Overview and Scope
Healthcare fraud analytics refers to on-premise and on-demand analytical solutions that assist in identifying issues such as duplication/repetition of claims and errors in claim healthcare operations and applications. Healthcare fraud analytics aims to help healthcare companies to audit their accounts and find out fraudulent activities in various transactions. It identifies frauds related to billings, claims, prepayment, post payments, and payment integrity.
Sizing and Forecast
The healthcare fraud analytics market size has grown exponentially in recent years. It will grow from $3 billion in 2023 to $3.8 billion in 2024 at a compound annual growth rate (CAGR) of 26.6%. The growth in the historic period can be attributed to rise in healthcare costs, complexity of healthcare systems, increasing volume of healthcare data, transition to electronic health records (ehrs), billing fraud challenges.
The healthcare fraud analytics market size is expected to see exponential growth in the next few years. It will grow to $9.66 billion in 2028 at a compound annual growth rate (CAGR) of 26.3%. The growth in the forecast period can be attributed to increasing sophistication of fraud schemes, integration of predictive analytics, regulatory evolution, global pandemic impact, enhanced patient identity verification.. Major trends in the forecast period include adoption of cloud-based analytics, user-friendly interfaces, automation in fraud investigations, real-time fraud detection, behavioral analytics.
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Segmentation & Regional Insights
The healthcare fraud analytics market covered in this report is segmented –
1) By Solution Type: Descriptive Analytics, Predictive Analytics, Prescriptive Analytics
2) By Delivery Model: On-Premise, On-Demand
3) By Application: Insurance Claims Review, Postpayment Review, Prepayment Review, Pharmacy Billing Misuse, Payment Integrity, Other Applications
4) By End User: Public & Government Agencies, Private Insurance Payers, Third-Party Service Providers
North America was the largest region in the healthcare fraud analytics market in 2023. North America is expected to be the fastest-growing region in the forecast period. The regions covered in the healthcare fraud analytics market report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East, Africa
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Major Driver Impacting Market Growth
A large number of fraudulent activities in the healthcare sector contribute to the growth of the healthcare fraud analytics market. Medical providers, patients, and third parties who intentionally deceive the healthcare system into acquiring unlawful benefits can commit fraud based on deception or misrepresentation. These fraud and abuse involve kickbacks, billing, billing for services not provided, medical testing, and other fraudulent activities. For instance, according to Blue Cross Blue Shield Association, a US-based federation, in 2021, The National Heath Care Anti-Fraud Association estimated that health care fraud costs the nation about $68 billion annually, about 3 percent of the nation’s $2.26 trillion in health care spending. Other estimates range as high as 10 percent of annual health care expenditure, or $230 billion. Thus, the increasing number of fraudulent activities in healthcare is contributing to the healthcare fraud market growth.
Key Industry Players
Major companies operating in the healthcare fraud analytics market report are International Business Machines Corporation, Optum Inc., Statistical Analysis Software Institute Inc., Change Healthcare, EXL Service Holdings Inc., Cotiviti Inc., DXC Technology Company, Wipro Limited, Conduent Incorporated, Consultants to Government and Industry Inc., HCL Technologies Limited, Qlarant Inc., Northrop Grumman Corporation, LEXIS-NEXIS Group, Healthcare Fraud Shield, Sharecare Inc., FraudLens Inc., HMS Holding Corp., Codoxo, H20. ai, Pondera Solutions Inc., Friss International B. V., MultiPlan Inc., FraudScope, Osp Labs Private Limited, Fair Isaac Corporation, Mckesson Corp, Relx Group PLC, FraudHunt, FraudGuardian
The healthcare fraud analytics market report table of contents includes:
1. Executive Summary
2. Healthcare Fraud Analytics Market Characteristics
3. Healthcare Fraud Analytics Market Trends And Strategies
4. Healthcare Fraud Analytics Market – Macro Economic Scenario
5. Global Healthcare Fraud Analytics Market Size and Growth
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26. South America Healthcare Fraud Analytics Market
27. Brazil Healthcare Fraud Analytics Market
28. Middle East Healthcare Fraud Analytics Market
29. Africa Healthcare Fraud Analytics Market
30. Healthcare Fraud Analytics Market Competitive Landscape And Company Profiles
Top Major Players:
- International Business Machines Corporation
- Optum Inc
- Statistical Analysis Software Institute Inc
- Change Healthcare
- EXL Service Holdings Inc
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