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Healthcare Fraud Analytics Market

Healthcare Fraud Analytics Market Size, Share & Segment by Solution Type (Descriptive Analytics, Prescriptive Analytics, Predictive Analytics), By Delivery Model (On-premises, Cloud-based), by Application (Insurance Claim Review (Post payment Review, Prepayment Review), Pharmacy billing Issue, Payment Integrity, Others), By End User (Public & Government Agencies, Private Insurance Payers, Third-party Service Providers, Employers), and by Regions | Global Market Forecast 2022-2028

Report Id: SNS/HC/1767 | June 2022 | Region: Global | 125 Pages

Report Scope & Overview:

The Healthcare Fraud Analytics Market Size was valued at USD 1.69 billion in 2021, and expected to reach USD 7.79 billion by 2028, and grow at a CAGR of 24.2% over the forecast period 2022-2028.

Fraud is known as illegal activity by an organization that results in the violation of regulation in order to obtain higher profits. Fraud has become a common word in many industries while in health care it involves illegal fraud or crime committed in the production of drugs, product quality, treatment, and the pursuit of health insurance. Fraud of medical bills, misuse of medical records to increase medical compensation, inaccurate diagnostic reporting are some of the most common frauds occurring in the health care sector. These scams are not trackable and are often unreported resulting in high financial losses to insurance companies and healthcare companies. Thus, the need to analyze fraud begins to take effect. Healthcare fraud analysis helps different health care organizations use predictable data methods in accounting and research activities.

Healthcare Fraud Analytics Market

With the growing trend of health care fraud in different parts of the world, the need for accurate identification is very important, which is drawing global attention to solutions to health fraud analysis. One of the key factors in promoting the adoption of the health fraud analysis market is the significant increase in the number of people using health care insurance, which increases the pressure on health care providers to protect themselves from any potential fraud and abuse. Also, the increasing number of healthcare BPOs and fraudulent identity management software, as well as the impact of media resources on the healthcare industry increases the need for a health fraud analysis market.

MARKET DYNAMICS

DRIVERS

  • The prevalence of pharmacy-related fraud is on the rise

  • In the healthcare industry, there are several instances of fraud

  • A rise in the number of people looking for health insurance

  • Model for evaluating prepayment

  • Exceptional ROI

RESTRAINTS

  • Data collection in Medicaid programmes has some limitations.

  • A reluctance to use fraud analytics in healthcare

OPPORTUNITIES

  • In underdeveloped countries, the use of healthcare fraud analytics is growing.

  • The rise of social media and its implications for healthcare

  • Artificial Intelligence's Role in Detecting Health-Care Fraud

CHALLENGES

  • Shortage of qualified employees

  • Deployment takes a long time, and upgrades are required on a regular basis.

IMPACT OF COVID-19

The worldwide healthcare fraud analytics industry is confronted with numerous obstacles. Travel bans and quarantines, halts in indoor/outdoor activities, temporary business shutdowns, supply demand changes, stock market volatility, dwindling corporate confidence, and a slew of other uncertainties are all having an impact on business dynamics. Patients, doctors, physicians, and other medical specialists have all been involved in fraud incidents in the healthcare industry. Several healthcare providers and professionals have been caught in the act of defrauding patients for financial gain. Patients' fraudulent acts in the healthcare sector include fraudulently obtaining sickness certificates, prescription fraud, and evasion of medical payments.

By Solution Type

Part of the descriptive statistics hold the largest market share of about 40.0% by 2021, due to its high acceptance due to its ease of use. Uses current and historical data to identify styles and relationships. This helps to identify potential fraud in a better way. It also serves as the basis for the effective use of descriptive and predictive statistics. This also supports partial growth.

Part of the forecast figures are expected to confirm rapid growth over the projected period. The most effective way to prevent fraud is to identify them before claims are made. As a result, healthcare providers have begun to adopt predictable statistical solutions. These solutions identify possible patterns of fraud, and then develop specific rules to mark certain claims.

By Delivery Model

The on-premise segment had the biggest revenue share due to the convenience of accessing data on-site, such as in hospitals, which has resulted in better record management and data monitoring, among other things. Current systems in small businesses are functional, but when scaled up, data management can become complicated and cumbersome, especially if the company is dealing with a large dataset. This could imply a significant financial investment in data storage and security.

