Global Healthcare Fraud Analytics Market Overview:
According to SPER Market Research, the global healthcare fraud analytics market was valued at USD 1.8 Bn in 2021 and estimated to reach USD 6.2 Bn by 2030 with a CAGR of 25.6%. Fraudulent activities in healthcare are rapidly increasing across the globe. Frauds related to pharmacy claims are also seizing to exist which contributes to the growth of global healthcare fraud analytics market in the forecast period.
Impact of COVID-19 on the Healthcare Fraud Analytics Market
The global pandemic of COVID-19 has fuelled the fraudulent activities in healthcare industry by patients or healthcare professionals. Many frauds such as fake prescriptions, procurement of fake certificates, evasion of healthcare charges or faults in the medical reports has been observed during this pandemic. Such scenarios coupled with travel bans, curfews, quarantines, and supply demand fluctuations pose significant challenges to the healthcare fraud analytics market.
Scope of Report:
| Report Metric | Details |
| Market size available for years | 2019-2030 |
| Base year considered | 2021 |
| Forecast period | 2022-2030 |
| Segments covered | By Solution type, By Delivery Mode, By Application, By End-user |
| Geographies covered | North America, Europe, APAC, Latin America, and the Middle East & Africa |
| Companies Covered | Canadian Global Information Technology Group Inc., Change Healthcare, Conduent, Inc., Cotiviti, DXC Technology Company, EXL Service Holdings, Inc., FraudLens, FraudScope, Healthcare Fraud Shield, Hindustan Computers Limited Technologies Limited, HMS, International Business Machines Corporation, LexisNexis Group, Northrop Grumman Corporation, Optum, Inc., Pondera Solutions, SAS Institute, Inc., WhiteHatAI, Wipro Limited |
Driver: Rising demand for healthcare insurance
Healthcare fraud analytics market is briefly supported by various healthcare schemes. More patients are opting for healthcare insurance for high return on investments, rising geriatric population, prevalence of chronic and lifestyle disorders and rising healthcare expenditure.
Challenge: Time consumption and frequent upgradation
The deployment of fraud analytics solutions involves creation of new databases, deploying models, predictive and evaluating models which make it tedious and time-consuming process. These solutions also require frequent upgradation and monitoring of the performance. Additionally, the fraudsters also keep updating their processes of fraudulent activities which requires changes in the fraud analytics solutions as well in order to detect it. Therefore, it can pose a challenge for the growth of this market.
Opportunity: Social media and its impact on healthcare industry
Social media is gaining attention for seeking healthcare information. It has provided the patients, healthcare providers a platform to have a large-scale discussion on health issues. Such interactions produce huge amount of data which creates opportunities for healthcare fraud analytics market.
Healthcare Fraud Analytics Market Segmentation:
By Solution Type: Based on solution type, the market has been segmented into descriptive analytics, predictive analytics and prescriptive analytics
By Delivery Model: Based on delivery model, the market has been segmented into on-premise and on-demand
By Applications: Based on application, the market has been segmented into insurance claim review, pharmacy billing misuse, payment integrity and other applications
By End-user: Based on end user, the market has been segmented into public & government agencies, private insurance payers, third party service providers and employers
Vascular Closure Devices Market by Region:
North America accounted for the largest share of Healthcare Fraud Analytics Market. The large share is ascribed by rising healthcare fraud, technological advancements, government policies to curb fraudulent activities and rising population with healthcare insurance
1. Introduction
2. Research Methodology
3. Executive Summary
4. Market Overview
4.1. Introduction
4.2. Market Dynamics
4.2.1. Drivers
4.2.2. Restraints
4.2.3. Opportunities
4.2.4. Challenges
4.3. COVID-19 Impact of the Healthcare Fraud Analytics Market
4.4. Market Trends
5. Global Healthcare Fraud Analytics Market, By Solution Type, 2021-2030 (USD Million)
5.1. Descriptive Analytics
5.2. Predictive Analytics
5.3. Prescriptive Analytics
6. Global Healthcare Fraud Analytics Market, By Delivery Model, 2021-2030 (USD Million)
6.1. On-premise
6.2. On-demand
7. Global Healthcare Fraud Analytics Market, By Application, 2021-2030 (USD Million)
7.1. Insurance Claims Review
7.1.1. Post-payment Review
7.1.2. Pre-payment Review
7.2. Pharmacy Billing Misuse
7.3. Payment Integrity
7.4. Other Applications
8. Global Healthcare Fraud Analytics Market, By End-user, 2021-2030 (USD Million)
8.1. Public & Government Agencies
8.2. Private Insurance Payers
8.3. Third-party service providers
8.4. Employers
9. Global Healthcare Fraud Analytics Market, By Geography, 2021-2030 (USD Million)
9.1. North America
9.1.1. US
9.1.2. Canada
9.2. Europe
9.2.1. Germany
9.2.2. UK
9.2.3. France
9.2.4. Italy
9.2.5. Spain
9.2.6. Rest of Europe
9.3. Asia-Pacific
9.3.1. China
9.3.2. Japan
9.3.3. India
9.3.4. Rest of Asia-Pacific
9.4. Rest of the World
9.4.1. Latin America
9.4.2. Middle East & Africa
10. Competitive Landscape
10.1. Introduction
10.2. Market Share Analysis, By Key Players (2021)
10.3. Competitive Scenario
10.3.1. Product Launches
10.3.2. Partnerships, Collaborations and Agreements
10.3.3. Acquisitions
10.3.4. Expansions
10.3.5. Other Developments
11. Company Profiles
11.1. Canadian Global Information Technology Group Inc.
11.2. Change Healthcare
11.3. Conduent, Inc.
11.4. Cotiviti
11.5. DXC Technology Company
11.6. EXL Service Holdings, Inc.
11.7. FraudLens
11.8. FraudScope
11.9. Healthcare Fraud Shield
11.10. Hindustan Computers Limited Technologies Limited
11.11. HMS
11.12. International Business Machines Corporation
11.13. LexisNexis Group
11.14. Northrop Grumman Corporation
11.15. Optum, Inc.
11.16. Pondera Solutions
11.17. SAS Institute, Inc.
11.18. WhiteHatAI
11.19. Wipro Limited
12. Appendix
SPER Market Research’s methodology uses great emphasis on primary research to ensure that the market intelligence insights are up to date, reliable and accurate. Primary interviews are done with players involved in each phase of a supply chain to analyze the market forecasting. The secondary research method is used to help you fully understand how the future markets and the spending patterns look likes.
The report is based on in-depth qualitative and quantitative analysis of the Product Market. The quantitative analysis involves the application of various projection and sampling techniques. The qualitative analysis involves primary interviews, surveys, and vendor briefings. The data gathered as a result of these processes are validated through experts opinion. Our research methodology entails an ideal mixture of primary and secondary initiatives.
