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Global Healthcare Fraud Detection Market: Information by Type (Descriptive Analytics, Predictive Analytics and Prescriptive Analytics), by Component (Services and Software), by Delivery Model (On-Premise and Cloud-Based), by Application (Insurance Claims Review and Payment Integrity), by End User (Private Insurance Payers, Public/Government Agencies and Third Party Service Providers) and by Region (North America, Europe, Asia-Pacific and the Middle East & Africa) - Forecast till 2024
Generally, the major market performers are actively participating in business advancement in the healthcare fraud detection and related organizations. For illustration, in 2019 Optum, Inc. purchased DaVita Medical Group, one of the foremost independent medical groups in the US. Frauds in healthcare increase the burden on the healthcare industry as a rise in the healthcare cost directly involve the products and services. The global healthcare fraud detection market is in the growing healthcare business continuum. The factors driving global healthcare fraud detection market are the rising number of patients opting for health insurance, an increase in the incidents of fraudulent activities, the escalation in healthcare expenditure, and others. However, the unwillingness of the end users to adopt healthcare fraud analytics systems in growing regions are likely to restrain the growth of the global healthcare fraud detection market during the forecast period. For example, agreeing to the National Health Care Anti-Fraud Association (NHCAA) the financial losses suffered from healthcare frauds add up to roughly USD 10 billion each year. This suggests that there is a looming need to detect fraudulent activities in healthcare business which in turn will boost the global healthcare fraud detection market. Healthcare fraud is a misrepresentation or intentional deception of facts by either healthcare specialists or patients, which can cause in illicit disbursements or advantages.
The Global Healthcare Fraud Detection Market is segmented based on type, component, delivery model, application, end user and region respectively. Based on component, the market has been bifurcated into services and software. By application, the global healthcare fraud detection market has been split into insurance claims review and payment integrity. Because of type healthcare fraud detection market has been separated into scientific analytics, predictive analytics, and prescriptive analytics. Descriptive analytics uses historical data to analyze the changes that have been made. It is helpful for the hospitals to analyze the total revenue produced per patient, month-over-month sales growth, and year-over-year pricing modifications, thus correctly retaining the related records. This information is used to analyze or understand the proceeds cycle during a set period. The prognostic analytics is also termed as a supervised learning technique. This model is built based on the past data which contains fraud or non-fraud indicators along with different elements such as the number of patients, bill amount, treatment characteristics, reporting lags, years of experience of the doctor, and the number of patient visits. Different organizations such as the National Health Care Anti-Fraud Association and the European Healthcare Fraud and Corruption Network (EHFCN) are involved in countering fraud in the healthcare sector. Based on end user the market has been classified as private insurance payers, public/government agencies, and third-party service sources.
Geographically the Global Healthcare Fraud Detection Market is split in regions like North & South America, Europe, Asia-Pacific, Middle east and Africa and Rest of the world. The Asia-Pacific region has been labeled as China, India, Japan, and the rest of Asia-Pacific. It retains the third-largest position in the healthcare fraud detection market. Europe held the second-leading market share owing to the high recognition of healthcare fraud detection by the exclusive protection payers. The Europe region is further accounted into Western Europe and Eastern Europe. Western Europe, based on countries has been, segmented into Germany, the UK, France, Italy, Spain, and the rest of Western Europe. The Middle East & Africa is anticipated to witness a astonishing growth owing to the developments in the healthcare services, such as hospitals, clinics, and others. The Americas settled for a market share of 49.97% in 2018. Americas is sub-segmented into North America and South America. North America has been further sub-settled into the US and Canada.
The proposed spectators in the Global Healthcare Fraud Detection Market are manufacturers, Retailers, distributors, wholesalers, Investors and trade experts, Governments, associations, industrial bodies, etc. The troupe’s operation in the global healthcare fraud exposure market are focusing on product launches, along with enlarging their global footprints by entering available markets. The major companies functioning in the Global Healthcare Fraud Detection Market are concentrating on firming their global ways by entering into untouched markets. The projected onlookers in the Global Healthcare Fraud Detection Market are companies like International Business Machines Corporation (IBM), UNITEDHEALTH group, SAS Institute Inc., FAIR ISAAC Corporation, McKesson Corporation, EXLSERVICE Holdings, Inc., DXC Technology Company, LEXISNEXIS, COTIVITI INC., WIPRO LIMITED, and CGI INC.
