CHICAGO, May 9, 2023 /PRNewswire/ — According to Arizton’s latest research report, the healthcare fraud analytics market will grow at a CAGR of 20.45% during 2022-2028.
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Healthcare fraud analytics is highly competitive, with many players vying for a market share. Major players in the market include IBM, LexisNexis Risk Solutions, Optum, SAS Institute, Verisk Analytics, and Wipro. These companies offer a variety of fraud analytics solutions, including data mining, predictive analytics, and ML technologies to identify, detect, and prevent fraud.
Data mining is one of healthcare organizations’ most popular fraud analytics tools. Data mining uses algorithms to analyze large datasets to detect suspicious activity. Predictive analytics uses predictive modeling techniques to identify patterns in the data that may indicate fraudulent activity. ML is used to train algorithms to recognize patterns and detect fraud.
One of the biggest trends in the healthcare fraud analytics market is the increasing use of AI and ML technologies. AI and ML technologies are used to automate the process of fraud detection and prevention. They enable healthcare organizations to process large volumes of data quickly and accurately, reducing the costs associated with manual fraud detection and prevention.
North America is expected to dominate the global healthcare fraud analytics market due to the presence of major healthcare fraud analytics players and government initiatives to prevent healthcare fraud. The APAC industry is expected to witness significant growth in the coming years due to the growing adoption of healthcare fraud analytics solutions and services by emerging countries such as India and China.
Healthcare Fraud Analytics Market Report Scope
|
Report Attributes |
Details |
|
Market Size (2028) |
USD 5.03 Billion |
|
Market Size (2022) |
USD 1.65 Billion |
|
CAGR (2022-2028) |
20.45 % |
|
Base Year |
2022 |
|
Forecast Year |
2023-2028 |
|
MARKET Segmentation |
Solution Type, Delivery Mode, Application, End-user, and Geography |
|
Geographic Analysis |
North America, Europe, APAC, Latin America, and Middle East & Africa |
|
Market Dynamics |
· Increase in Healthcare Fraudulent Activities · Increasing Number of Patients Benefiting from Healthcare Insurance · Rising Number of Pharmacy Claims-related Frauds |
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Market Trends & Drivers
Increasing Healthcare Fraudulent Activities
Healthcare fraud has been an ongoing problem in the healthcare industry for a long time. The increase in healthcare costs, the rise in technological advances, and a greater reliance on electronic data have all contributed to an increase in healthcare fraud. The healthcare fraud analytics market helps combat this issue by identifying fraudulent activities and helping organizations take proactive measures to prevent future fraud. Healthcare fraud analytics uses various analytic techniques to analyze large datasets and detect suspicious behavior patterns. These techniques can detect billing and coding errors, improper payments, and other forms of fraud. Healthcare fraud analytics also helps organizations identify trends in healthcare fraud and proactively address areas of risk. The increasing prevalence of healthcare fraud is driving the demand for healthcare fraud analytics solutions. Organizations increasingly invest in healthcare fraud analytics solutions to detect and prevent fraudulent activities and protect their financial and reputational interests.
The Increasing Number of Pharmacy Claims-Related Frauds
With the growth of the healthcare industry, fraud & abuse have become increasingly serious problems. Fraudsters are taking advantage of the complexity of the healthcare system and the lack of oversight to commit fraud. As a result, healthcare organizations are facing increasing pressure to protect their finances from fraudulent activities. The healthcare fraud analytics market is growing as healthcare organizations begin recognizing the need for advanced analytics solutions to detect and prevent fraud. Healthcare analytics solutions are used to identify suspicious transactions and activities that could indicate fraudulent behavior. These solutions help detect and prevent fraud by providing insights into fraud patterns, allowing organizations to take corrective action.
Key Insights
- Technological advances in healthcare product development are key to achieving high sales growth.
- Data sources such as claims, billing, and patient records are increasingly used to power fraud analytics solutions. Healthcare fraud analytics solutions must be tailored to the organization’s specific needs to be effective.