During the forecast period, the cloud-based segment is expected to develop at the fastest rate, as it has been the emerging delivery option because it provides a bigger virtual area to store data for a large number of patients. This is a more economical and commercially feasible choice for businesses. More security worries about data theft and less privacy are limitations of this category.

COMPETITIVE LANDSCAPE

Some of the major key players of Healthcare Fraud Analytics Market are as follows: Cotiviti, Inc, Conduent Inc, DXC Technology, EXL Service Holdings Inc., HCL Technologies Limited, IBM, OSP Labs, Optum Inc., SAS Institute Inc., Wipro Limited, and other players.

MARKET SEGMENTATION:

By Solution Type

  • Descriptive Analytics

  • Prescriptive Analytics

  • Predictive Analytics

By Delivery Model

  • On-premises

  • Cloud-based

By Application

  • Insurance Claim Review

    • Postpayment Review

    • Prepayment Review

  • Pharmacy billing Issue

  • Payment Integrity

  • Others

By End User

  • Public & Government Agencies

  • Private Insurance Payers

  • Third-party Service Providers

  • Employers

Healthcare Fraud Analytics Market

REGIONAL ANALYSIS

North America, Europe, Latin America, the Middle East, Asia Pacific, and Africa are the continents represented. In 2021, the healthcare fraud analytics market in North America accounted for the biggest proportion. The large majority of individuals with health insurance, rising healthcare fraud, favorable government anti-fraud initiatives, pressure to cut healthcare costs, technological innovations, and greater service and product availability in this region are all factors that contribute to the region's significant market share. Furthermore, North America is home to the majority of the market's main players in healthcare fraud detection.

REGIONAL COVERAGE:

  • North America

    • USA

    • Canada

    • Mexico

  • Europe

    • Germany

    • UK

    • France

    • Italy

    • Spain

    • The Netherlands

    • Rest of Europe

  • Asia-Pacific

    • Japan

    • south Korea

    • China

    • India

    • Australia

    • Rest of Asia-Pacific

  • The Middle East & Africa

    • Israel

    • UAE

    • South Africa

    • Rest of Middle East & Africa

  • Latin America

    • Brazil

    • Argentina

    • Rest of Latin America

 

Healthcare Fraud Analytics Market Report Scope:
Report Attributes Details
Market Size in 2021 US$ 1.69 Billion
Market Size by 2028 US$ 7.79 Billion
CAGR CAGR of 24.2% From 2022 to 2028
Base Year 2021
Forecast Period 2022-2028
Historical Data 2017-2020
Report Scope & Coverage Market Size, Segments Analysis, Competitive  Landscape, Regional Analysis, DROC & SWOT Analysis, Forecast Outlook
Key Segments • By Solution Type (Descriptive Analytics, Prescriptive Analytics, Predictive Analytics)
• By Delivery Model (On-premises, Cloud-based)
• By Application (Insurance Claim Review (Post payment Review, Prepayment Review), Pharmacy billing Issue, Payment Integrity, Others)
• By End User (Public & Government Agencies, Private Insurance Payers, Third-party Service Providers, Employers)
Regional Analysis/Coverage North America (USA, Canada, Mexico), Europe
(Germany, UK, France, Italy, Spain, Netherlands,
Rest of Europe), Asia-Pacific (Japan, South Korea,
China, India, Australia, Rest of Asia-Pacific), The
Middle East & Africa (Israel, UAE, South Africa,
Rest of Middle East & Africa), Latin America (Brazil, Argentina, Rest of Latin America)
Company Profiles Healthcare Fraud Analytics Market are as follows: Cotiviti, Inc, Conduent Inc, DXC Technology, EXL Service Holdings Inc., HCL Technologies Limited, IBM, OSP Labs, Optum Inc., SAS Institute Inc., Wipro Limited, and other players.
DRIVERS • The prevalence of pharmacy-related fraud is on the rise
• In the healthcare industry, there are several instances of fraud
• A rise in the number of people looking for health insurance
RESTRAINTS • Data collection in Medicaid programmes has some limitations.
• A reluctance to use fraud analytics in healthcare


Frequently Asked Questions (FAQ) :

key drivers of the Healthcare Fraud Analytics Market is In the healthcare industry, there are several instances of fraud, A rise in the number of people looking for health insurance

The challenges faced by Healthcare Fraud Analytics is Shortage of qualified employees, Deployment takes a long time, and upgrades are required on a regular basis.

