Healthcare

Global healthcare Fraud Analytics Market

December 14, 2021
ID: SR/HC-174
Format:Pdf
Pages:220

Global healthcare Fraud Analytics Market By Type (Descriptive, Predictive, Prescriptive), By Application Type (Insurance Claim, Payment Integrity), By Delivery Type (On-Premises, Cloud), By End-User Type (Government, Employers, Payers), and By Region (North America, Europe, Asia Pacific, South America, and the Middle East & Africa)-Global Forecast to 2027.

Description

The Global Healthcare Fraud Analytics Market size was calculated at USD 1.5 Billion in 2021 and is projected to reach 5.0 Billion by 2027, growing at a CAGR 26.7% during the forecast period, 2021-2027. Market growth can be allocated a large number of fraudulent activities in healthcare, the increase in the number of patients looking for health insurance, gives high returns on investment, and the increasing number of pharmacy claims-related frauds. However, the insufficiency of skilled persons is expected to shortfall the growth of the health care fraud analytics market. However, the unskilled and un-professional personnel are expected to slow down the growth of this market. The global healthcare fraud analytic market is projected to be driven by the growing fraudulent activities in healthcare, the increased number of patients seeking health insurance, and the growth in the prepayment review models in the insurance policies.

What is the Healthcare Fraud Analytics Market?

Healthcare fraud occurs when a person, a group of people, or a company knowingly misrepresents the type, the scope, or the identification of the medical service provided in a manner that could result in unauthorized payments being made—for example- falsifying certificates of medical necessity and billing for services not medically necessary, falsifying plans of treatment or medical records to justify insurance claim, falsification charges or entitlements to payments in cost records. Beneficiaries and other healthcare recipients pay for these significant losses through higher premiums, increased taxes and reduced services. In recent years, fiscal intermediaries and carriers for Medicare have been required to send notices and descriptions of benefits to Medicare users and patients in virtually all circumstances. All beneficiaries must review and verify the information on these documents and question any entries or notations that are compatible with or unconnected to the essential health care services provided. In particular, you should be attentive to and question notices and explanations that memorialize payment for any medical services, medical treatment, supplies or equipment that you did not receive; duplicate payments for the same services or items or home medical equipment while you were hospitalized.

Growth Driver

The increase in the number of patients exploring the health insurance

Pre-Covid-19 Impact on Healthcare Fraud Analytics Market

The rise in disposable income created in the individual life, globally the healthcare expenditure is rising especially in the low and the middle earning countries. As per the World Health Organization (WHO) 2016 report, the rise in healthcare expenditure in these countries was approximately 6% per annum compared to 4% in high-income countries.

Before the Covid-19, the healthcare fraud analytics market grew proportionally with the individual’s income.

Covid-19 Impact on Healthcare Fraud Analytics Market

The global Healthcare Fraud Analytics market faces many challenges, temporary shutdown of business, and break from indoor/outdoor activities, travel bans and quarantines. Supply and demand fluctuations, stock market changes, falling business assurance, and many uncertainties negatively impact business dynamics. The healthcare industry has shown many fraud cases done by the patients, physicians’ doctors and other medical service providers. Many healthcare specialists and providers have been seen in fraudulent activities only for profit. In the healthcare sector, fraudulent actions done by patients include fraudulent sickness certificates, prescription fraud and unnecessary medical charges.

Post-Covid-19 Impact on Healthcare Fraud Analytics Market

The Healthcare Fraud Analytics Market is estimated to increase steadily after the covid-19 breakout. One of the major elements driving the demand for the healthcare fraud analytic market is the increase in the popularity of healthcare communication through social media, rise in the number of health care BPO and fraud identity management software and government support and initiative in the healthcare and fraud marketing. Also, The rapid acceptance of cloud-based analytical solutions and the effectiveness of artificial intelligence in healthcare services and solutions.

Descriptive Segmental Analysis

The market is segmented on descriptive type, application type, delivery model type and end-user. Based on the solution type, the descriptive analytics segment is considered the highest share of the market in 2019. Descriptive analytics uses the basics of descriptive analytics and integrates them with additional data sources to produce meaningful insights

Delivery Segmental Analysis

The healthcare fraud market is segmented into the on-premise and on-demand models. The on-demand models involve cloud-based and web-based models. The on-demand segment is calculated the highest CAGR during the forecast period. Factors such as on-demand self-serving analytical, the lack of up-front capital investment for hardware, extreme capacity flexibility, and the pay-as-you-go pricing model drive the demand for on-demand fraud detection solutions.

Application Segmental Analysis

In 2020, the insurance claims review segment was considered the largest market share.

The healthcare fraud analytics market is segmented into insurance claims review, medical and pharmacy billing exploitation and misuse, payment honesty, and other applications. In 2019, the insurance claims review segment controlled the healthcare fraud analytics market. The rise in the number of patients looking for health insurance, the increase in the number of fraudulent claims, and the increase in acceptance of the prepayment review model are expected to drive this segment’s growth in coming years. The insurance claims review segment is mainly divided into post-payment, and prepayment review, with the latter, anticipated to register the highest growing share during the forecasts period. It is mainly because prepayment review protocols and analytics can help organizations proactively prevent fraud before payment, allowed to take rapid action. As a result, prepayment review solutions are assumed to gain more attention.

