カテゴリ： QYResearch, 世界, 医療/バイオ

医療費不正検出の世界市場2025年：オンプレミス、クラウドベース

■ 英語タイトル：Global Medical Payment Fraud Detection Market Research Report 2025

調査会社QYResearch社が発行したリサーチレポート（データ管理コード：QYR23MA7498）■ 発行会社/調査会社：QYResearch
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■ 発行日：2025年3月
■ 調査対象地域：グローバル
■ 産業分野：医療
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★グローバルリサーチ資料[医療費不正検出の世界市場2025年：オンプレミス、クラウドベース]についてメールでお問い合わせはこちら
*** レポート概要（サマリー）***

当調査資料は医療費不正検出のグローバル市場について調査・分析し、世界の医療費不正検出市場概要、市場トレンド、主要企業別競争状況、タイプ別セグメント分析（オンプレミス、クラウドベース）、用途別セグメント分析（民間保険会社、公的/政府機関、サードパーティサービスプロバイダー）、地域別市場規模、主要企業のプロファイルなどに関する情報を掲載しています。主要企業としては、LexisNexis Risk Solutions、International Business Machines Corporation、Optuminsight、OSP Labs、DXC Technology Company、Unitedhealth Group、SAS Institute、Fair Isaac Corporation、EXL Service Holdings, Inc.、CGI GROUPなどが含まれています。医療費不正検出のグローバル市場は、2024年にXXX米ドル、2031年にはXXX米ドルに達すると予測され、予測期間の年平均成長率はXXX％です。貿易戦争とロシア・ウクライナ戦争の影響は、医療費不正検出市場規模を算出する際に考慮しました。

・医療費不正検出市場の概要
- 医療費不正検出の種類別セグメント
- 世界の医療費不正検出市場規模：タイプ別分析（オンプレミス、クラウドベース）
- 医療費不正検出の用途別セグメント
- 世界の医療費不正検出市場規模：用途別分析（民間保険会社、公的/政府機関、サードパーティサービスプロバイダー）
- 世界の医療費不正検出市場規模予測（2020年-2031年）

・医療費不正検出市場の成長トレンド
- 医療費不正検出の地域別市場規模（2020年-2031年）
- 医療費不正検出市場ダイナミクス
- 医療費不正検出の業界動向
- 医療費不正検出市場の成長ドライバ、課題、阻害要因

・主要企業別競争状況
- 企業別市場シェア
- 世界の主要企業、業界ランキング分析
- 市場への参入、M＆A動向

・種類別セグメント：オンプレミス、クラウドベース
- 世界の医療費不正検出のタイプ別市場規模（2020年-2025年）
- 世界の医療費不正検出のタイプ別市場規模（2024年-2029年）

・用途別セグメント：民間保険会社、公的/政府機関、サードパーティサービスプロバイダー
- 世界の医療費不正検出の用途別市場規模（2020年-2025年）
- 世界の医療費不正検出の用途別市場規模（2024年-2029年）

・医療費不正検出の地域別市場規模
- 北米の医療費不正検出市場規模（2020年-2031年）
- 米国の医療費不正検出市場規模（2020年-2031年）
- ヨーロッパの医療費不正検出市場規模（2020年-2031年）
- アジア太平洋の医療費不正検出市場規模（2020年-2031年）
- 中国の医療費不正検出市場規模（2020年-2031年）
- 日本の医療費不正検出市場規模（2020年-2031年）
- 韓国の医療費不正検出市場規模（2020年-2031年）
- インドの医療費不正検出市場規模（2020年-2031年）
- オーストラリアの医療費不正検出市場規模（2020年-2031年）
- 中南米の医療費不正検出市場規模（2020年-2031年）
- 中東・アフリカの医療費不正検出市場規模（2020年-2031年）

・主要企業のプロファイル：企業情報、事業概要、売上、動向
LexisNexis Risk Solutions、International Business Machines Corporation、Optuminsight、OSP Labs、DXC Technology Company、Unitedhealth Group、SAS Institute、Fair Isaac Corporation、EXL Service Holdings, Inc.、CGI GROUP

