US Insurance Fraud Detection Market (2025-2031) | Outlook, Growth, Forecast, Size, Value, Companies, Share, Trends, Analysis, Industry & Revenue

Topics Covered in the US Insurance Fraud Detection Market

US Insurance Fraud Detection Market report thoroughly covers the market by component, by application area, by deployment mode, and by organization size. The market outlook report provides an unbiased and detailed analysis of the ongoing market trends, opportunities/high growth areas, and market drivers which would help the stakeholders to devise and align their market strategies according to the current and future market dynamics.

US Insurance Fraud Detection Market Synopsis

US Insurance Fraud Detection Market is experiencing rapid growth, driven mainly by the high risk of losing revenue and the increasing adoption of big data and advanced analytics solutions that can help in detecting fraudulent behavior in real-time. The growth of the market has also been fueled by the increasing awareness of insurers about the importance of fraud resistance and prevention.

According to 6Wresearch, the US Insurance Fraud Detection Market size is anticipated to grow rapidly at projected CAGR of 14.34% during the forecast period of 2025-2031. The rise in fraudulent activities in healthcare, workers' compensation, and auto insurance claims, along with the increasing adoption of advanced technologies, has led to the US Insurance Fraud Detection Market Growth. Advanced fraud detection technologies such as artificial intelligence, machine learning, blockchain, and data analytics can effectively detect fraudulent activities and minimize financial losses for insurance providers. Despite the growth, the insurance fraud detection market in the US is facing several challenges.

One of the significant challenges is the lack of skilled professionals in the insurance industry who can handle fraud detections as it requires analytical skills and good understanding of insurance policies. However, opportunities exist in the US insurance fraud detection market, including the growth of cross-industry partnerships and collaborations, thereby leading to the sharing of data and expertise. Insurers and law enforcement teaming up together can provide a powerful solution to the problem of fraud. Also, artificial intelligence and machine learning can help improve fraud detection by providing a more accurate and automated system.

Government policies and schemes introduced in the US Insurance Fraud Detection Market

The US government has implemented several policies and schemes aimed at fighting fraud in the insurance industry. One of the most notable policies is the False Claims Act (FCA), which imposes liability on those who submit false or fraudulent claims to government agencies. The FCA is designed to protect the government from financial losses caused by fraudulent claims. Insurance companies are also protected under the FCA, as the act covers all claims submitted to government-funded programs like Medicare and Medicaid. Failure to comply with the FCA can result in significant fines or even imprisonment. Another significant policy is the Health Insurance Portability and Accountability Act (HIPAA), which ensures the confidentiality of patient information and restricts access to personal health information. HIPAA also imposes penalties on those who disclose patient information without proper authorization. HIPAA not only protects policyholders but also helps insurance companies detect instances of fraud.

Key players in the US Insurance Fraud Detection Market

The key players in the US Insurance Fraud Detection Industry include FICO, SAS, IBM, and BAE Systems. FICO is one of the most prominent companies in the industry, offering fraud detection software and solutions to insurance companies. SAS is another major player that offers a range of fraud detection and analytics solutions. IBM is a leading provider of big data and analytics tools, which can be used to detect fraudulent claims. BAE Systems is a global defense, security, and aerospace company that offers advanced fraud detection solutions to insurance companies.

Market by Application Area

According to Suryakant, Senior Research Analyst, 6Wresearch, the claims fraud is among the most common types of insurance fraud, which is often committed by shirking legitimate claims or submitting false ones.

Market by Deployment Mode

By Deployment mode, on-premises solutions are expected to dominate the US Insurance Fraud Detection Market Share, owing to their ability to offer greater customizability, security, and control. However, cloud-based solutions are projected to grow rapidly, as they are cost-effective and offer greater accessibility.

Market by Organization Size

By Organization Size, the large enterprises tend to have more resources, budgeting, and IT staff to implement and maintain a robust fraud detection system. On the other hand, SMEs may partner with third-party service providers to implement a more cost-effective solution that meets their unique needs and budget.

