Healthcare Fraud Analytics Market Outlook 2030: Industry Insights & Opportunity Evaluation, 2019-2030

Healthcare Fraud Analytics Market Outlook 2030: Industry Insights & Opportunity Evaluation, 2019-2030

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The healthcare fraud analytics market is projected to reach USD 6.2billion by 2030 from USD 1.4 billion in 2020, at a CAGR of 28.8%.

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Description

Healthcare Fraud Analytics Market

by Solution Type (Descriptive, Predictive, Prescriptive), Application (Insurance Claim (Postpayment, Prepayment), Payment Integrity), Delivery (On-premise, Cloud), End User (Insurance, Government) – Global Forecast to 2030

Product Overview
Healthcare fraud is difficult to detect and is generally go unnoticed; therefore, detection of such fraudulent claims is necessary, as they increase the burden on society. The use of fraud detection solution enables healthcare firms in accounting, and auditing by predictive data methodologies. Careful account auditing can reveal suspicious providers and policyholders and detect potential fraudulent cases before it occurs.

Market Overview
The healthcare fraud analytics market is projected to reach USD 6.2billion by 2030 from USD 1.4 billion in 2020, at a CAGR of 28.8%. Market growth can be attributed to the large number of fraudulent activities in healthcare; the increasing number of patients seeking health insurance; high returns on investment; and rising pharmacy claim-related frauds. However, the dearth of skilled personnel is likely to restrain the growth of this market.
The descriptive analytics segment dominated the healthcare fraud analytics market in 2019

The market is segmented based on solution type, delivery model, application, and end user. Based on the solution type, the descriptive analytics segment accounted for the largest share of the market in 2019. Descriptive analytics forms the base for the effective application of predictive or prescriptive analytics. Hence, these analytics use the basics of descriptive analytics and integrate them with additional sources of data in order to produce meaningful insights.

Market Dynamics
Drivers
Expanding Patient Pool Opting for Healthcare Insurance to Benefit the Market
Burgeoning patient pool opting for health care insurance, alarming rise in fraudulent events in the healthcare industry, and the rising pressure to track abuse and fraud in healthcare are some of the top growth boosters in the global market.

Restraints
Low Awareness Level in Emerging Countries to be a Restraint
Lower awareness level regarding healthcare fraud analytics solutions in emerging countries is expected to restrain the market growth in the near future.

North America will dominate the healthcare fraud analytics market from 2020–2030
Geographically, the global healthcare fraud analytics market is segmented into North America, Europe, the Asia Pacific, Latin America, and the Middle East and Africa. North America accounted for the largest share of the market in 2019. The high share of the North American market is attributed to the large number of people having health insurance, growing healthcare fraud, favorable government anti-fraud initiatives, the pressure to reduce healthcare costs, technological advancements, and greater product and service availability in this region. Moreover, a majority of leading players in the healthcare fraud detection market have their headquarters in North America.

Key Market players
The healthcare fraud detection market is consolidated and competitive in nature. Major players in this market include IBM Corporation (US), Optum (US), SAS Institute (US), Change Healthcare (US), EXL Service Holdings (US), Cotiviti (US), Wipro Limited (India), Conduent (US), HCL (India), Canadian Global Information Technology Group (Canada), DXC Technology Company (US), Northrop Grumman Corporation (US), LexisNexis Group (US), and Pondera Solutions (US).

Healthcare fraud analytics market, by Solution Type
• Descriptive Analytics
• Predictive Analytics
• Prescriptive Analytics

Healthcare fraud analytics market, by Selivery model
• On-premise
• On-demand

Healthcare fraud analytics market, by application
• Insurance Claims Review
o Postpayment Review
o Prepayment Review
• Pharmacy Billing Misuse
• Payment Integrity
• Other applications*
• *Other applications include identity management and case management

Healthcare fraud analytics market, by End User
• Public & Government Agencies
• Private Insurance Payers
• Third-party service providers
• Employers

