Market Trends of Global Healthcare Fraud Detection Industry
This section covers the major market trends shaping the Healthcare Fraud Detection Market according to our research experts:
Review of Insurance Claims by Application Segment is Expected to Witness Growth Over the Forecast Period
Healthcare Fraud Detection solutions play a major role in the review of insurance claims, as most fraud cases occur while claiming insurance. In healthcare insurance fraud, false information is provided to a health insurance company to have them pay unauthorized benefits to the policyholder or the service provider. Machine learning techniques help in improving predictive accuracy and enable loss control units to achieve higher coverage with low false-positive rates. Moreover, the quality and quantity of the available data have a huge impact on the predictive accuracy compared to the quality of the algorithm.
Globally, various organizations, such as the Insurance Fraud Bureau of Australia (IFBA), the Canadian Life and Health Insurance Association (CLHIA), the NHS Counter Fraud Authority (NHSCFA), and the European Healthcare Fraud & Corruption Network (EHFCN), among others, aim to reduce healthcare insurance fraud. The growing interest of the government and private sectors in the review of healthcare insurance claims to save individuals and nations money is driving the growth of the segment.
The Insurance Regulatory and Development Authority of India (IRDAI), annual report 2021, reported that, globally, the share of life insurance business in total premium was 44.5%, and the share of non-life insurance premium was 55.5% in 2020, but India's share of life insurance business was high, and it was at 75.24%, while non-life insurance for non-life business accounted for only 24.76%. This high number of health care life insurance claims has been increasing the demand for solutions in reviewing the insurance claim segment.
Therefore, the increasing number of insurance claims by patients, family members, companies, and others is increasing the demand for the review of the insurance claims segment over the forecast period.
North America Dominates the Market and is Expected to Do the Same over the Forecast Period
North America is expected to dominate the overall market throughout the forecast period. This is due to increasing healthcare spending, rising healthcare IT adoption, and the growing number of fraud cases in the healthcare industry.
The National Health Care Anti-Fraud Association (NHCAA) website Consumer Information section, updated in 2021, stated that every year the United States spends over USD 2.27 trillion on health care. An NHCAA estimate shows that USD 10 billion is lost to health care fraud, and USD 54 billion is estimated to be scammed and stolen every year in the United States. These activities and the loss of wealth in the form of fraud and illegal activities make healthcare fraud the biggest problem in the country. This is expected to drive the demand for healthcare fraud detection solutions over the forecast period.
Additionally, in June 2021, Artivatic launched the ALFRED-AI HEALTH CLAIMS platform for automating end-to-end health claims, and its fraud and abuse detection capacity is 30% or more. The ALFRED-AI HEALTH CLAIMS platform also allows users to self-learn and evolve a system for better risk assessment, fraud detection, and decision-making.
Thus, owing to the availability of numerous advanced services and solutions related to healthcare fraud detection and strategic steps taken by major players present in the country, the market for healthcare fraud detection is expected to bolster within the North American region.