Market analysis
Generally, the major market performers are actively participating in business advancement in the healthcare fraud detection and related organizations. For illustration, in 2019 Optum, Inc. purchased DaVita Medical Group, one of the foremost independent medical groups in the US. Frauds in healthcare increase the burden on the healthcare industry as a rise in the healthcare cost directly involve the products and services. The global healthcare fraud detection market is in the growing healthcare business continuum. The factors driving global healthcare fraud detection market are the rising number of patients opting for health insurance, an increase in the incidents of fraudulent activities, the escalation in healthcare expenditure, and others. However, the unwillingness of the end users to adopt healthcare fraud analytics systems in growing regions are likely to restrain the growth of the global healthcare fraud detection market during the forecast period. For example, agreeing to the National Health Care Anti-Fraud Association (NHCAA) the financial losses suffered from healthcare frauds add up to roughly USD 10 billion each year. This suggests that there is a looming need to detect fraudulent activities in healthcare business which in turn will boost the global healthcare fraud detection market. Healthcare fraud is a misrepresentation or intentional deception of facts by either healthcare specialists or patients, which can cause in illicit disbursements or advantages.
Market segmentation
The Global Healthcare Fraud Detection Market is segmented based on type, component, delivery model, application, end user and region respectively. Based on component, the market has been bifurcated into services and software. By application, the global healthcare fraud detection market has been split into insurance claims review and payment integrity. Because of type healthcare fraud detection market has been separated into scientific analytics, predictive analytics, and prescriptive analytics. Descriptive analytics uses historical data to analyze the changes that have been made. It is helpful for the hospitals to analyze the total revenue produced per patient, month-over-month sales growth, and year-over-year pricing modifications, thus correctly retaining the related records. This information is used to analyze or understand the proceeds cycle during a set period. The prognostic analytics is also termed as a supervised learning technique. This model is built based on the past data which contains fraud or non-fraud indicators along with different elements such as the number of patients, bill amount, treatment characteristics, reporting lags, years of experience of the doctor, and the number of patient visits. Different organizations such as the National Health Care Anti-Fraud Association and the European Healthcare Fraud and Corruption Network (EHFCN) are involved in countering fraud in the healthcare sector. Based on end user the market has been classified as private insurance payers, public/government agencies, and third-party service sources.
Regional analysis
Geographically the Global Healthcare Fraud Detection Market is split in regions like North & South America, Europe, Asia-Pacific, Middle east and Africa and Rest of the world. The Asia-Pacific region has been labeled as China, India, Japan, and the rest of Asia-Pacific. It retains the third-largest position in the healthcare fraud detection market. Europe held the second-leading market share owing to the high recognition of healthcare fraud detection by the exclusive protection payers. The Europe region is further accounted into Western Europe and Eastern Europe. Western Europe, based on countries has been, segmented into Germany, the UK, France, Italy, Spain, and the rest of Western Europe. The Middle East & Africa is anticipated to witness a astonishing growth owing to the developments in the healthcare services, such as hospitals, clinics, and others. The Americas settled for a market share of 49.97% in 2018. Americas is sub-segmented into North America and South America. North America has been further sub-settled into the US and Canada.
Major players
The proposed spectators in the Global Healthcare Fraud Detection Market are manufacturers, Retailers, distributors, wholesalers, Investors and trade experts, Governments, associations, industrial bodies, etc. The troupe’s operation in the global healthcare fraud exposure market are focusing on product launches, along with enlarging their global footprints by entering available markets. The major companies functioning in the Global Healthcare Fraud Detection Market are concentrating on firming their global ways by entering into untouched markets. The projected onlookers in the Global Healthcare Fraud Detection Market are companies like International Business Machines Corporation (IBM), UNITEDHEALTH group, SAS Institute Inc., FAIR ISAAC Corporation, McKesson Corporation, EXLSERVICE Holdings, Inc., DXC Technology Company, LEXISNEXIS, COTIVITI INC., WIPRO LIMITED, and CGI INC.
Frequently Asked Questions
This market study covers the global and regional market with an in-depth analysis of the overall growth prospects in the market. Furthermore, it sheds light on the comprehensive competitive landscape of the global market. The report further offers a dashboard overview of leading companies encompassing their successful marketing strategies, market contribution, recent developments in both historic and present contexts.
- By product type
- By End User/Applications
- By Technology
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The report provides a detailed evaluation of the market by highlighting information on different aspects which include drivers, restraints, opportunities, and threats. This information can help stakeholders to make appropriate decisions before investing.