Additional information

Publisher

Geography Covered

Date Published

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Pages

Format

Table of Contents

Contents 1. Executive Summary 2. Global Healthcare Analytical Testing Services Market 2.1. Product Overview 2.2. Market Definition 2.3. Segmentation 2.4. Assumptions and Acronyms 3. Research Methodology 3.1. Research Objectives 3.2. Primary Research 3.3. Secondary Research 3.4. Forecast Model 3.5. Market Size Estimation 4. Average Pricing Analysis 5. Macro-Economic Indicators 6. Market Dynamics 6.1. Growth Drivers 6.2. Restraints 6.3. Opportunity 6.4. Trends 7. Correlation & Regression Analysis 7.1. Correlation Matrix 7.2. Regression Matrix 8. Recent Development, Policies & Regulatory Landscape 9. Risk Analysis 9.1. Demand Risk Analysis 9.2. Supply Risk Analysis 10. Global Healthcare Analytical Testing Services Market Analysis 10.1. Porters Five Forces 10.1.1. Threat of New Entrants 10.1.2. Bargaining Power of Suppliers 10.1.3. Threat of Substitutes 10.1.4. Rivalry 10.2. PEST Analysis 10.2.1. Political 10.2.2. Economic 10.2.3. Social 10.2.4. Technological 11. Global Healthcare Analytical Testing Services Market 11.1. Market Size & forecast, 2020A-2030F 11.1.1. By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F 11.1.2. By Volume (Million Units) 2020-2030F; Y-o-Y Growth (%) 2021-2030F 12. Global Healthcare Analytical Testing Services Market: Market Segmentation 12.1. By Regions 12.1.1. North America:(U.S. and Canada), By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F 12.1.2. Latin America: (Brazil, Mexico, Argentina, Rest of Latin America), By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F 12.1.3. Europe: (Germany, UK, France, Italy, Spain, BENELUX, NORDIC, Hungary, Poland, Turkey, Russia, Rest of Europe), By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F 12.1.4. Asia-Pacific: (China, India, Japan, South Korea, Indonesia, Malaysia, Australia, New Zealand, Rest of Asia Pacific), By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F 12.1.5. Middle East and Africa: (Israel, GCC, North Africa, South Africa, Rest of Middle East and Africa), By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F 12.2. By Solution Type: Market Share (2020-2030F) 12.2.1. Descriptive Analytics, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F 12.2.2. Predictive Analytics, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F 12.2.3. Prescriptive Analytics, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F 12.3. By Selivery model: Market Share (2020-2030F) 12.3.1. On-premise, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F 12.3.2. On-demand, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F 1.1. By Application: Market Share (2020-2030F) 1.1.1. Insurance Claims Review, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F 1.1.2. Pharmacy Billing Misuse, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F 1.1.3. Payment Integrity, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F 1.1.4. Other, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F 1.2. By End User: Market Share (2020-2030F) 1.2.1. Public & Government Agencies, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F 1.2.2. Private Insurance Payers, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F 1.2.3. Third-party service providers, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F 1.2.4. Employers, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F 13 Company Profile 13.1. IBM (US) 13.1.1. Company Overview 13.1.2. Company Total Revenue (Financials) 13.1.3. Market Potential 13.1.4. Global Presence 13.1.5. Key Performance Indicators 13.1.6. SWOT Analysis 13.1.7. Product Launch 13.2. Optum, Inc. (US) 13.3. SAS Institute, Inc. (SAS) (US) 13.4. Change Healthcare(US) 13.5. EXL Service Holdings, Inc. (EXL) (US) 13.6. Cotiviti (US) 13.7. Wipro Limited (Wipro) (India) 13.8. Conduent, Inc. (Conduent) (US) 13.9. Canadian Global Information Technology Group Inc. (CGI) (Canada) 13.10. DXC Technology Company (DXC) (US) 13.11. Other Prominent Players 14 Consultant Recommendation **The above given segmentations and companies could be subjected to further modification based on in-depth feasibility studies conducted for the final deliverable.

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