Healthcare Fraud Analytics Market is Expected to Reach .0 Billion

/EIN News/ — Chicago, June 15, 2023 (GLOBE NEWSWIRE) — The healthcare fraud analytics industry is poised for significant growth and transformation in the near future. With the increasing complexity of healthcare systems and the rise in fraudulent activities, there is a growing need for advanced analytics solutions to detect and prevent healthcare fraud. The industry will witness the emergence of sophisticated fraud detection algorithms and machine learning models that can analyze vast amounts of healthcare data to identify patterns, anomalies, and suspicious behaviors. These analytics tools will enable healthcare organizations and insurance providers to proactively detect fraudulent activities, such as billing fraud, prescription fraud, and identity theft, leading to substantial cost savings and improved regulatory compliance. Additionally, advancements in artificial intelligence and natural language processing will enhance the capabilities of fraud analytics systems, enabling real-time monitoring, predictive modeling, and automated fraud alert generation. The integration of healthcare fraud analytics with electronic health records (EHRs), claims data, and external data sources will further enhance the accuracy and efficiency of fraud detection and investigation. The healthcare fraud analytics industry will play a crucial role in safeguarding the integrity of healthcare systems, reducing financial losses, protecting patient data, and promoting trust and transparency in the healthcare industry.

Healthcare Fraud Analytics market in terms of revenue was estimated to be worth $1.5 billion in 2021 and is poised to reach $5.0 Billion by 2026, growing at a CAGR of 26.7% from 2021 to 2026 according to a latest report published by MarketsandMarkets. Market growth can be attributed to a large number of fraudulent activities in healthcare, increasing number of patients seeking health insurance, high returns on investment, and the rising number of pharmacy claims-related frauds. However, the dearth of skilled personnel is expected to restrain the growth of this market.

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Healthcare Fraud Analytics Market Scope:

Report Coverage Details
Market Revenue in 2021 $1.5 billion
Estimated Value by 2026 $5.0 Billion
Growth Rate Poised to grow at a CAGR of 26.7%
Market Size Available for 2019–2026
Forecast Period 2021–2026
Forecast Units Value (USD Billion)
Report Coverage Revenue Forecast, Competitive Landscape, Growth Factors, and Trends
Segments Covered Solution Type, Delivery Model, Application, End User
Geographies Covered North America, Europe, Asia, Pacific, Latin America, and the Middle East and Africa
Report Highlights Updated financial information / product portfolio of players
Key Market Opportunities Emergence of social media and its impact on the healthcare industry
Key Market Drivers Increased number of patients seeking health insurance

Healthcare Fraud Analytics market major players covered in the report, such as:

  • IBM Corporation (US)
  • OptumInc. (US)
  • Cotiviti Inc. (US)
  • Change Healthcare (US)
  • Fair Isaac Corporation (US)
  • SAS Institute Inc. (US)
  • EXLService Holdings Inc. (US)
  • Wipro Limited (India)
  • Conduent Incorporated (US)
  • CGI Inc. (Canada)
  • HCL Technologies Limited (India)
  • Qlarant Inc. (US)
  • DXC Technology (US)
  • Northrop Grumman Corporation (US)
  • LexisNexis (US)
  • Healthcare Fraud Shield (US)
  • Sharecare Inc. (US)
  • FraudLens Inc. (US)
  • HMS Holding Corp. (US)
  • Codoxo (US)
  • (US)
  • Pondera Solutions Inc. (US)
  • FRISS (The Netherlands)
  • Multiplan (US)
  • FraudScope (US)
  • OSP Labs (US)
  • and Among Others

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The study categorizes the healthcare fraud analytics market based on solution type, delivery model, application, end user, and regional and global level:

Global healthcare fraud analytics market, by Solution Type

  • Descriptive Analytics
  • Predictive Analytics
  • Prescriptive Analytics                                    

Global healthcare fraud analytics market, by Delivery Model

Global healthcare fraud analytics market, by Application

  • Insurance Claims Review
    • Postpayment Review
    • Prepayment Review
  • Pharmacy Billing Misuse
  • Payment Integrity
  • Other applications

Global healthcare fraud analytics market, by End User

  • Public & Government Agencies
  • Private Insurance Payers
  • Third-party service providers
  • Employers

Global healthcare fraud analytics market, by region

  • North America
  • Europe
    • Germany
    • France
    • UK
    • Italy
    • Spain
    • Rest of Europe
  • Asia
    • China
    • Japan
    • Rest of Asia
    • Pacific
  • Latin America
  • Middle East & Africa

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The key stakeholders in the Healthcare Fraud Analytics market include:

