Healthcare Fraud Analytics Market Size, Share, Opportunities, And Trends By Component (Software, Services), By Deployment (On-Premises, Cloud-Based Others), By Application (Insurance Claims Review, Payment Integrity, Identity & Access Management, Others), By End-User (Healthcare Payers, Healthcare Providers, Government Agencies, Others), And By Geography - Forecasts From 2023 To 2028

The healthcare fraud analytics market is expected to grow at a CAGR of 20.47% from US$1.626 billion in 2021 to US$5.989 billion in 2028.

The healthcare fraud analytics market size is growing and focuses on detecting and preventing fraudulent actions in the healthcare business. Billing fraud, identity theft, and needless treatments all cost the healthcare system billions of dollars each year. Advanced data analytics techniques and algorithms are used in healthcare fraud analytics systems to uncover trends, abnormalities, and suspicious activity, allowing for proactive fraud detection and prevention. The healthcare fraud analytics market growth has enormous potential to reduce fraudulent activities, safeguard healthcare organizations from financial losses, and maintain the healthcare industry's confidence and integrity. In terms of market share, numerous industry competitors, such as specialized analytics solution providers, technology firms, and healthcare organizations themselves, are striving to grab a substantial chunk of the market. The market is likely to expand further as healthcare organizations invest in sophisticated analytics tools and technology to detect and prevent fraud in the sector.

Need for Cost Containment and Financial Loss Prevention in Healthcare Fraud Analytics Market.

A primary driver in the Healthcare Fraud Analytics industry is the requirement for cost conservation and financial loss avoidance. Healthcare fraud is projected to account for 3% to 10% of worldwide healthcare spending each year, according to NHCAA. This financial burden emphasizes the need to implement fraud analytics tools to detect and prevent fraudulent actions. According to research, employing such solutions can result in considerable cost reductions for healthcare organizations. The market's demand for advanced analytics solutions is being driven by a focus on cost conservation and financial loss avoidance.

Growing Awareness and Focus on Fraud Prevention Enhances the Healthcare Fraud Analytics Market Size.

In the Healthcare Fraud Analytics industry, there is a rising awareness of and emphasis on fraud prevention. In the Healthcare Fraud Analytics industry, the emphasis on fraud prevention drives market growth and innovation.

Government Initiatives and Regulations to Combat Healthcare Fraud in Healthcare Fraud Analytics Market.

The role of government actions and legislation in preventing healthcare fraud is crucial. Governments throughout the world are enacting stronger measures to combat fraud and defend the integrity of healthcare systems. These approaches include the creation of specialized anti-fraud teams, greater financing for fraud detection programs, and the passage of legislation to discourage and penalize fraudulent behaviour. Furthermore, governments work with industry players to create best practices, share information, and increase transparency in billing and claims procedures. Combating healthcare fraud provides financial responsibility, protects patients, and promotes a safer and more efficient healthcare system.

North America is a Market Leader in the Healthcare Fraud Analytics Market.

North America is the industry leader in healthcare fraud analytics market share. This can be linked to a variety of causes, including the region's rigorous regulatory framework, high healthcare spending, and rising occurrences of healthcare fraud. Furthermore, North America has a well-established healthcare system that places a premium on fraud prevention and compliance. The region's emphasis on preventing healthcare fraud, along with the deployment of advanced analytics technology, underpins its market leadership in Healthcare Fraud Analytics.

Rising Adoption of Electronic Health Records (EHRs) and Digital Health Systems in Healthcare Fraud Analytics Market.

The growing use of Electronic Health Records (EHRs) and digital health systems is having a significant influence on the Healthcare Fraud Analytics industry. By 2021, 96% of non-federal acute care hospitals in the United States have adopted certified EHR systems, according to the Office of the National Coordinator for Health Information Technology. This digitization of healthcare data gives a lot of information that fraud analytics systems may use to detect and prevent fraudulent activity. The integration of EHRs with digital health systems enables real-time monitoring, data analysis, and pattern identification, allowing healthcare organizations to discover fraudulent billing, coding errors, and other fraudulent practices in real time.

Key Developments:

• In June 2022, Patient Engagement is a line of products from Change Healthcare that connects touchpoints throughout the patient experience, increasing access and improving communication between patients and physicians. Change Healthcare services laid out income cycle the board capacities, joined with Luma Health's industry-driving arrangements, empower suppliers to coordinate functional, clinical, and monetary excursions, bringing about a more improved understanding experience.

Company Products:

• Fraud Detection Systems: IBM provides sophisticated analytics tools that leverage machine learning and artificial intelligence to detect trends and anomalies that may indicate fraudulent activity. Large amounts of healthcare data, such as claims, billing records, and patient information, are analyzed by these systems to detect unusual behavior and probable fraud.
• Real-time Monitoring and Alerting: Optum offers real-time monitoring systems that continually monitor healthcare transactions and data streams. These systems employ rule-based algorithms to detect and notify of potentially fraudulent activity, allowing for quick intervention and prevention.
• Identity Verification: LexisNexis Risk Solutions offers identity verification technologies to assist healthcare organizations in validating the identities of their patients, providers, and other entities. To avoid identity theft and fraudulent actions, these solutions make use of powerful identity verification algorithms and databases.
• Provider Network Analysis: Optum's fraud analytics solutions use network analysis techniques to uncover linkages and interconnections among healthcare providers, patients, and other organizations. This study aids in the detection of fraudulent schemes involving cooperation, incorrect billing practices, or organized networks.

