US Medical Payment Fraud Detection Market

ID: MRFR/MED/15181-HCR
100 Pages
Vikita Thakur
Last Updated: April 06, 2026
US Medical Payment Fraud Detection Market Research Report By Type (Descriptive Analytics, Predictive Analytics, Prescriptive Analytics), By Component (Services, Software), By Delivery Mode (On-premise, Cloud-based), By Source of Service (In-house, Outsourced) and By End-User (Private Insurance Payers, Public/Government Agencies, Third-Party Service Providers) - Growth & Industry Forecast 2025 To 2035
US Medical Payment Fraud Detection Market
Market Size
Forecast Period2025 - 2035
CAGR (2025 - 2035)8.07%
2024 Market Size$ 492.49 Million
2025 Market Size$ 532.23 Million
2035 Market Size$ 1,156.78 Million
Key Players
Optum
Cognizant
Change Healthcare
McKesson
Anthem
Quest Diagnostics
Trends
  • Increased Use of Artificial Intelligence
  • Enhanced Regulatory Compliance
  • Integration of Real-Time Monitoring
Opportunities
  • Rising Healthcare Costs
  • Technological Advancements
  • Increased Regulatory Scrutiny
Summary Table of Contents Segmentation Download PDF
  1. 1 SECTION I: EXECUTIVE SUMMARY AND KEY HIGHLIGHTS
    1. 1.1 EXECUTIVE SUMMARY
      1. 1.1.1 Market Overview
      2. 1.1.2 Key Findings
      3. 1.1.3 Market Segmentation
      4. 1.1.4 Competitive Landscape
      5. 1.1.5 Challenges and Opportunities
      6. 1.1.6 Future Outlook
  2. 2 SECTION II: SCOPING, METHODOLOGY AND MARKET STRUCTURE
    1. 2.1 MARKET INTRODUCTION
      1. 2.1.1 Definition
      2. 2.1.2 Scope of the study
        1. 2.1.2.1 Research Objective
        2. 2.1.2.2 Assumption
        3. 2.1.2.3 Limitations
    2. 2.2 RESEARCH METHODOLOGY
      1. 2.2.1 Overview
      2. 2.2.2 Data Mining
      3. 2.2.3 Secondary Research
      4. 2.2.4 Primary Research
        1. 2.2.4.1 Primary Interviews and Information Gathering Process
        2. 2.2.4.2 Breakdown of Primary Respondents
      5. 2.2.5 Forecasting Model
      6. 2.2.6 Market Size Estimation
        1. 2.2.6.1 Bottom-Up Approach
        2. 2.2.6.2 Top-Down Approach
      7. 2.2.7 Data Triangulation
      8. 2.2.8 Validation
  3. 3 SECTION III: QUALITATIVE ANALYSIS
    1. 3.1 MARKET DYNAMICS
      1. 3.1.1 Overview
      2. 3.1.2 Drivers
      3. 3.1.3 Restraints
      4. 3.1.4 Opportunities
    2. 3.2 MARKET FACTOR ANALYSIS
      1. 3.2.1 Value chain Analysis
      2. 3.2.2 Porter's Five Forces Analysis
        1. 3.2.2.1 Bargaining Power of Suppliers
        2. 3.2.2.2 Bargaining Power of Buyers
        3. 3.2.2.3 Threat of New Entrants
        4. 3.2.2.4 Threat of Substitutes
        5. 3.2.2.5 Intensity of Rivalry
      3. 3.2.3 COVID-19 Impact Analysis
        1. 3.2.3.1 Market Impact Analysis
        2. 3.2.3.2 Regional Impact
        3. 3.2.3.3 Opportunity and Threat Analysis
  4. 4 SECTION IV: QUANTITATIVE ANALYSIS
