Report Code: A05264 | Pages: 310 | Jul 2022 | 3630 Views | ||
Author(s) : Swapna S , Onkar S | Tables: 238 | Charts: 57 |
|
The global healthcare fraud detection market size was valued at $1.1 billion in 2021, and is projected to reach $3.6 billion by 2031, growing at a CAGR of 12.6% from 2022 to 2031. Healthcare fraud detection involves account auditing, medical claim auditing and auditing of healthcare funds. The medical fraudulence cases, such as healthcare funds fraudulence, claims and healthcare insurance fraudulence are increased in healthcare sector. In addition, healthcare fraud detection market actually helps in preventing healthcare fraud, waste, and abuse. Healthcare fraud is completely a misrepresentation or intentional deception of facts by healthcare professionals or patients, which can be led to unauthorized payments or benefits. Some examples of healthcare frauds are including falsified data by physicians, multiple claims filed by different providers for the same patients, submitting claims for services which are not provided, misrepresenting dates in various treatments, frequency, and duration or description of services provided.
The main cause of the interruptions experienced by the healthcare payer and government agencies. As a result, the COVID-19 outbreak will slow global market growth of healthcare fraud detection, which will have a negative effect on the market's value in 2021 and beyond.
The healthcare fraud detection market size is projected to experience rapid growth, as the various new software based on data mining and artificial intelligence are being used by the healthcare industry. Furthermore, this market is anticipated to advance due to the expansion of analysis, services, insurance claim reviews and by maintaining payment integrity. Moreover, the global healthcare fraud detection market share is expanding due to increased fraud in healthcare domain, increase in pressure of abuse and fraud, and rise in patient benefiting by health insurance. Morover, as the various new software based on data mining and artificial intelligence are being used by the healthcare industry is boosting the market growth. Furthermore, this market is anticipated to advance due to the expansion of analysis, services, insurance claim reviews and by maintaining payment integrity.
Moreover, increase in use of advanced analytics, machine learning and artificial intelligence boosting the growth of the market. However, increase in data breaches in healthcare industry and lower awareness level regarding healthcare fraud analytics solutions in emerging countries is expected to restrain the healthcare fraud detection market growth. The increase in number of fraudulent activities in healthcare, rise in the number of patients seeking healthcare insurance are the major driving factors and will boost the market growth during the healthcare fraud detection market forecast.
Impact of COVID-19 on the Market
Coronavirus Severe acute respiration syndrome (SARS-CoV-2) is an infectious disease caused by the novel coronavirus (COVID-19), which originated in the Wuhan district in China in the late 2019, and since has spread to 212 countries. The virus was initially referred to as “novel coronavirus 2019” (2019-nCoV) by the WHO, However, on February 11, 2020, it was given the official name of SARS-CoV-2 by the International Committee on Taxonomy of Viruses. WHO declared COVID-19 as pandemic on March 11, 2020, and by September 1, 2020, over 28.1 million people have been infected globally with over 909,000 deaths. COVID-19 symptoms include fever, cough, and shortness of breath.
Nearly all industries have been impacted by the global public health epidemic COVID-19. As coronavirus crises sweep the globe and force healthcare organizations to devote the majority of their funds to fight COVID-19, the outbreak of COVID-19 has resulted in a significant decline in demand for the healthcare fraud detection market across several sectors, particularly the health and pharmaceutical sector. The main cause of the interruptions experienced by the healthcare payer and government agencies. As a result, the COVID-19 outbreak will slow global market growth of healthcare fraud detection, which will have a negative effect on the market's value in 2021 and beyond.
The medical fraud detection management market is segmented into Application, End User, Type and Component.
The healthcare fraud detection market is segmented on the basis of type, component, application, end user, and region. By type, it is divided into descriptive analytics, predictive analytics and prescriptive analysis. By component, it is bifurcated into services and software. By application, the market is classified into insurance claims review and payment integrity. By end user, the market is categorized into healthcare payer (Public Payer and Private Payers), government agencies, and others. Region wise, the market is analyzed across North America, Europe, Asia-Pacific, and LAMEA.
By Type Segment Review
By type, descriptive analytics segment was the highest revenue contributor to the market. The growth of this segment is increased owing to high demand of descriptive analytics-based service across U.S and European countries.
By Component Segment Review
By type of component, the software segment was the highest revenue contributor to the market. As majority of the medical industries use the software-based fraud detection techniques. The market growth of the segment driven by use of newly developed software based on machine learning and artificial intelligence.
