Increasing Number Of False Claims Is Driving Demand For Insurance Fraud Detection Systems

The global insurance fraud detection market is estimated to gain significant returns, while exhibiting a lucrative growth rate during the forecast period. The market is driven by the increasingly growing efforts undertaken by businesses to foster digital robustness and readiness. Technologies like machine learning, Artificial Intelligence (AI), the Internet of Things (IoT), and big data are being used to design automated business rules, image screening, predictive analysis, device identification, and deliver actionable insights to the business administrator. 

The market is primarily driven by the increasing need for ensuring protection against business scams and reduce the number of false positives. Federal Bureau of Investigation (FBI), Office of Personnel Management-Office of Inspector General (OPM-OIG), Services-Office of Inspector General (HHS-OIG), Drug Enforcement Administration (DEA), Food and Drug Administration (FDA), Defense Criminal Investigative Service (DCIS), and Internal Revenue Service-Criminal Investigation (IRS-CI) are some of the organizations and units involved in the investigation of fraudulent matters.

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FRISS fraud detection systems are AI-powered software systems that helps the user automatically detect suspicious financial claims. It also discovers hidden patterns and reveals networks. The system aids in saving money as it effectively reduces the financial loss ratio using automated processes. Also, IBM has been on the technological forefront in creating cutting-edge solutions. Their IBM SPSS data mining tools are designed based on industrial standards that integrates IBM SPSS data mining tools with fraud detection algorithms to enhance result accuracy, minimize loss, and decrease manpower required. Therefore, the combined solution of SPSS and IBM have brought in utmost flexibility in data mining and result deployment. 

Geographically the market has been segmented into North America, Asia Pacific, Europe, the Middle East & Africa, and South America. In the United States, technological advancements and significant boom in medical sciences have improved the general well-being of their population. With this unrelenting progress, provisions like Medicare facilities are being rendered to manage high quality healthcare costs. Unfortunately, there are significant number of fraudulent activities being carried out by individuals for personal gain and nefarious reasons. This is therefore, limiting Medicare’s capability to efficiently provide healthcare needs, especially for the geriatric population and other qualifying people. To minimize deceptive activities, the Centers for Medicare and Medicaid Services (CMS) recently released a large array of Big Data datasets for various parts of the Medicare program.

The market has witnessed numerous collaborations and partnerships among the players in order to expand their presence and create a strong foothold. Some of the major contenders of the market consist of  Accenture; Fair Issac corporation (FICO); ACI Worldwide, Inc.; SAP SE; IBM Corporation; Fiserv, Inc.; PayPal Holdings, Inc.; RELX PLC; Software AG; TransUnion LLC; Experian Plc; and BAE Systems.