Market
Analysis
The global healthcare fraud
detection market size is projected to reach USD 18.3 billion by 2030 at CAGR
26.7% during the forecast year 2023-2030. Healthcare fraud takes places when a
healthcare provider or an insured person offers misleading or false information
to health insurance companies with an intention to have it paid to another
party, individual, healthcare provider or policy holder for unauthorized
benefits. Health care fraud comprise of medical fraud, drug fraud and health
insurance fraud. Some common examples of such fraud include misrepresenting
dates, duration, description of services and frequency, submitting claims for
services that is not provided, numerous claims filed for same patients by
different providers, data falsification by physicians. Healthcare fraud
detection will help to prevent healthcare fraud, abuse and waste.
There are many factors that is
driving the growth of the healthcare fraud detection market.
Some of
these factors as per the Market Research Future (MRFR) report include
increasing fraudulent activities in the healthcare sector, growing number of
patients looking for health insurance, prepayment review model, increasing
pressure of abuse, waste and fraud on healthcare spending, high investment
returns, and thorough and stringent checks in claims procedure to reduce losses
to insurance companies. On the contrary, factors such as requirement for
recurrent upgrades made in the fraud detection software, time-consuming
deployment and the reluctance to use healthcare fraud analytics especially in
the developing economies may impede the healthcare fraud detection market
growth.
Key Players
healthcare fraud detection market players include Pondera
Solutions, Northrop Grumman, DXC Technology, CGI Group, Scio Health Analytics,
International Business Machines Corporation (IBM), LexisNexis, Wipro, Conduent,
HCL Technologies, SAS Institute, Fair Isaac, McKesson, Verscend Technologies,
Optum and others.
Market
Segmentation
Market
Research Future report offers an all-inclusive segmental analysis of the healthcare fraud
detection market on the basis of component, end-user, delivery model,
application and type.
Based on component, it is segmented
into software and services. Of these, services will dominate the market over
the estimated years.
Based on end-users, the healthcare
fraud detection market is segmented into private insurance payers, employers,
government agencies and others.
Based on delivery model, it is
segmented into on-premise and on-demand delivery models. Of these, on-demand
will dominate the market.
Based on application, the healthcare
fraud detection market is segmented into insurance claims review and payment
integrity. The insurance claims review is again segmented into post and
prepayment review. Of these, insurance claims review will dominate the market.
Based on type, it is segmented into
prescriptive analytics, descriptive analytics and predictive analytics. Of
these, descriptive analytics will lead the healthcare fraud detection market
over the estimated years.
Regional
Analysis
Based on
region, the healthcare fraud detection market insights covers
growth opportunities and latest trends across Americas, Europe, Asia Pacific
and Middle East and Africa. Of these, Americas will govern the market over the
estimated years owing to increasing fraud cases in healthcare sector, promising
government initiatives for preventing fraud in healthcare sector and more and
more people requesting for health insurance. This will be followed by Europe
that holds the second position owing to rising incidences of corruption and
healthcare fraud in the region, developing state to cut down fraud within the
healthcare sector and progress of the information technology sector. In the
APAC region, the healthcare fraud detection market is predicted in being the fastest
developing due to increasing frequency of frauds, evolving IT sector and
constantly developing economies. On the other hand, the healthcare fraud
detection market in the Middle East and Africa will have the least share. The
Middle Eastern region however is anticipated to have a key share owing to the
increasing health insurance frauds cases.
About US:
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