・アナリストの観点/結論

・調査手法と情報源

Medical fraud is increasingly apperceived as one of the social concerns. Healthcare fraud varies, but generally, it involves filing dishonest health claims for profit.
Highlights
The global Medical Payment Fraud Detection market was valued at US$ million in 2024 and is anticipated to reach US$ million by 2031, witnessing a CAGR of % during the forecast period 2025-2031. The influence of trade war and the Russia-Ukraine War were considered while estimating market sizes.
North American market for Medical Payment Fraud Detection is estimated to increase from $ million in 2023 to reach $ million by 2031, at a CAGR of % during the forecast period of 2025 through 2031.
Asia-Pacific market for Medical Payment Fraud Detection is estimated to increase from $ million in 2023 to reach $ million by 2031, at a CAGR of % during the forecast period of 2025 through 2031.
The global market for Medical Payment Fraud Detection in Private Insurance Payers is estimated to increase from $ million in 2023 to $ million by 2031, at a CAGR of % during the forecast period of 2025 through 2031.
The key global companies of Medical Payment Fraud Detection include LexisNexis Risk Solutions, International Business Machines Corporation, Optuminsight, OSP Labs, DXC Technology Company, Unitedhealth Group, SAS Institute, Fair Isaac Corporation and EXL Service Holdings, Inc., etc. In 2022, the world’s top three vendors accounted for approximately % of the revenue.
Report Scope
This report aims to provide a comprehensive presentation of the global market for Medical Payment Fraud Detection, with both quantitative and qualitative analysis, to help readers develop business/growth strategies, assess the market competitive situation, analyze their position in the current marketplace, and make informed business decisions regarding Medical Payment Fraud Detection.
The Medical Payment Fraud Detection market size, estimations, and forecasts are provided in terms of and revenue ($ millions), considering 2024 as the base year, with history and forecast data for the period from 2020 to 2031. This report segments the global Medical Payment Fraud Detection market comprehensively. Regional market sizes, concerning products by type, by application, and by players, are also provided.
For a more in-depth understanding of the market, the report provides profiles of the competitive landscape, key competitors, and their respective market ranks. The report also discusses technological trends and new product developments.
The report will help the Medical Payment Fraud Detection companies, new entrants, and industry chain related companies in this market with information on the revenues for the overall market and the sub-segments across the different segments, by company, by type, by application, and by regions.
By Company
LexisNexis Risk Solutions
International Business Machines Corporation
Optuminsight
OSP Labs
DXC Technology Company
Unitedhealth Group
SAS Institute
Fair Isaac Corporation
EXL Service Holdings, Inc.
CGI GROUP
Segment by Type
On-premise
Cloud-based
Segment by Application
Private Insurance Payers
Public/Government Agencies
Third-Party Service Providers
By Region
North America
United States
Canada
Europe
Germany
France
UK
Italy
Russia
Nordic Countries
Rest of Europe
Asia-Pacific
China
Japan
South Korea
Southeast Asia
India
Australia
Rest of Asia
Latin America
Mexico
Brazil
Rest of Latin America
Middle East & Africa
Turkey
Saudi Arabia
UAE
Rest of MEA
Core Chapters
Chapter 1: Introduces the report scope of the report, executive summary of different market segments (by type, application, etc), including the market size of each market segment, future development potential, and so on. It offers a high-level view of the current state of the market and its likely evolution in the short to mid-term, and long term.
Chapter 2: Introduces executive summary of global market size, regional market size, this section also introduces the market dynamics, latest developments of the market, the driving factors and restrictive factors of the market, the challenges and risks faced by companies in the industry, and the analysis of relevant policies in the industry.
Chapter 3: Detailed analysis of Medical Payment Fraud Detection companies’ competitive landscape, revenue market share, latest development plan, merger, and acquisition information, etc.
Chapter 4: Provides the analysis of various market segments by type, covering the market size and development potential of each market segment, to help readers find the blue ocean market in different market segments.
Chapter 5: Provides the analysis of various market segments by application, covering the market size and development potential of each market segment, to help readers find the blue ocean market in different downstream markets.
Chapter 6, 7, 8, 9, 10: North America, Europe, Asia Pacific, Latin America, Middle East and Africa segment by country. It provides a quantitative analysis of the market size and development potential of each region and its main countries and introduces the market development, future development prospects, market space, and capacity of each country in the world.
Chapter 11: Provides profiles of key players, introducing the basic situation of the key companies in the market in detail, including product revenue, gross margin, product introduction, recent development, etc.
Chapter 12: The main points and conclusions of the report.

