Global Healthcare Fraud Detection Market Forecast to 2026

Global Healthcare Fraud Detection Market Forecast to 2026

By 2026, the global healthcare fraud detection market expects a compound annual growth rate (CAGR) of 28.97%.  This constitutes an estimated monetary value growth from $840 million today, to $6.4 billion by 2026.  The rapid rise in healthcare fraud is the single largest factor in the growth of the detection and prevention industry.

Key Market Drivers

More of the global population is adopting health insurances.  The more of the population that adopts health insurance, the more opportunity for provider fraud.

In the US alone, healthcare spending has reached over $4 trillion annually, nearly $12,000 per capita. Spending will continue to grow and is expected to reach $6 trillion by 2028.  With this influx of funds and monetary transfers, the opportunity for fraud has vastly increased.

Fraudsters have no qualms about stealing money from healthcare insurers or private citizens. With so much money involved, and much of the current anti-fraud technology so obsolete, the healthcare industry will become a major target. It’s estimated that $23 billion in healthcare fraud occurs annually in the US. Unless proper steps are taken, this number will balloon further.

Key Market Restraints

Growth of the healthcare fraud market is restrained by the lack of adoption of fraud analytics tools.  The more fraud is perpetrated on the industry, the higher the costs to consumers and the more scrutinization needed for care solutions. However, many insurers are reluctant to invest in healthcare fraud detection and prevention tools. Instead, they rely on old-school methods to prevent fraud, often accepting fraud as a cost of doing business. Because of this, losses will mount and costs to consumers will skyrocket.

Adoptable Solutions

Health insurers must implement Ai tools, like those from ToolCASE, to stem the metastasizing of fraud.

There is currently a lack of skilled, or well-trained, professionals in anti-fraud departments, worldwide. And many insurers are reluctant to spend on training. However, the implementation of simple-to-use analytics measures, like those from ToolCASE could help solve this.

The ToolCASE technology can help detect and prevent healthcare fraud in real-time, as it’s occurring. The relatively simple to use systems are easily adoptable by fraud teams, even those with lesser training and lesser technical knowledge, and can be fully supported remotely.

ToolCASE’s plug-and-play healthcare fraud solutions help prevent attempts at illegal activities from becoming successful frauds. It can help insurers save perhaps millions in fraud losses, while boosting their bottom lines.

As the healthcare market continues to grow, the healthcare fraud detection market will as well. However, not all solutions are created equal. Insurers must incorporate cutting-edge, real-time tools that can detect the smallest of anomalies in provider data, patient data and transactional data.

ToolCASE is this solution.

Learn more about the ToolCASE anti-fraud tools HERE

Or read the full report on the Global Healthcare Fraud Detection Market, HERE

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