Allied Market Research

2024

Healthcare Fraud Analytics Market

Healthcare Fraud Analytics Market Size, Share, Competitive Landscape and Trend Analysis Report by Component (Services, Software), by Delivery Mode (On-Demand, On-Premise), by Analytical Type (Predictive Analytics, Prescriptive Analytics, Descriptive Analytics), by Application (Insurance Claims Review, Pharmacy Billing Misuse, Payment Integrity, Identity Case Management, Others) and by End User (Public Government Agencies, Private Insurance Payers, Third-Party Service Providers, Employers): Global Opportunity Analysis and Industry Forecast, 2023-2032

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Author's: | Vineet Kumar
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Healthcare Fraud Analytics Market Statistics: 2027

Healthcare fraud detection is a set of analytical solutions that help in identifying issues such as errors in claim submission forms and duplication/repetition of claims. Healthcare fraud detection of claims is necessary as fraud claims increase burden on healthcare industry and society. The use of fraud detection solution allows healthcare firms to audit and account analytical data methodologies. Traditionally cautious account auditing was followed that reveled various suspicious providers and policy holders but with technological advancements identifying potential fraudulent cases before it occurs boosts the healthcare fraud analytics market growth. The global healthcare fraud detection market is expected to expand over the next decade. Dominating trends that are leading the market growth include rise in adoption of analytics in healthcare business processing outsourcing (BPO), implementation of fraud risk management solutions, and emergence of social media. This has positively impacted the growth of applications based on machine learning for fraud detection developing among healthcare industry.

Healthcare Fraud Analytics Market

COVID-19 Scenario Analysis:

  • The cancellation of pre-birth checkups or their transfer to a telemedicine approach was part of a significantly larger effect on primary care during the outbreak of COVID-19.
  • The effect of COVID-19 upon digital solutions over delivery of healthcare has been and continues to be very substantial and it is speeds up as fast as COVID-19 is moving across the globe. 
  • Some countries like South Korea have developed the use of smartphone technology to assist in better managing contacts with quite exceptional results.
  • During the crisis, there is a surge in demand for medicines, medical devices, and other essential products such as PPE kits, gloves, and sanitizers.

Top impacting factors: Market Scenario Analysis, Trends, Drivers, and Impact Analysis

Increase in number of patients seeking health insurance and large number of fraudulent activities in healthcare are the major factors that are expected to drive the healthcare fraud analytics market growth during the forecast period. Moreover, high return on investments and rise in pharmacy claim related frauds also propel the growth of market.

However, concerns associated with healthcare fraud analytics such as lack of privacy is a restraint, which is expected to hinder the market growth. Contrarily, adoption of healthcare fraud analytics in developing countries, emergence of social media and its impact on the healthcare industry, and role of AI in healthcare fraud detection act as opportunities for the healthcare fraud analytics market.

Increase in number of patients seeking health insurance

Healthcare fraud detection applications have evolved the way evaluation of insurance claims are performed. As majority of fraud cases occur while claiming health insurance policies, many insurance companies have opted for healthcare fraud detection solutions. As the number of patients increases, healthcare insurance fraud is expected to rise as false information given to  health insurance companies may increase unauthorized payment advantages to policyholders‚ third party service providers‚ or the service suppliers.

Lack of privacy

One of the strongest concerns relating to the use and gathering of big data in healthcare analytics is the lack of privacy, especially when it comes to health records of sensitive patients. To be effective and get the full, detailed look at a patient, big data must have access to all information, comprising private records and social media posts. According to several big data experts, the technology takes away personal privacy for the greater good. 

Key benefits of the report:

  • This study presents the analytical depiction of the global healthcare fraud analytics industry along with the current trends and future estimations to determine the imminent investment pockets.
  • The report presents information related to key drivers, restraints, and opportunities along with detailed analysis of the healthcare fraud analytics market share.
  • The current healthcare fraud analytics market is quantitatively analyzed to highlight the growth scenario.
  • Porter’s five forces analysis illustrates the potency of buyers & suppliers in the healthcare fraud analytics market. 
  • The report provides a detailed healthcare fraud analytics market analysis based on the present and future competitive intensity of the market.

Healthcare Fraud Analytics Market Report Highlights

Aspects Details
Healthcare Fraud Analytics Market By Component
By Component
  • Services
  • Software
Healthcare Fraud Analytics Market By Delivery Mode
By Delivery Mode
  • On-Demand
  • On-Premise
Healthcare Fraud Analytics Market By Analytical Type
By Analytical Type
  • Predictive Analytics
  • Prescriptive Analytics
  • Descriptive Analytics
Healthcare Fraud Analytics Market By Application
By Application
  • Insurance Claims Review
  • Pharmacy Billing Misuse
  • Payment Integrity
  • Identity & Case Management
  • Others
Healthcare Fraud Analytics Market By End User
By End User
  • Public & Government Agencies
  • Private Insurance Payers
  • Third-Party Service Providers
  • Employers
Healthcare Fraud Analytics Market By Region
By Region
  • North America  (US, Canada)
  • Europe  (Germany, UK, France, rest of Europe)
  • Asia-Pacific  (China, Japan, India, rest of Asia-Pacific)
  • Latin America  (Brazil, Mexico, rest of LATAM)
  • the Middle East 
  • Africa 
Key Market Players
Key Market Players

IBM Corporatio, SCIO Insprise, Corp., HCL Technologies Ltd., Fair Isaac Corporation, Wipro Limited., Conduent Inc., Mckesson Corporation, CGI Group Inc., SAS Institute, Inc.

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Healthcare Fraud Analytics Market

Global Opportunity Analysis and Industry Forecast, 2023-2032