世界の市場調査レポート販売サイト（H&Iグローバルリサーチ株式会社運営）
*** レポート目次（コンテンツ）***

1 Report Overview
1.1 Study Scope
1.2 Market Analysis by Type
1.2.1 Global Medical Payment Fraud Detection Market Size Growth Rate by Type: 2020 VS 2024 VS 2031
1.2.2 On-premise
1.2.3 Cloud-based
1.3 Market by Application
1.3.1 Global Medical Payment Fraud Detection Market Growth by Application: 2020 VS 2024 VS 2031
1.3.2 Private Insurance Payers
1.3.3 Public/Government Agencies
1.3.4 Third-Party Service Providers
1.4 Study Objectives
1.5 Years Considered
1.6 Years Considered
2 Global Growth Trends
2.1 Global Medical Payment Fraud Detection Market Perspective (2020-2031)
2.2 Medical Payment Fraud Detection Growth Trends by Region
2.2.1 Global Medical Payment Fraud Detection Market Size by Region: 2020 VS 2024 VS 2031
2.2.2 Medical Payment Fraud Detection Historic Market Size by Region (2020-2025)
2.2.3 Medical Payment Fraud Detection Forecasted Market Size by Region (2026-2031)
2.3 Medical Payment Fraud Detection Market Dynamics
2.3.1 Medical Payment Fraud Detection Industry Trends
2.3.2 Medical Payment Fraud Detection Market Drivers
2.3.3 Medical Payment Fraud Detection Market Challenges
2.3.4 Medical Payment Fraud Detection Market Restraints
3 Competition Landscape by Key Players
3.1 Global Top Medical Payment Fraud Detection Players by Revenue
3.1.1 Global Top Medical Payment Fraud Detection Players by Revenue (2020-2025)
3.1.2 Global Medical Payment Fraud Detection Revenue Market Share by Players (2020-2025)
3.2 Global Medical Payment Fraud Detection Market Share by Company Type (Tier 1, Tier 2, and Tier 3)
3.3 Players Covered: Ranking by Medical Payment Fraud Detection Revenue
3.4 Global Medical Payment Fraud Detection Market Concentration Ratio
3.4.1 Global Medical Payment Fraud Detection Market Concentration Ratio (CR5 and HHI)
3.4.2 Global Top 10 and Top 5 Companies by Medical Payment Fraud Detection Revenue in 2022
3.5 Medical Payment Fraud Detection Key Players Head office and Area Served
3.6 Key Players Medical Payment Fraud Detection Product Solution and Service
3.7 Date of Enter into Medical Payment Fraud Detection Market
3.8 Mergers & Acquisitions, Expansion Plans
4 Medical Payment Fraud Detection Breakdown Data by Type
4.1 Global Medical Payment Fraud Detection Historic Market Size by Type (2020-2025)
4.2 Global Medical Payment Fraud Detection Forecasted Market Size by Type (2026-2031)
5 Medical Payment Fraud Detection Breakdown Data by Application
5.1 Global Medical Payment Fraud Detection Historic Market Size by Application (2020-2025)
5.2 Global Medical Payment Fraud Detection Forecasted Market Size by Application (2026-2031)
6 North America
6.1 North America Medical Payment Fraud Detection Market Size (2020-2031)
6.2 North America Medical Payment Fraud Detection Market Growth Rate by Country: 2020 VS 2024 VS 2031
6.3 North America Medical Payment Fraud Detection Market Size by Country (2020-2025)
6.4 North America Medical Payment Fraud Detection Market Size by Country (2026-2031)
6.5 United States
6.6 Canada
7 Europe
7.1 Europe Medical Payment Fraud Detection Market Size (2020-2031)
7.2 Europe Medical Payment Fraud Detection Market Growth Rate by Country: 2020 VS 2024 VS 2031
7.3 Europe Medical Payment Fraud Detection Market Size by Country (2020-2025)
7.4 Europe Medical Payment Fraud Detection Market Size by Country (2026-2031)
7.5 Germany
7.6 France
7.7 U.K.
7.8 Italy
7.9 Russia
7.10 Nordic Countries
8 Asia-Pacific
8.1 Asia-Pacific Medical Payment Fraud Detection Market Size (2020-2031)
8.2 Asia-Pacific Medical Payment Fraud Detection Market Growth Rate by Region: 2020 VS 2024 VS 2031
8.3 Asia-Pacific Medical Payment Fraud Detection Market Size by Region (2020-2025)
8.4 Asia-Pacific Medical Payment Fraud Detection Market Size by Region (2026-2031)
8.5 China
8.6 Japan
8.7 South Korea
8.8 Southeast Asia
8.9 India
8.10 Australia
9 Latin America
9.1 Latin America Medical Payment Fraud Detection Market Size (2020-2031)
9.2 Latin America Medical Payment Fraud Detection Market Growth Rate by Country: 2020 VS 2024 VS 2031