Healthcare Fraud Analytics Market Scope:

 

Report Metric	Details
Market Size Value in 2021	US$1.626 billion
Market Size Value in 2028	US$5.989 billion
Growth Rate	CAGR of 20.47% from 2021 to 2028
Base Year	2021
Forecast Period	2023 – 2028
Forecast Unit (Value)	USD Billion
Segments Covered	Component, Deployment, Application, End-User, and Geography
Regions Covered	North America, South America, Europe, Middle East and Africa, Asia Pacific
Companies Covered	Ibm Corporation, Sas Institute Inc., Optum (A Part Of Unitedhealth Group), Fairwarning (Acquired By Imprivata), Exl Service Holdings, Inc., Pondera Solutions (Acquired By Thomson Reuters), Cotiviti Holdings, Inc., Change Healthcare, Wipro Limited, Fico (Fair Isaac Corporation)
Customization Scope	Free report customization with purchase

 

Segmentation

• By Component
  • Software
  • Services             
• By Deployment
  • On-Premises
  • Cloud-Based 
• By Application
  • Insurance Claims Review
  • Payment Integrity
  • Identity & Access Management
  • Others
• By End-User
  • Healthcare Payers
  • Healthcare Providers
  • Government Agencies
  • Others      
• By Geography
  • North America
    • United States
    • Canada
    • Mexico
  • South America
    • Brazil
    • Argentina
    • Others
  • Europe
    • United Kingdom
    • Germany
    • France
    • Italy
    • Spain    
    • Others
  • Middle East and Africa
    • Saudi Arabia
    • UAE
    • Others
  • Asia Pacific
    • Japan
    • China
    • India
    • South Korea
    • Indonesia
    • Taiwan
    • Others

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1. INTRODUCTION

1.1. Market Overview

1.2. Market Definition

1.3. Scope of the Study

1.4. Market Segmentation

1.5. Currency

1.6. Assumptions

1.7. Base, and Forecast Years Timeline

2. RESEARCH METHODOLOGY  

2.1. Research Data

2.2. Sources

2.3. Research Design

3. EXECUTIVE SUMMARY

3.1. Research Highlights

4. MARKET DYNAMICS

4.1. Market Drivers

4.2. Market Restraints

4.3. Porters Five Forces Analysis

4.3.1. Bargaining Power of Suppliers

4.3.2. Bargaining Power of Buyers

4.3.3. Threat of New Entrants

4.3.4. Threat of Substitutes

4.3.5. Competitive Rivalry in the Industry

4.4. Industry Value Chain Analysis

5. HEALTHCARE FRAUD ANALYTICS MARKET, BY COMPONENT

5.1. Introduction

5.2. Software

5.3. Services              

6. HEALTHCARE FRAUD ANALYTICS MARKET, BY DEPLOYMENT

6.1. Introduction

6.2. On-Premises

6.3. Cloud-based

7. HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION

7.1. Introduction

7.2. Insurance Claims Review

7.3. Payment Integrity

7.4. Identity & Access Management

7.5. Others

8. HEALTHCARE FRAUD ANALYTICS MARKET, BY END-USER

8.1.  Introduction

8.2. Healthcare Payers

8.3. Healthcare Providers

8.4. Government Agencies

8.5. Others       

9. HEALTHCARE FRAUD ANALYTICS MARKET, BY GEOGRAPHY

9.1. Introduction

9.2. North America

9.2.1. United States

9.2.2. Canada

9.2.3. Mexico

9.3. South America

9.3.1. Brazil

9.3.2. Argentina

9.3.3. Others

9.4. Europe

9.4.1. United Kingdom

9.4.2. Germany

9.4.3. France

9.4.4. Italy

9.4.5. Spain

9.4.6. Others

9.5. Middle East and Africa

9.5.1. Saudi Arabia

9.5.2. UAE

9.5.3. Others

9.6. Asia Pacific

9.6.1. Japan

9.6.2. China

9.6.3. India

9.6.4. South Korea

9.6.5. Indonesia 

9.6.6. Taiwan

9.6.7. Others

10. COMPETITIVE ENVIRONMENT AND ANALYSIS

10.1. Major Players and Strategy Analysis

10.2. Emerging Players and Market Lucrativeness

10.3. Mergers, Acquisitions, Agreements, and Collaborations

10.4. Vendor Competitiveness Matrix

11. COMPANY PROFILES

11.1. IBM Corporation

11.2. SAS Institute Inc.

11.3. Optum (a part of UnitedHealth Group)

11.4. FairWarning (acquired by Imprivata)

11.5. EXL Service Holdings, Inc.

11.6. Pondera Solutions (acquired by Thomson Reuters)

11.7. Cotiviti Holdings, Inc.

11.8. Change Healthcare

11.9. Wipro Limited

11.10. FICO (Fair Isaac Corporation)  

Ibm Corporation

Sas Institute Inc.

Optum (A Part Of Unitedhealth Group)

Fairwarning (Acquired By Imprivata)

Exl Service Holdings, Inc.

Pondera Solutions (Acquired By Thomson Reuters)

Cotiviti Holdings, Inc.

Change Healthcare

Wipro Limited

Fico (Fair Isaac Corporation)