United States Healthcare Fraud Detection Market Trends

The healthcare fraud detection solution plays a major role in the review of insurance claims, as most fraud cases occur while claiming insurance. As per the estimates of the National Health Care Anti-Fraud Association (NHCAA) in August 2022, healthcare fraud costs the United States around USD 68 billion, annually. Additionally, in August 2022 updates by Coalition Against Insurance Fraud (CAIF), insurance fraud can cost Unite States consumers USD 308.6 billion per year. This figure includes estimates of yearly fraud expenses in a variety of liability sectors, including life insurance (USD 74.7 billion). Health insurance fraud is a type of fraud, in which false or misleading information is provided to a health insurance company in an attempt to have them pay unauthorized benefits to the policyholder another party, or the entity providing services. The offense can be committed by the insured individual or the provider of health services.

Most health insurances include specific benefits and health insurance fraud practices, such as overbilling for the type of services received. A central objective of the recent United States healthcare policy reform has been to increase access to stable, affordable health insurance. Many strategic initiatives are being taken in the country too. For instance, 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.

Owing to the aforementioned factors, the review of the insurance claims segment is expected to grow exponentially in the United States healthcare fraud detection market.