9.3 Latin America Medical Payment Fraud Detection Market Size by Country (2020-2025)
9.4 Latin America Medical Payment Fraud Detection Market Size by Country (2026-2031)
9.5 Mexico
9.6 Brazil
10 Middle East & Africa
10.1 Middle East & Africa Medical Payment Fraud Detection Market Size (2020-2031)
10.2 Middle East & Africa Medical Payment Fraud Detection Market Growth Rate by Country: 2020 VS 2024 VS 2031
10.3 Middle East & Africa Medical Payment Fraud Detection Market Size by Country (2020-2025)
10.4 Middle East & Africa Medical Payment Fraud Detection Market Size by Country (2026-2031)
10.5 Turkey
10.6 Saudi Arabia
10.7 UAE
11 Key Players Profiles
11.1 LexisNexis Risk Solutions
11.1.1 LexisNexis Risk Solutions Company Detail
11.1.2 LexisNexis Risk Solutions Business Overview
11.1.3 LexisNexis Risk Solutions Medical Payment Fraud Detection Introduction
11.1.4 LexisNexis Risk Solutions Revenue in Medical Payment Fraud Detection Business (2020-2025)
11.1.5 LexisNexis Risk Solutions Recent Development
11.2 International Business Machines Corporation
11.2.1 International Business Machines Corporation Company Detail
11.2.2 International Business Machines Corporation Business Overview
11.2.3 International Business Machines Corporation Medical Payment Fraud Detection Introduction
11.2.4 International Business Machines Corporation Revenue in Medical Payment Fraud Detection Business (2020-2025)
11.2.5 International Business Machines Corporation Recent Development
11.3 Optuminsight
11.3.1 Optuminsight Company Detail
11.3.2 Optuminsight Business Overview
11.3.3 Optuminsight Medical Payment Fraud Detection Introduction
11.3.4 Optuminsight Revenue in Medical Payment Fraud Detection Business (2020-2025)
11.3.5 Optuminsight Recent Development
11.4 OSP Labs
11.4.1 OSP Labs Company Detail
11.4.2 OSP Labs Business Overview
11.4.3 OSP Labs Medical Payment Fraud Detection Introduction
11.4.4 OSP Labs Revenue in Medical Payment Fraud Detection Business (2020-2025)
11.4.5 OSP Labs Recent Development
11.5 DXC Technology Company
11.5.1 DXC Technology Company Company Detail
11.5.2 DXC Technology Company Business Overview
11.5.3 DXC Technology Company Medical Payment Fraud Detection Introduction
11.5.4 DXC Technology Company Revenue in Medical Payment Fraud Detection Business (2020-2025)
11.5.5 DXC Technology Company Recent Development
11.6 Unitedhealth Group
11.6.1 Unitedhealth Group Company Detail
11.6.2 Unitedhealth Group Business Overview
11.6.3 Unitedhealth Group Medical Payment Fraud Detection Introduction
11.6.4 Unitedhealth Group Revenue in Medical Payment Fraud Detection Business (2020-2025)
11.6.5 Unitedhealth Group Recent Development
11.7 SAS Institute
11.7.1 SAS Institute Company Detail
11.7.2 SAS Institute Business Overview
11.7.3 SAS Institute Medical Payment Fraud Detection Introduction
11.7.4 SAS Institute Revenue in Medical Payment Fraud Detection Business (2020-2025)
11.7.5 SAS Institute Recent Development
11.8 Fair Isaac Corporation
11.8.1 Fair Isaac Corporation Company Detail
11.8.2 Fair Isaac Corporation Business Overview
11.8.3 Fair Isaac Corporation Medical Payment Fraud Detection Introduction
11.8.4 Fair Isaac Corporation Revenue in Medical Payment Fraud Detection Business (2020-2025)
11.8.5 Fair Isaac Corporation Recent Development
11.9 EXL Service Holdings, Inc.
11.9.1 EXL Service Holdings, Inc. Company Detail
11.9.2 EXL Service Holdings, Inc. Business Overview
11.9.3 EXL Service Holdings, Inc. Medical Payment Fraud Detection Introduction
11.9.4 EXL Service Holdings, Inc. Revenue in Medical Payment Fraud Detection Business (2020-2025)
11.9.5 EXL Service Holdings, Inc. Recent Development
11.10 CGI GROUP
11.10.1 CGI GROUP Company Detail
11.10.2 CGI GROUP Business Overview
11.10.3 CGI GROUP Medical Payment Fraud Detection Introduction
11.10.4 CGI GROUP Revenue in Medical Payment Fraud Detection Business (2020-2025)
11.10.5 CGI GROUP Recent Development
12 Analyst’s Viewpoints/Conclusions
13 Appendix
13.1 Research Methodology
13.1.1 Methodology/Research Approach
13.1.2 Data Source
13.2 Disclaimer
13.3 Author Details