    1. 4.1 Construction, BY Type (USD Million)
      1. 4.1.1 Descriptive Analytics
      2. 4.1.2 Predictive Analytics
      3. 4.1.3 Prescriptive Analytics
    2. 4.2 Construction, BY Component (USD Million)
      1. 4.2.1 Services
      2. 4.2.2 Software
    3. 4.3 Construction, BY Delivery Mode (USD Million)
      1. 4.3.1 On-premise
      2. 4.3.2 Cloud-based
    4. 4.4 Construction, BY Source of Service (USD Million)
      1. 4.4.1 In-house
      2. 4.4.2 Outsourced
    5. 4.5 Construction, BY End-User (USD Million)
      1. 4.5.1 Private Insurance Payers
      2. 4.5.2 Public/Government Agencies
      3. 4.5.3 Third-Party Service Providers
  5. 5 SECTION V: COMPETITIVE ANALYSIS
    1. 5.1 Competitive Landscape
      1. 5.1.1 Overview
      2. 5.1.2 Competitive Analysis
      3. 5.1.3 Market share Analysis
      4. 5.1.4 Major Growth Strategy in the Construction
      5. 5.1.5 Competitive Benchmarking
      6. 5.1.6 Leading Players in Terms of Number of Developments in the Construction
      7. 5.1.7 Key developments and growth strategies
        1. 5.1.7.1 New Product Launch/Service Deployment
        2. 5.1.7.2 Merger & Acquisitions
        3. 5.1.7.3 Joint Ventures
      8. 5.1.8 Major Players Financial Matrix
        1. 5.1.8.1 Sales and Operating Income
        2. 5.1.8.2 Major Players R&D Expenditure. 2023
    2. 5.2 Company Profiles
      1. 5.2.1 Optum (US)
        1. 5.2.1.1 Financial Overview
        2. 5.2.1.2 Products Offered
        3. 5.2.1.3 Key Developments
        4. 5.2.1.4 SWOT Analysis
        5. 5.2.1.5 Key Strategies
      2. 5.2.2 Cognizant (US)
        1. 5.2.2.1 Financial Overview
        2. 5.2.2.2 Products Offered
        3. 5.2.2.3 Key Developments
        4. 5.2.2.4 SWOT Analysis
        5. 5.2.2.5 Key Strategies
      3. 5.2.3 Change Healthcare (US)
        1. 5.2.3.1 Financial Overview
        2. 5.2.3.2 Products Offered
        3. 5.2.3.3 Key Developments
        4. 5.2.3.4 SWOT Analysis
        5. 5.2.3.5 Key Strategies
      4. 5.2.4 McKesson (US)
        1. 5.2.4.1 Financial Overview
        2. 5.2.4.2 Products Offered
        3. 5.2.4.3 Key Developments
        4. 5.2.4.4 SWOT Analysis
        5. 5.2.4.5 Key Strategies
      5. 5.2.5 Anthem (US)
        1. 5.2.5.1 Financial Overview
        2. 5.2.5.2 Products Offered
        3. 5.2.5.3 Key Developments
        4. 5.2.5.4 SWOT Analysis
        5. 5.2.5.5 Key Strategies
      6. 5.2.6 Quest Diagnostics (US)
        1. 5.2.6.1 Financial Overview
        2. 5.2.6.2 Products Offered
        3. 5.2.6.3 Key Developments
        4. 5.2.6.4 SWOT Analysis
        5. 5.2.6.5 Key Strategies
      7. 5.2.7 IBM Watson Health (US)
        1. 5.2.7.1 Financial Overview
        2. 5.2.7.2 Products Offered
        3. 5.2.7.3 Key Developments
        4. 5.2.7.4 SWOT Analysis