Region Segmental Analysis

The global healthcare fraud analytics market has to be segmented into North America, Europe, APAC, South America and the Middle East and Africa. North America estimated the largest share in the healthcare fraud analytics market in 2019. The highest share of the North American market is allocated to the large number of people holding health insurance, growing healthcare fraud, favorable government anti-fraud initiatives, the pressure to reduce healthcare costs—technological advancements, and greater product and services availability in the region. Most leading healthcare fraud detection market players have their headquarters in North America.

Competitor Analysis

The key player in the global health care analytical markets are IBM Corporation, Optum, INC., Cotiviti, INC., Change Healthcare, Fair Isaac Corporation, SAS Institute Inc., EXL Services Holdings, Wipro Limited, Conduent, Incorporated, CGI Inc, HCL Technologies Limited, Qlarant, DXC Technology, Northrop Grumman Corporation, LexisNexis, Healthcare Fraud Sheild, Sharecare, FraudLens, HMS Holding Corp., Codoxo, H20.ai, Pondera Solutions, Friss, Multiplan, FraudScope.

Key Stakeholders

Market research
Insurance associations
Governments
Research Organizations
Regulatory bodies

Recent Developments

In June 2018, The SAS Institute & Prime Therapeutics LLC collaborated and authorized Prime Therapeutics to fulfill SAS’S analytic efficiency to combat the opioid crisis in us.
In August 2018, Verscend Technologies took over Cotiviti Holdings. This partnership gives the enhancement and the affordability of fraud detection solutions.
In January 2019, LexisNexis risk solutions partnership with the QuadraMed to authorize the patient to recognize the efficiency and reduce the number of duplicate identities & fraudulent claims.

Scope of the Report

Report Attribute	Details
Market Size Value in 2021	USD 1.5 Billion
The revenue forecast in 2027	USD 5 Billion
Growth Rate	CAGR of 26.7 % from 2020 to 2027
Historical data	2017-2019
Forecast period	2021 – 2027
Region covered	North America, Europe, South America, Asia-Pacific, and Middle East & Africa
Key companies Profiled	IBM Corporation, Optum, INC., Cotiviti, INC., Change Healthcare, Fair Isaac Corporation, SAS Institute Inc., EXL Services Holdings, Wipro Limited, Conduent, Incorporated, CGI Inc, HCL Technologies Limited, Qlarant, DXC Technology, Northrop Grumman Corporation, LexisNexis, Healthcare Fraud

Market Modelling

By Solution Type

Descriptive Analytics
Predictive Analytics
Prescriptive Analytics

By Delivery Type

On-premise
On-demand

By Application Type

Insurance Claims Review
Pharmacy billing misuse
Other applications

By End-users

Public & Government
Private Insurance payers
Third-party service providers
Employers

By Region

North America
Europe
APAC
South America

Table Of Contents

Methodology

Request Sample

Frequently Asked Questions (FAQ):

What is the size of the Healthcare Fraud Analytics Market?

The size of the Healthcare Fraud Analytic market, USD1.5 Billion in 2021, will reach USD5.0 Billion by 2027.

What is the growth rate of the global healthcare fraud analytic market?

The growth rate of the global healthcare fraud analytic market is 26.7% during the forecast period.

What are growth drivers for the healthcare fraud analytic market?

The major driver for the growth of the healthcare fraud analytic market is: increase in the number of fraudulent activities, awareness of patients & service providers and government support and initiatives plans for insurance policies.

What is the competitive landscape of the healthcare fraud analytics market?

IBM Corporation, Optum, INC., Cotiviti, INC., Change Healthcare, Fair Isaac Corporation, SAS Institute Inc., EXL Services Holdings, Wipro Limited, Conduent, Incorporated, CGI Inc, HCL Technologies Limited, Qlarant, DXC Technology, Northrop Grumman Corporation, LexisNexis, Healthcare Fraud Sheild, Sharecare, FraudLens, HMS Holding Corp., Codoxo, H20.ai, Pondera Solutions, Friss, Multiplan, FraudScope.

Which region is leading the healthcare fraud analytics market?

North America region has dominated the global healthcare fraud analytics market because of the increasing cases of healthcare fraud and growing favorable government initiatives to combat healthcare fraud. However, an increasing number of healthcare payer organizations are opting for on-demand models for analytics due to their accessibility, flexibility, scalability and cost-effectiveness.

Select License

We Accept

Analyst support

After evaluating your requirements and addressing your technical problems, the expert analyst will resolve your query directly.

Customer satisfaction

According to your needs, our expert team will assist you with the capabilities, services, and proper research needs to be required and customize the report accordingly.

Inimitable expertise

Our expert team will create unrivaled reviews to provide you with a deep understanding of the reports.

Assured quality

We have created a systematic way to determine standards and satisfy your expectations.

Instant delivery

Unlike others, we provide you a great deal of instant delivery in the form of PDF/PPT/Word Doc directly to your email address within 24 hours after receiving full payment.

Privacy policy

We understand the inkling of your privacy, we will never misuse your email address.

Custom research service

We are giving you an opportunity through which you can directly ask our expert analyst to customize an exclusive study of the report to serve your research needs.

Quality & accuracy

We provide you with the accurate quality of the customized study of an exclusive report according to your research need.

Data visualization

As the business world’s growing faster every day, we understand the value of data management. We will create the reports by keeping all the visual data sets and metrics in the charts.

Information security

We truly respect your privacy and promise to keep your personal and confidential information safe and secure.