List of Tables
Table 1. Global Medical Payment Fraud Detection Market Size Growth Rate by Type (US$ Million): 2020 VS 2024 VS 2031
Table 2. Key Players of On-premise
Table 3. Key Players of Cloud-based
Table 4. Global Medical Payment Fraud Detection Market Size Growth by Application (US$ Million): 2020 VS 2024 VS 2031
Table 5. Global Medical Payment Fraud Detection Market Size by Region (US$ Million): 2020 VS 2024 VS 2031
Table 6. Global Medical Payment Fraud Detection Market Size by Region (2020-2025) & (US$ Million)
Table 7. Global Medical Payment Fraud Detection Market Share by Region (2020-2025)
Table 8. Global Medical Payment Fraud Detection Forecasted Market Size by Region (2026-2031) & (US$ Million)
Table 9. Global Medical Payment Fraud Detection Market Share by Region (2026-2031)
Table 10. Medical Payment Fraud Detection Market Trends
Table 11. Medical Payment Fraud Detection Market Drivers
Table 12. Medical Payment Fraud Detection Market Challenges
Table 13. Medical Payment Fraud Detection Market Restraints
Table 14. Global Medical Payment Fraud Detection Revenue by Players (2020-2025) & (US$ Million)
Table 15. Global Medical Payment Fraud Detection Market Share by Players (2020-2025)
Table 16. Global Top Medical Payment Fraud Detection Players by Company Type (Tier 1, Tier 2, and Tier 3) & (based on the Revenue in Medical Payment Fraud Detection as of 2022)
Table 17. Ranking of Global Top Medical Payment Fraud Detection Companies by Revenue (US$ Million) in 2024
Table 18. Global 5 Largest Players Market Share by Medical Payment Fraud Detection Revenue (CR5 and HHI) & (2020-2025)
Table 19. Key Players Headquarters and Area Served
Table 20. Key Players Medical Payment Fraud Detection Product Solution and Service
Table 21. Date of Enter into Medical Payment Fraud Detection Market
Table 22. Mergers & Acquisitions, Expansion Plans
Table 23. Global Medical Payment Fraud Detection Market Size by Type (2020-2025) & (US$ Million)
Table 24. Global Medical Payment Fraud Detection Revenue Market Share by Type (2020-2025)
Table 25. Global Medical Payment Fraud Detection Forecasted Market Size by Type (2026-2031) & (US$ Million)
Table 26. Global Medical Payment Fraud Detection Revenue Market Share by Type (2026-2031)
Table 27. Global Medical Payment Fraud Detection Market Size by Application (2020-2025) & (US$ Million)
Table 28. Global Medical Payment Fraud Detection Revenue Market Share by Application (2020-2025)
Table 29. Global Medical Payment Fraud Detection Forecasted Market Size by Application (2026-2031) & (US$ Million)
Table 30. Global Medical Payment Fraud Detection Revenue Market Share by Application (2026-2031)
Table 31. North America Medical Payment Fraud Detection Market Size Growth Rate by Country (US$ Million): 2020 VS 2024 VS 2031
Table 32. North America Medical Payment Fraud Detection Market Size by Country (2020-2025) & (US$ Million)
Table 33. North America Medical Payment Fraud Detection Market Size by Country (2026-2031) & (US$ Million)
Table 34. Europe Medical Payment Fraud Detection Market Size Growth Rate by Country (US$ Million): 2020 VS 2024 VS 2031
Table 35. Europe Medical Payment Fraud Detection Market Size by Country (2020-2025) & (US$ Million)
Table 36. Europe Medical Payment Fraud Detection Market Size by Country (2026-2031) & (US$ Million)
Table 37. Asia-Pacific Medical Payment Fraud Detection Market Size Growth Rate by Region (US$ Million): 2020 VS 2024 VS 2031
Table 38. Asia-Pacific Medical Payment Fraud Detection Market Size by Region (2020-2025) & (US$ Million)
Table 39. Asia-Pacific Medical Payment Fraud Detection Market Size by Region (2026-2031) & (US$ Million)
Table 40. Latin America Medical Payment Fraud Detection Market Size Growth Rate by Country (US$ Million): 2020 VS 2024 VS 2031
Table 41. Latin America Medical Payment Fraud Detection Market Size by Country (2020-2025) & (US$ Million)
Table 42. Latin America Medical Payment Fraud Detection Market Size by Country (2026-2031) & (US$ Million)
Table 43. Middle East & Africa Medical Payment Fraud Detection Market Size Growth Rate by Country (US$ Million): 2020 VS 2024 VS 2031
