The global healthcare fraud analytics market is expected to be valued at USD 6.65 Billion in 2027 from USD 1.02 Billion in 2019, registering a CAGR of 27.8% through the forecast period. Healthcare fraud analytics refers to fraud detection software and solutions that assist in the early detection of frauds in the healthcare sector, such as duplication of claims, errors in claim submissions, health insurance frauds, and prescription fraud by pharmacists. Healthcare fraud, which is often considered a white-collar crime, involves dishonest schemes and fraudulent activities taking place in the healthcare industry to make profits. Numerous healthcare providers are said to have been engaged in various dishonest activities for making profits. Medical professionals are also involved in fraudulent activities, such as errors in medical test payments and facility services. Therefore, healthcare companies nowadays leverage advanced techniques like data mining to avoid such frauds and faultlessly examine healthcare information systems, health insurance data, etc.
The global healthcare fraud analytics market is projected to record significant growth over the forecast period, owing to the rising incidences of healthcare insurance frauds, the boom in the healthcare insurance sector, and the increasing government spending to prevent healthcare frauds. The global healthcare fraud analytics market has gained major traction over the last few years due to increasing health insurance claim-related fraud, rising demand for health insurance policies, and integrating social media analytics and AI into healthcare fraud detection.
Healthcare fraud analytics has gained massive significance in recent years, as they play a vital role in health insurance claim reviews. As reported by the National Health Care Anti-Fraud Association (NHCAA), the U.S. incurs a loss of around USD 68 billion due to healthcare frauds each year. Increasing adoption of fraud identity management software and amplifying demand for cloud-based healthcare analytical solutions have further bolstered this market’s growth. Furthermore, various organizations, including the European Healthcare Fraud & Corruption Network (EHFCN), Canadian Life and Health Insurance Association (CLHIA), and the Insurance Fraud Bureau of Australia (IFBA), are striving to create awareness about healthcare insurance frauds through various initiatives, which, in turn, boosts the demand for healthcare fraud detection solutions.
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Key Highlights of the Report:
- Based on solution type, the predictive analytics sub-segment leads the global healthcare fraud analytics market in terms of revenue share. The segment is expected to register the highest CAGR of 28.0% over the estimated period.
- In terms of application, the insurance claims sub-segment accounts for the largest market share. The growing number of patients seeking medical insurance, rising healthcare fraud incidents, and growing adoption of the pre-payment assessment process are propelling this segment’s growth.
- North America is the leading regional healthcare fraud analytics market, with the highest revenue share. The surging demand for new health insurance schemes, increasing frauds associated with medical insurance, rise in government efforts to prevent such frauds, and the emergence of advanced healthcare fraud detection solutions are the key factors responsible for market growth in this region.
- The key market participants include DXC Technology Co, SAS Institute, FraudScope, Inc., Wipro Limited, Conduent Inc., International Business Machines Corporation (IBM), Pondera Solutions, LLC, HCL Technologies Limited, CGI Inc., and ExlService Holdings, Inc.
- In July 2020, SAS Institute, the American analytics software developer, joined forces with the National Health Authority (NHA) to support fraud detection in healthcare. As per the deal, SAS provided an end-to-end framework for health insurance claim processing, powered with advanced fraud detection and alert management software.
Emergen Research has segmented the global healthcare fraud analytics market on the basis of deployment mode, solution type, application, and region:
By Deployment Mode (Revenue, USD Billion; 2017–2027)
By Solution Type (Revenue, USD Billion; 2017–2027)
- Predictive Analytics
- Prescriptive Analytics
- Descriptive Analytics
By Application (Revenue, USD Billion; 2017–2027)
- Insurance Claim
- Payment Integrity
By Region (Revenue, USD Billion; 2017–2027)
- North America
- Rest of Europe
- Asia Pacific
- South Korea
- Rest of the Asia Pacific
- Latin America
- Rest of Latin America
- Middle East & Africa
- Saudi Arabia
- Rest of the Middle East & Africa
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