market is segmented as public/government agencies, private insurance payers, third-party service providers and employers.

North America is anticipated to hold largest share of the healthcare fraud detection market, followed by Europe. Factors such as rise in the number of people adopting health insurance, rising cases of healthcare fraud, favorable government initiatives to combat healthcare fraud, rising pressure to reduce healthcare costs, and greater product and service availability are expected to drive market growth in this region. Moreover, Asia Pacific is expected to grow at a fastest rate during the analysis period due to increasing awareness, improving healthcare infrastructure and growing investment in the healthcare technology.



The key takeaways are that computers being used to detect fraud will make compliance very difficult and you need a friend in Patient Options to help you be guided through.