  • Healthcare Providers: Healthcare providers, including hospitals, clinics, and medical practices, are important stakeholders in the healthcare fraud analytics market. They rely on fraud analytics solutions to identify and prevent fraudulent activities within their own organizations, ensuring accurate billing and maintaining the integrity of their services.
  • Insurance Providers: Insurance companies and payers are major stakeholders in the healthcare fraud analytics market. They utilize fraud analytics tools to detect and prevent fraudulent claims, which can lead to significant financial losses. Fraud analytics helps insurance providers identify suspicious patterns, uncover fraudulent networks, and improve claims processing efficiency.
  • Government Agencies: Government agencies, such as healthcare regulatory bodies and law enforcement agencies, play a crucial role in combating healthcare fraud. These stakeholders leverage fraud analytics solutions to investigate and prosecute fraudulent activities, protect public funds, and enforce compliance with healthcare regulations.
  • Data Analytics and Technology Companies: Data analytics and technology companies that specialize in healthcare fraud analytics are key stakeholders in the market. They develop and provide advanced analytics tools, machine learning algorithms, and data management platforms that enable healthcare organizations to analyze large volumes of data and detect potential fraud.
  • Compliance and Audit Professionals: Compliance officers and audit professionals within healthcare organizations are essential stakeholders in the healthcare fraud analytics market. They utilize fraud analytics solutions to monitor and ensure compliance with healthcare regulations, identify potential fraud risks, and conduct internal audits to mitigate fraud and abuse.
  • Legal and Investigative Services: Legal and investigative services, including law firms, forensic accountants, and private investigators, play a critical role in the healthcare fraud analytics market. These stakeholders use fraud analytics tools to support their investigations, gather evidence, and build cases against individuals or entities involved in fraudulent healthcare activities.
  • Healthcare Consumers: Healthcare consumers, including patients and beneficiaries, are indirect stakeholders in the healthcare fraud analytics market. By implementing robust fraud detection systems, healthcare organizations and insurance providers can protect the interests of consumers by minimizing fraud-related costs, maintaining affordable premiums, and ensuring the availability of quality healthcare services.
  • Healthcare Industry Associations and Advocacy Groups: Industry associations and advocacy groups focused on healthcare fraud prevention and detection are stakeholders in the market. They collaborate with other stakeholders to promote awareness, share best practices, and advocate for policies and regulations that strengthen healthcare fraud analytics efforts.

Collaboration and cooperation among these stakeholders are crucial for the effective detection, prevention, and prosecution of healthcare fraud. By leveraging advanced analytics tools and working together, these stakeholders can collectively combat fraud, protect healthcare resources, and enhance the overall integrity of the healthcare system.

Healthcare Fraud Analytics Market Frequently Asked Questions (FAQs):

Q1. What is the total market value of Healthcare Fraud Analytics Market report?

Q2. Which are the top companies holding the market share in Healthcare Fraud Analytics Market?

Q3. Which are the largest regions for this Market?

Q4. What is the leading technology of Healthcare Fraud Analytics Market?

Q5. What are the major drivers for this specific Market?

Q6. What are the upcoming key trends in the Healthcare Fraud Analytics Market report?

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Recent Developments:

  • In January 2019, LexisNexis Risk Solutions collaborated with QuadraMed to enable patient identification capabilities and reduce the number of duplicate identities & fraudulent claims.
  • In August 2018, Verscend Technologies acquired Cotiviti Holdings. This acquisition helped improve the affordability of fraud detection solutions.
  • In June 2018, SAS Institute & Prime Therapeutics LLC teamed up, enabling Prime Therapeutics to utilize SAS’s analytic capabilities to combat the opioid crisis in the US.

Reasons to Buy the Report:
The report will enrich established firms as well as new entrants/smaller firms to gauge the pulse of the market, which in turn would help them, garner a more significant share of the market. Firms purchasing the report could use one or any combination of the below-mentioned strategies to strengthen their position in the market.

This report provides insights into the following pointers:

  • Market Penetration: Comprehensive information on product portfolios offered by the top players in the global healthcare fraud analytics market. The report analyzes this market by solution type, application, delivery model, and end user.
  • Solution Enhancement/Innovation: Detailed insights on upcoming trends and solution launches in the global healthcare fraud analytics market.
  • Market Development: Comprehensive information on the lucrative emerging markets by products and services, and end user.
  • Market Diversification: Exhaustive information about new solutions or service enhancements, growing geographies, recent developments, and investments in the global healthcare fraud analytics market.
  • Competitive Assessment: In-depth assessment of market shares, growth strategies, solution offerings, competitive leadership mapping, and capabilities of leading players in the global healthcare fraud analytics market.

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With the given market data, MarketsandMarkets offers customizations as per your company’s specific needs. The following customization options are available for the report:

Company Information:

  • Detailed analysis and profiling of additional market players (up to 5)
  • Geographic Analysis
  • Further breakdown of the Latin America healthcare fraud analytics market into Brazil, Mexico, and other countries
  • Further breakdown of the Rest of Asia Pacific healthcare fraud analytics market into India, Australia, and others

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