The by type is divided into 3 sub segments is Descriptive Analytics, Prescriptive Analytics, Predictive Analytics

Healthcare fraud analytics market in North America accounted for the biggest proportion.

Healthcare Fraud Analytics Market is expected to reach USD 7.79 billion by 2028.


Table of Contents

 

1. Introduction

1.1 Market Definition

1.2 Scope

1.3 Research Assumptions

 

2. Research Methodology

 

3. Market Dynamics

3.1 Drivers

3.2 Restraints

3.3 Opportunities

3.4 Challenges

 

4. Impact Analysis

4.1 COVID 19 Impact Analysis

4.2 Impact of Ukraine ware

 

5. Value Chain Analysis

 

6. Porter’s 5 forces model

 

7.  PEST Analysis

  

8. Healthcare Fraud Analytics Segmentation, By Solution Type

8.1 Descriptive Analytics

8.2 Prescriptive Analytics

8.3 Predictive Analytics

 

9. Healthcare Fraud Analytics Segmentation, By Delivery Model

9.1 On-premises

10.1Cloud-based

 

10. Healthcare Fraud Analytics Segmentation, By Application

10.1 Insurance Claim Review

10.1.1 Postpayment Review

10.1.2Prepayment Review

10.2Pharmacy billing Issue

10.3Payment Integrity

10.4 Others

 

11. Healthcare Fraud Analytics Segmentation, By End User

11.1 Public & Government Agencies

11.2 Private Insurance Payers

11.3 Third-party Service Providers

11.4 Employers

 

12. Regional Analysis

12.1 Introduction

12.2 North America

12.2.1 USA

12.2.2 Canada

12.2.3 Mexico

12.3 Europe

12.3.1 Germany

12.3.2 UK

12.3.3 France

12.3.4 Italy

12.3.5 Spain

12.3.6 The Netherlands

12.3.7 Rest of Europe

12.4 Asia-Pacific

12.4.1 Japan

12.4.2 South Korea

12.4.3 China

12.4.4 India

12.4.5 Australia

12.4.6 Rest of Asia-Pacific

12.5 The Middle East & Africa

12.5.1 Israel

12.5.2 UAE

12.5.3 South Africa

12.5.4 Rest

12.6 Latin America

12.6.1 Brazil

12.6.2 Argentina

12.6.3 Rest of Latin America

 

13 Company Profiles

13.1 Wipro Limited

            13.1.1 Financial

13.1.2 Products/ Services Offered

13.1.3 SWOT Analysis

13.1.4 The SNS view

13.2 Cotiviti, Inc

13.3 Conduent, Inc

13.4 DXC Technology

13.5 EXL Service Holdings Inc

13.6 HCL Technologies Limited

13.7 IBM

13.8 OSP Labs

13.9 Optum Inc

13.10 SAS Institute Inc

 

14 Competitive Landscape

14.1 Competitive Benchmark

14.2 Market Share analysis

14.3 Recent Developments

 

15 Conclusion

 

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The 5 steps process:

Step 1: Secondary Research:

Secondary Research or Desk Research is as the name suggests is a research process wherein, we collect data through the readily available information. In this process we use various paid and unpaid databases which our team has access to and gather data through the same. This includes examining of listed companies’ annual reports, Journals, SEC filling etc. Apart from this our team has access to various associations across the globe across different industries. Lastly, we have exchange relationships with various university as well as individual libraries.

Secondary Research

Step 2: Primary Research

When we talk about primary research, it is a type of study in which the researchers collect relevant data samples directly, rather than relying on previously collected data.  This type of research is focused on gaining content specific facts that can be sued to solve specific problems. Since the collected data is fresh and first hand therefore it makes the study more accurate and genuine.

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