- The rising preference for healthcare fraud analytics with ML and AI is the key driving factor of the global healthcare fraud analytics market.
- Based on geography, North America dominates the global healthcare fraud analytics market, followed by Europe, APAC, Latin America, and the Middle East & Africa.
- Arizton predicted North America could witness the highest growth over the forecast period, growing at a 23.39% CAGR.
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Key Company Profiles
- IBM
- LexisNexis Risk Solutions
- Optum
- SAS Institute
- Verisk Analytics
- Wipro
- Alivia Analytics
- CGI
- Codoxo
- Conduent
- COTIVITI
- FraudLens
- FRISS
- Healthcare Fraud Shield
- Northrop Grumman Corporation
- OSP
- Qlarant
- Qualetics Data Machines
- Sharecare
Market Segmentation
Solution Type
- Descriptive Analytics
- Predictive Analytics
- Prescriptive Analytics
Delivery Mode
- On-premises
- Cloud-based
Application
- Medical Provider Fraud
- Patient Fraud
- Prescription Fraud
- General Healthcare Fraud
End-user
- Public Health Insurance Companies
- Private Health Insurance Companies
- Third-party Service Providers
- Others
Geography
- North America
- The US
- Canada
- Europe
- Germany
- The UK
- France
- Italy
- Spain
- APAC
- China
- Japan
- South Korea
- India
- Australia
- Latin America
- Brazil
- Mexico
- Argentina
- Middle East & Africa
- Turkey
- Saudi Arabia
- South Africa
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Table of Content
1 RESEARCH METHODOLOGY
2 RESEARCH OBJECTIVES
3 RESEARCH PROCESS
4 SCOPE & COVERAGE
4.1 MARKET DEFINITION
4.1.1 INCLUSIONS
4.1.2 EXCLUSIONS
4.1.3 MARKET ESTIMATION CAVEATS
4.2 BASE YEAR
4.3 SCOPE OF THE STUDY
4.3.1 MARKET SEGMENTATION BY SOLUTION TYPE
4.3.2 MARKET SEGMENTATION BY DELIVERY MODE
4.3.3 MARKET SEGMENTATION BY APPLICATION
4.3.4 MARKET SEGMENTATION BY END-USER
4.3.5 MARKET SEGMENTATION BY GEOGRAPHY
5 REPORT ASSUMPTIONS & CAVEATS
5.1 KEY CAVEATS
5.2 CURRENCY CONVERSION
5.3 MARKET DERIVATION
6 MARKET AT A GLANCE
7 PREMIUM INSIGHTS
7.1 OVERVIEW
8 INTRODUCTION
8.1 OVERVIEW
9 MARKET OPPORTUNITIES & TRENDS
9.1 INVESTMENT IN INFORMATION & COMMUNICATION TECHNOLOGY (ICT)
9.2 ADVANCED TECHNOLOGIES OFFER GREAT POTENTIAL TO SECURE AGAINST FRAUD
9.3 AI IN HEALTHCARE FRAUD DETECTION
10 MARKET GROWTH ENABLERS
10.1 INCREASING HEALTHCARE FRAUDULENT ACTIVITIES
10.2 INCREASING NUMBER OF PATIENTS BENEFITING FROM HEALTHCARE INSURANCE
10.3 RISING NUMBER OF PHARMACY CLAIM-RELATED FRAUDS