Table 44. Middle East & Africa Medical Payment Fraud Detection Market Size by Country (2020-2025) & (US$ Million)
Table 45. Middle East & Africa Medical Payment Fraud Detection Market Size by Country (2026-2031) & (US$ Million)
Table 46. LexisNexis Risk Solutions Company Detail
Table 47. LexisNexis Risk Solutions Business Overview
Table 48. LexisNexis Risk Solutions Medical Payment Fraud Detection Product
Table 49. LexisNexis Risk Solutions Revenue in Medical Payment Fraud Detection Business (2020-2025) & (US$ Million)
Table 50. LexisNexis Risk Solutions Recent Development
Table 51. International Business Machines Corporation Company Detail
Table 52. International Business Machines Corporation Business Overview
Table 53. International Business Machines Corporation Medical Payment Fraud Detection Product
Table 54. International Business Machines Corporation Revenue in Medical Payment Fraud Detection Business (2020-2025) & (US$ Million)
Table 55. International Business Machines Corporation Recent Development
Table 56. Optuminsight Company Detail
Table 57. Optuminsight Business Overview
Table 58. Optuminsight Medical Payment Fraud Detection Product
Table 59. Optuminsight Revenue in Medical Payment Fraud Detection Business (2020-2025) & (US$ Million)
Table 60. Optuminsight Recent Development
Table 61. OSP Labs Company Detail
Table 62. OSP Labs Business Overview
Table 63. OSP Labs Medical Payment Fraud Detection Product
Table 64. OSP Labs Revenue in Medical Payment Fraud Detection Business (2020-2025) & (US$ Million)
Table 65. OSP Labs Recent Development
Table 66. DXC Technology Company Company Detail
Table 67. DXC Technology Company Business Overview
Table 68. DXC Technology Company Medical Payment Fraud Detection Product
Table 69. DXC Technology Company Revenue in Medical Payment Fraud Detection Business (2020-2025) & (US$ Million)
Table 70. DXC Technology Company Recent Development
Table 71. Unitedhealth Group Company Detail
Table 72. Unitedhealth Group Business Overview
Table 73. Unitedhealth Group Medical Payment Fraud Detection Product
Table 74. Unitedhealth Group Revenue in Medical Payment Fraud Detection Business (2020-2025) & (US$ Million)
Table 75. Unitedhealth Group Recent Development
Table 76. SAS Institute Company Detail
Table 77. SAS Institute Business Overview
Table 78. SAS Institute Medical Payment Fraud Detection Product
Table 79. SAS Institute Revenue in Medical Payment Fraud Detection Business (2020-2025) & (US$ Million)
Table 80. SAS Institute Recent Development
Table 81. Fair Isaac Corporation Company Detail
Table 82. Fair Isaac Corporation Business Overview
Table 83. Fair Isaac Corporation Medical Payment Fraud Detection Product
Table 84. Fair Isaac Corporation Revenue in Medical Payment Fraud Detection Business (2020-2025) & (US$ Million)
Table 85. Fair Isaac Corporation Recent Development
Table 86. EXL Service Holdings, Inc. Company Detail
Table 87. EXL Service Holdings, Inc. Business Overview
Table 88. EXL Service Holdings, Inc. Medical Payment Fraud Detection Product
Table 89. EXL Service Holdings, Inc. Revenue in Medical Payment Fraud Detection Business (2020-2025) & (US$ Million)
Table 90. EXL Service Holdings, Inc. Recent Development
Table 91. CGI GROUP Company Detail
Table 92. CGI GROUP Business Overview
Table 93. CGI GROUP Medical Payment Fraud Detection Product
Table 94. CGI GROUP Revenue in Medical Payment Fraud Detection Business (2020-2025) & (US$ Million)
Table 95. CGI GROUP Recent Development
Table 96. Research Programs/Design for This Report
Table 97. Key Data Information from Secondary Sources
Table 98. Key Data Information from Primary Sources
List of Figures
Figure 1. Global Medical Payment Fraud Detection Market Size Comparison by Type (2025-2031) & (US$ Million)
Figure 2. Global Medical Payment Fraud Detection Market Share by Type: 2022 VS 2029
Figure 3. On-premise Features
Figure 4. Cloud-based Features
Figure 5. Global Medical Payment Fraud Detection Market Size Comparison by Application (2025-2031) & (US$ Million)
Figure 6. Global Medical Payment Fraud Detection Market Share by Application: 2022 VS 2029
