Table of Contents
Historical Data, Premium Insights, Market Dynamic, Analysis and Projection, By Product, Analysis and Projection, By Application, Analysis and Projection, By End-Use, Analysis and Projection, By Regional Analysis, Competitive Landscape, Company Profiles, Market Revenue, Sale & Price Analysis
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According to a research report published by Spherical Insights & Consulting, the Global Healthcare Fraud Analytics Market Size is Expected to Grow from USD 2.41 Billion in 2023 to USD 25.87 Billion by 2033, at a CAGR of 26.79% during the forecast period 2023-2033.
Browse 210 market data Tables and 45 Figures spread through 190 Pages and in-depth TOC on the Global Healthcare Fraud Analytics Market Size, Share, and COVID-19 Impact Analysis, By Solution Type (Descriptive, Prescriptive, and Predictive), By Delivery Model (On-premises and Cloud-based), By Application (Insurance Claims Review, Pharmacy Billing Issue, and Payment Integrity), By End-User (Public & Government Agencies, Private Insurance Payers, Third-party service provider, and Employers), and By Region (North America, Europe, Asia-Pacific, Latin America, Middle East, and Africa), Analysis and Forecast 2023 – 2033
The health analytics practice of fraud involves the advanced applications of data analysis techniques incorporating statistical methods, and especially in conjunction with AI and machine learning, for identifying, preventing against, and thus mitigating fraudulent activities. These will include billing, identity theft, and prescription drug fraud amongst other health insurance claims frauds. Furthermore, the increasing healthcare fraud cases, acceptance of big data and AI, tightening of government regulations on healthcare services, and increasing cost-cutting measures in the health sector are some drivers propelling the global healthcare fraud analytics market. Advanced analytics tools improve fraud detection efficiency, reduce financial losses, and ensure compliance, thus fostering market growth around the world. However, the restraining factors of the global healthcare fraud analytics market are high implementation costs, data privacy issues, scarcity of skilled professionals, legacy system integration challenges, and the reluctance to adapt to the latest technologies.
The descriptive analytics segment is expected to hold the largest share of the global healthcare fraud analytics market during the projected timeframe.
Based on solution type, the global healthcare fraud analytics market is categorized as descriptive, prescriptive, and predictive. Among these, the descriptive analytics segment is expected to hold the largest share of the global healthcare fraud analytics market during the projected timeframe. This is attributed to the descriptive analytics which forms the base for the effective application of predictive or prescriptive analytics. Hence, these analytics use the basics of descriptive analytics. It utilizes current as well as historical data for the identification of trends and relationships.
The on-premises segment is expected to hold the largest share of the global healthcare fraud analytics market during the projected timeframe.
Based on the delivery model, the global healthcare fraud analytics market is categorized as on-premises and cloud-based. Among these, the on-premises segment is expected to hold the largest share of the global healthcare fraud analytics market during the projected timeframe. This is because on-premises solutions, as opposed to cloud-based systems, provide a greater degree of control over data security. Data can be safeguarded within an organization's infrastructure by putting their security protocols into practice. The demand for on-premises fraud analytics solutions is largely driven by the need for improved data security and privacy.
The insurance claims review segment is expected to hold the largest share of the global healthcare fraud analytics market during the projected timeframe.
Based on the application, the global healthcare fraud analytics market is categorized as insurance claims review, pharmacy billing issue, and payment integrity. Among these, the insurance claims review segment is expected to hold the largest share of the global healthcare fraud analytics market during the projected timeframe. This is attributed to the increasing number of fraudulent insurance claims is a primary driver for enhanced claims review processes. The rising incidence of such fraudulent claims directly drives the adoption of advanced healthcare fraud analytics tools to identify and mitigate these risks.
The public and government agencies segment is expected to hold the largest share of the global healthcare fraud analytics market during the projected timeframe.
Based on the end-user, the global healthcare fraud analytics market is categorized as public & government agencies, private insurance payers, third-party service provider, and employers. Among these, the public and government agencies segment is expected to hold the largest share of the global healthcare fraud analytics market during the projected timeframe. This is due to government hospitals see more patients and because government agencies are more susceptible to fraud because they lack modern infrastructure, particularly in developing countries.
North America is projected to hold the largest share of the global healthcare fraud analytics market over the forecast period.
North America is projected to hold the largest share of the global healthcare fraud analytics market over the forecast period. Technological innovation makes possible the more efficient detection of fraud by analyzing vast amounts of data and considering patterns that might indicate fraudulent activity. Because advanced fraud analytics solutions are available in the region, the country is adopting them. More legislators, insurers, and healthcare providers are also recognizing the importance of fraud prevention. Initiatives by government organizations such as the Department of Justice (DOJ) and the Centers for Medicare & Medicaid Services (CMS) have raised awareness about the importance of effective fraud detection systems.
Asia Pacific is expected to grow at a rapid CAGR growth of the global healthcare fraud analytics market during the forecast period. This is owing to the increasing adoption of technologically advanced solutions. NHCAA estimates that tens of billions of dollars are lost to healthcare fraud. Thus, owing to the availability of numerous advanced services and solutions related to healthcare fraud detection, and strategic steps taken by major players present in the country, results in the growth of the market.
Competitive Analysis
Major vendors in the global healthcare fraud analytics market are CGI Inc., Change Healthcare, Conduent Incorporated, Cotiviti, Inc., DXC Technology Company, EPIC, ExlService Holdings, Inc., Fair Isaac Corporation, HCL Technologies Limited, IBM Corporation, LexisNexis Risk Solutions., Optum Inc., Qlarant Commercial Solutions, Inc., SAS Institute Inc., WIPRO LIMITED, and others.
Key Target Audience
Key Market Development
Market Segment
This study forecasts revenue at global, regional, and country levels from 2020 to 2033. Spherical Insights has segmented the global healthcare fraud analytics market based on the below-mentioned segments:
Global Healthcare Fraud Analytics Market, By Solution Type
Global Healthcare Fraud Analytics Market, By Delivery Model
Global Healthcare Fraud Analytics Market, By Application
Global Healthcare Fraud Analytics Market, By End-User
Global Healthcare Fraud Analytics Market, By Regional
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