        5. 5.2.7.5 Key Strategies
      8. 5.2.8 Verisk Analytics (US)
        1. 5.2.8.1 Financial Overview
        2. 5.2.8.2 Products Offered
        3. 5.2.8.3 Key Developments
        4. 5.2.8.4 SWOT Analysis
        5. 5.2.8.5 Key Strategies
    3. 5.3 Appendix
      1. 5.3.1 References
      2. 5.3.2 Related Reports
  6. 6 LIST OF FIGURES
    1. 6.1 MARKET SYNOPSIS
    2. 6.2 US MARKET ANALYSIS BY TYPE
    3. 6.3 US MARKET ANALYSIS BY COMPONENT
    4. 6.4 US MARKET ANALYSIS BY DELIVERY MODE
    5. 6.5 US MARKET ANALYSIS BY SOURCE OF SERVICE
    6. 6.6 US MARKET ANALYSIS BY END-USER
    7. 6.7 KEY BUYING CRITERIA OF CONSTRUCTION
    8. 6.8 RESEARCH PROCESS OF MRFR
    9. 6.9 DRO ANALYSIS OF CONSTRUCTION
    10. 6.10 DRIVERS IMPACT ANALYSIS: CONSTRUCTION
    11. 6.11 RESTRAINTS IMPACT ANALYSIS: CONSTRUCTION
    12. 6.12 SUPPLY / VALUE CHAIN: CONSTRUCTION
    13. 6.13 CONSTRUCTION, BY TYPE, 2024 (% SHARE)
    14. 6.14 CONSTRUCTION, BY TYPE, 2024 TO 2035 (USD Million)
    15. 6.15 CONSTRUCTION, BY COMPONENT, 2024 (% SHARE)
    16. 6.16 CONSTRUCTION, BY COMPONENT, 2024 TO 2035 (USD Million)
    17. 6.17 CONSTRUCTION, BY DELIVERY MODE, 2024 (% SHARE)
    18. 6.18 CONSTRUCTION, BY DELIVERY MODE, 2024 TO 2035 (USD Million)
    19. 6.19 CONSTRUCTION, BY SOURCE OF SERVICE, 2024 (% SHARE)
    20. 6.20 CONSTRUCTION, BY SOURCE OF SERVICE, 2024 TO 2035 (USD Million)
    21. 6.21 CONSTRUCTION, BY END-USER, 2024 (% SHARE)
    22. 6.22 CONSTRUCTION, BY END-USER, 2024 TO 2035 (USD Million)
    23. 6.23 BENCHMARKING OF MAJOR COMPETITORS
  7. 7 LIST OF TABLES
    1. 7.1 LIST OF ASSUMPTIONS
  8. 7.1.1
    1. 7.2 US MARKET SIZE ESTIMATES; FORECAST
      1. 7.2.1 BY TYPE, 2025-2035 (USD Million)
      2. 7.2.2 BY COMPONENT, 2025-2035 (USD Million)
      3. 7.2.3 BY DELIVERY MODE, 2025-2035 (USD Million)
      4. 7.2.4 BY SOURCE OF SERVICE, 2025-2035 (USD Million)
      5. 7.2.5 BY END-USER, 2025-2035 (USD Million)
    2. 7.3 PRODUCT LAUNCH/PRODUCT DEVELOPMENT/APPROVAL
  9. 7.3.1
    1. 7.4 ACQUISITION/PARTNERSHIP
  10. 7.4.1

US Medical Payment Fraud Detection Market Segmentation

US Medical Payment Fraud Detection Market By Type (USD Million, 2025-2035)

  • Descriptive Analytics
  • Predictive Analytics
  • Prescriptive Analytics

US Medical Payment Fraud Detection Market By Component (USD Million, 2025-2035)

  • Services
  • Software

US Medical Payment Fraud Detection Market By Delivery Mode (USD Million, 2025-2035)

  • On-premise
  • Cloud-based

US Medical Payment Fraud Detection Market By Source of Service (USD Million, 2025-2035)

  • In-house
  • Outsourced

US Medical Payment Fraud Detection Market By End-User (USD Million, 2025-2035)

  • Private Insurance Payers
  • Public/Government Agencies
  • Third-Party Service Providers

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