Figure 7. Private Insurance Payers Case Studies
Figure 8. Public/Government Agencies Case Studies
Figure 9. Third-Party Service Providers Case Studies
Figure 10. Medical Payment Fraud Detection Report Years Considered
Figure 11. Global Medical Payment Fraud Detection Market Size (US$ Million), Year-over-Year: 2020-2031
Figure 12. Global Medical Payment Fraud Detection Market Size, (US$ Million), 2020 VS 2024 VS 2031
Figure 13. Global Medical Payment Fraud Detection Market Share by Region: 2022 VS 2029
Figure 14. Global Medical Payment Fraud Detection Market Share by Players in 2024
Figure 15. Global Top Medical Payment Fraud Detection Players by Company Type (Tier 1, Tier 2, and Tier 3) & (based on the Revenue in Medical Payment Fraud Detection as of 2022)
Figure 16. The Top 10 and 5 Players Market Share by Medical Payment Fraud Detection Revenue in 2024
Figure 17. North America Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 18. North America Medical Payment Fraud Detection Market Share by Country (2020-2031)
Figure 19. United States Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 20. Canada Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 21. Europe Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 22. Europe Medical Payment Fraud Detection Market Share by Country (2020-2031)
Figure 23. Germany Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 24. France Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 25. U.K. Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 26. Italy Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 27. Russia Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 28. Nordic Countries Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 29. Asia-Pacific Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 30. Asia-Pacific Medical Payment Fraud Detection Market Share by Region (2020-2031)
Figure 31. China Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 32. Japan Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 33. South Korea Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 34. Southeast Asia Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 35. India Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 36. Australia Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 37. Latin America Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 38. Latin America Medical Payment Fraud Detection Market Share by Country (2020-2031)
Figure 39. Mexico Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 40. Brazil Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 41. Middle East & Africa Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 42. Middle East & Africa Medical Payment Fraud Detection Market Share by Country (2020-2031)
Figure 43. Turkey Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 44. Saudi Arabia Medical Payment Fraud Detection Market Size YoY Growth (2020-2031) & (US$ Million)
Figure 45. LexisNexis Risk Solutions Revenue Growth Rate in Medical Payment Fraud Detection Business (2020-2025)
Figure 46. International Business Machines Corporation Revenue Growth Rate in Medical Payment Fraud Detection Business (2020-2025)
Figure 47. Optuminsight Revenue Growth Rate in Medical Payment Fraud Detection Business (2020-2025)
Figure 48. OSP Labs Revenue Growth Rate in Medical Payment Fraud Detection Business (2020-2025)
Figure 49. DXC Technology Company Revenue Growth Rate in Medical Payment Fraud Detection Business (2020-2025)
Figure 50. Unitedhealth Group Revenue Growth Rate in Medical Payment Fraud Detection Business (2020-2025)
Figure 51. SAS Institute Revenue Growth Rate in Medical Payment Fraud Detection Business (2020-2025)
Figure 52. Fair Isaac Corporation Revenue Growth Rate in Medical Payment Fraud Detection Business (2020-2025)
Figure 53. EXL Service Holdings, Inc. Revenue Growth Rate in Medical Payment Fraud Detection Business (2020-2025)
Figure 54. CGI GROUP Revenue Growth Rate in Medical Payment Fraud Detection Business (2020-2025)
Figure 55. Bottom-up and Top-down Approaches for This Report
Figure 56. Data Triangulation
Figure 57. Key Executives Interviewed

