Market Analysis
The global healthcare fraud detection market share is projected to reach
at CAGR 29.5% during the forecast year 2023-2032. 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.
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 outlook 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.
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.
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.
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