Key Attractiveness of the Report

• 10 Years of Market Numbers.
• Historical Data Starting from 2021 to 2024.
• Base Year: 2024
• Forecast Data until 2031.
• Key Performance Indicators Impacting the Market.
• Major Upcoming Developments and Projects.

Key Highlights of the Report:

• US Insurance Fraud Detection Market Outlook
• Market Size of US Insurance Fraud Detection Market, 2024
• Forecast of US Insurance Fraud Detection Market, 2031
• Historical Data and Forecast of US Insurance Fraud Detection Revenues & Volume for the Period 2021 - 2031
• US Insurance Fraud Detection Market Trend Evolution
• US Insurance Fraud Detection Market Drivers and Challenges
• US Insurance Fraud Detection Price Trends
• US Insurance Fraud Detection Porter's Five Forces
• US Insurance Fraud Detection Industry Life Cycle
• Historical Data and Forecast of US Insurance Fraud Detection Market Revenues & Volume By Component for the Period 2021 - 2031
• Historical Data and Forecast of US Insurance Fraud Detection Market Revenues & Volume By Solutions (Fraud Analytics, Authentication, and GRC) for the Period 2021 - 2031
• Historical Data and Forecast of US Insurance Fraud Detection Market Revenues & Volume By Service for the Period 2021 - 2031
• Historical Data and Forecast of US Insurance Fraud Detection Market Revenues & Volume By Application Area for the Period 2021 - 2031
• Historical Data and Forecast of US Insurance Fraud Detection Market Revenues & Volume By Claims Fraud for the Period 2021 - 2031
• Historical Data and Forecast of US Insurance Fraud Detection Market Revenues & Volume By Identity Theft for the Period 2021 - 2031
• Historical Data and Forecast of US Insurance Fraud Detection Market Revenues & Volume By Payment for the Period 2021 - 2031
• Historical Data and Forecast of US Insurance Fraud Detection Market Revenues & Volume By Billing Fraud for the Period 2021 - 2031
• Historical Data and Forecast of US Insurance Fraud Detection Market Revenues & Volume By Money Laundering for the Period 2021 - 2031
• Historical Data and Forecast of US Insurance Fraud Detection Market Revenues & Volume By Deployment Mode for the Period 2021 - 2031
• Historical Data and Forecast of US Insurance Fraud Detection Market Revenues & Volume By On-Premises for the Period 2021 - 2031
• Historical Data and Forecast of US Insurance Fraud Detection Market Revenues & Volume By Cloud for the Period 2021 - 2031
• Historical Data and Forecast of US Insurance Fraud Detection Market Revenues & Volume By Organization Size for the Period 2021 - 2031
• Historical Data and Forecast of US Insurance Fraud Detection Market Revenues & Volume By Large Enterprises for the Period 2021 - 2031
• Historical Data and Forecast of US Insurance Fraud Detection Market Revenues & Volume By SMES for the Period 2021 - 2031
• US Insurance Fraud Detection Import Export Trade Statistics
• Market Opportunity Assessment By Component
• Market Opportunity Assessment By Application Area
• Market Opportunity Assessment By Deployment Mode
• Market Opportunity Assessment By Organization Size
• US Insurance Fraud Detection Top Companies Market Share
• US Insurance Fraud Detection Competitive Benchmarking By Technical and Operational Parameters
• US Insurance Fraud Detection Company Profiles
• US Insurance Fraud Detection Key Strategic Recommendations

Market Covered

The report offers a comprehensive study of the subsequent market segments:

By Component

• Solutions
• Fraud Analytics
• Authentication
• GRC
• Service

By Application Area

• Claims Fraud
• Identity Theft
• Payment
• Billing Fraud
• Money Laundering

By Deployment Mode

• On-Premises
• Cloud

By Organization Size

• Large Enterprises
• SMES