※参考情報

医療費不正検出は、医療サービスにおける詐欺や不正行為を識別し、予防するためのプロセスを指します。近年、医療費の高騰とともに、医療サービスが不正に請求される事例が増加しており、この問題に対処することが重要となっています。医療費不正検出の概念は、個人と組織の両方にとって深刻な問題であり、その影響は国全体の医療費に波及します。

まず、医療費不正検出の定義について考えます。医療費不正検出とは、医療行為や請求プロセスにおいて不正な請求や不適切な診療行為を特定し、それに対処するための手段や方法論を含む広範な概念です。これは、医療機関、医師、保険会社などの関係者が関与し、データ分析、監視、さらには法的措置を通じて行われます。

特徴としては、まず第一に、データの大量性が挙げられます。医療サービスには膨大な数のデータが関与しており、診療記録や請求書、患者のプロフィールなど、多種多様な情報が存在します。これらのデータを効果的に分析することで、不正行為を特定することが可能になります。また、医療費不正検出は、非常に複雑なプロセスを含むため、高度な専門知識や技術が必要とされます。倫理的および法的な観点からも多くの配慮が求められるため、専門家たちが関連することが一般的です。

医療費不正検出の種類には、さまざまなアプローチが存在します。例えば、データマイニング技術を使用した異常検知や、機械学習を活用した予測モデルなどがあります。これにより、過去のデータを分析し、通常のパターンから逸脱した請求を特定することが可能になります。さらに、ヒューマンインターフェースを通じて実施される手動での監査や、AIを使用した自動化されたシステムも利用されています。これにより、効率的かつ正確な不正検出が促進されます。

用途としては、医療費不正検出は、主に保険会社や医療機関において活用されています。保険会社は、保険金の不正請求を防ぐために、不正検出システムを導入しています。このシステムにより、異常な請求や不正な診療行為を事前に察知し、適切な対応を取ることができます。また、医療機関においても適正な請求を行うための内部監査やコンプライアンス体制の整備が求められます。

関連技術としては、主にデータ分析技術や機械学習、ビッグデータ技術が挙げられます。データ分析技術は、医療記録や請求書のデータを効率的に処理し、パターンを分析するために不可欠です。機械学習は、過去のデータに基づいて不正行為を特定するモデルの構築に役立ちます。これにより、リアルタイムでの異常検知が可能となり、不正行為を迅速に把握することができます。ビッグデータ技術により、さまざまなデータソースから情報を集約し、複雑な医療エコシステムを包括的に理解することが可能になります。

今後の医療費不正検出に関する展望としては、AI技術のさらなる進化が期待されています。AIの進化により、より高度な予測分析や異常検知が実現し、問題の早期発見と対応が可能になるでしょう。加えて、ブロックチェーン技術を用いたデータ管理も注目されています。ブロックチェーンは、データの改ざんを防ぐ特徴を持つため、医療記録の信頼性を向上させるとともに、不正行為の検出を容易にすると考えられています。

総じて、医療費不正検出は、医療サービスの適正化を図るために不可欠なプロセスであり、今後も様々な技術の進化とともに、絶えず発展していく分野と言えるでしょう。医療関係者、保険会社、技術者が一体となって取り組むことで、より安全で信頼性の高い医療サービスの提供が実現されることを期待しています。


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