By Application Segment Review
By application type, the insurance claims review was the highest revenue contributor to the market. Furthermore, most of the medical fraudulence is observed in the healthcare insurance therefore, insurance claims review generated the greater revenue and contribute to the growth of global healthcare fraud detection market. The payment integrity held the fastest growing segment.
By End User Segment Review
By end user the market is classified into healthcare payer, government agencies and others. The healthcare payer was the highest revenue contributor to the market. Furthermore, the government agencies also contributed to the global market growth.
Region Type Segment Review
Region wise, in healthcare fraud detection industry, North America was the highest revenue contributor. As the fraudulence cases observed in the U.S and Mexico was highest in past few years. Moreover, the innovative analytical techniques and software use is increasing in the North America which is driving the market growth.
Major key players that operate in the global healthcare fraud detection market are CGI Group, Conduent, DXC Technology Company, EXLSERVICE Holdings Inc., Fair ISAAC Corporation, HCL Technologies, International Business Machines Corporation (IBM), LexisNexis, McKesson Corporation, Northrop Grumman, Optum, OSP Labs, SAS Institute Inc., Scioinspire CORP., UNITEDHEALTH Group, Verscend Technologies, and WIPRO Limited.
Healthcare Fraud Detection Market Report Highlights
Aspects | Details |
---|---|
Application |
|
End User |
|
Type |
|
Component |
|
By Region |
|
Key Market Players | International Business Machines Corporation (IBM), Optum Inc., Verscend Technologies, McKesson Corporation, FAIR ISAAC Corporation, SAS Institute Inc., HCL Technologies, WIPRO LIMITED, Conduent, CGI Group, DXC Technology Company, UnitedHealth Group, Inc., Exlservice Holdings Inc., Cotiviti Inc., LexisNexis, OSP Labs, Northrop Grumman, Northrop Grumman Corp |
Loading Table Of Content...
This section provides various opinions of the top-level CXOs in healthcare fraud detection market. In accordance with several interviews conducted, the utilization of software services is likely to witness a significant growth in the market. The healthcare fraud managed by descriptive analytics, predictive analysis and prescriptive analysis. Introduction of various new software and technologies lead to the expansion of the global healthcare fraud detection market.
Increase in number of fraudulence in the medical claims and health insurances are expected to grow in the future. Also, surge in pressure of fraud and abuse of healthcare are projected to expand the market growth. For instance, the services of software and breakthrough inventions in artificial intelligence is projected to drive the global healthcare fraud detection market growth.
According to the perspectives of CXOs of leading companies in the market, developing the new innovative methods for fraud detection in healthcare industry. Rapid growth was observed in the adoption of services and software by the healthcare payer and government agencies. As per CXOs, although North America and Asia-Pacific are expected to dominate the global healthcare fraud detection market during the forecast period, emerging countries in Latin America are expected to offer significant growth opportunities in the near future.
A. The upcoming trends of healthcare fraud detection market are increase in number of fraudulent activities in healthcare, rise in the number of patients seeking healthcare insurance.
A. The leading application of healthcare fraud detection market are preventing healthcare fraud, waste, and abuse.
A. North America is the largest regional market for healthcare fraud detection.
A. Healthcare fraud detection is projected to reach $3,600.0 million by 2031.
A. Major key players that operate in the global healthcare fraud detection market are International Business Machines Corporation (IBM), Optum, Verscend Technologies, McKesson Corporation, FAIR ISAAC Corporation, SAS Institute Inc., HCL Technologies, Wipro Limited, Conduent, CGI Group, DXC Technology Company, UnitedHealth Group, Exlservice Holdings Inc., Scio inspire Corp, LexisNexis, OSP Labs, Northrop Grumman.
A. The forecast period for healthcare fraud detection market is 2022 to 2031.
A. The base year is 2021 for healthcare fraud detection market.
Start reading instantly.
This Report and over 19,662+ more Reports, Available with Avenue Library. T&C*.
Enterprise
License/PDF
Library
Membership
*Taxes/Fees, if applicable will be added during checkout. All prices in USD
To ensure high-level data integrity, accurate analysis, and impeccable forecasts
For complete satisfaction
On-demand customization of scope of the report to exactly meet your needs
Targeted market view to provide pertinent information and save time of readers
Get insights on topics that are crucial for your business. Stay abreast of your interest areas.
Get Industry Data AlertsTo ensure high-level data integrity, accurate analysis, and impeccable forecasts
For complete satisfaction
On-demand customization of scope of the report to exactly meet your needs
Targeted market view to provide pertinent information and save time of readers