11 MARKET RESTRAINTS
11.1 CHANGE IN FRAUD PATTERNS
11.2 SECURITY & PRIVACY RISKS WITH FRAUD ANALYTICS SOLUTIONS
11.3 TIME-CONSUMING DEPLOYMENT AND NEED FOR FREQUENT UPGRADES
12 MARKET LANDSCAPE
12.1 MARKET OVERVIEW
12.2 MARKET SIZE & FORECAST
12.2.1 GEOGRAPHY INSIGHTS
12.2.2 SOLUTION TYPE INSIGHTS
12.2.3 DELIVERY MODE INSIGHTS
12.2.4 APPLICATION INSIGHTS
12.2.5 END-USER INSIGHTS
12.3 FIVE FORCES ANALYSIS
12.3.1 THREAT OF NEW ENTRANTS
12.3.2 BARGAINING POWER OF SUPPLIERS
12.3.3 BARGAINING POWER OF BUYERS
12.3.4 THREAT OF SUBSTITUTES
12.3.5 COMPETITIVE RIVALRY
13 SOLUTION TYPE
13.1 MARKET SNAPSHOT & GROWTH ENGINE
13.2 MARKET OVERVIEW
13.3 DESCRIPTIVE ANALYTICS
13.3.1 MARKET OVERVIEW
13.3.2 MARKET SIZE & FORECAST
13.3.3 MARKET BY GEOGRAPHY
13.4 PREDICTIVE ANALYTICS
13.4.1 MARKET OVERVIEW
13.4.2 MARKET SIZE & FORECAST
13.4.3 MARKET BY GEOGRAPHY
13.5 PRESCRIPTIVE ANALYTICS
13.5.1 MARKET OVERVIEW
13.5.2 MARKET SIZE & FORECAST
13.5.3 MARKET BY GEOGRAPHY
14 DELIVERY MODE
14.1 MARKET SNAPSHOT & GROWTH ENGINE
14.2 MARKET OVERVIEW
14.3 ON-PREMISES
14.3.1 MARKET OVERVIEW
14.3.2 MARKET SIZE & FORECAST
14.3.3 MARKET BY GEOGRAPHY
14.4 CLOUD-BASED
14.4.1 MARKET OVERVIEW
14.4.2 MARKET SIZE & FORECAST
14.4.3 MARKET BY GEOGRAPHY
15 APPLICATION
15.1 MARKET SNAPSHOT & GROWTH ENGINE
15.2 MARKET OVERVIEW
15.3 MEDICAL PROVIDER FRAUD
15.3.1 MARKET OVERVIEW
15.3.2 MARKET SIZE & FORECAST
15.3.3 MARKET BY GEOGRAPHY
15.4 PATIENT FRAUD
15.4.1 MARKET OVERVIEW
15.4.2 MARKET SIZE & FORECAST
15.4.3 MARKET BY GEOGRAPHY
15.5 PRESCRIPTION FRAUD
15.5.1 MARKET OVERVIEW
15.5.2 MARKET SIZE & FORECAST
15.5.3 MARKET BY GEOGRAPHY
15.6 GENERAL HEALTHCARE FRAUD
15.6.1 MARKET OVERVIEW
15.6.2 MARKET SIZE & FORECAST
15.6.3 MARKET BY GEOGRAPHY
16 END-USER
16.1 MARKET SNAPSHOT & GROWTH ENGINE
16.2 MARKET OVERVIEW
16.3 PUBLIC HEALTH INSURANCE COMPANIES
16.3.1 MARKET OVERVIEW
16.3.2 MARKET SIZE & FORECAST
16.3.3 MARKET BY GEOGRAPHY
16.4 PRIVATE HEALTH INSURANCE COMPANIES
16.4.1 MARKET OVERVIEW
16.4.2 MARKET SIZE & FORECAST
16.4.3 MARKET BY GEOGRAPHY
16.5 THIRD-PARTY SERVICE PROVIDERS
16.5.1 MARKET OVERVIEW
16.5.2 MARKET SIZE & FORECAST
16.5.3 MARKET BY GEOGRAPHY
16.6 OTHERS
16.6.1 MARKET OVERVIEW
16.6.2 MARKET SIZE & FORECAST
16.6.3 MARKET BY GEOGRAPHY
17 GEOGRAPHY
17.1 MARKET SNAPSHOT & GROWTH ENGINE
17.2 GEOGRAPHIC OVERVIEW
18 NORTH AMERICA
18.1 MARKET OVERVIEW
18.2 MARKET SIZE & FORECAST
18.2.1 MARKET BY SOLUTION TYPE
18.2.2 MARKET BY DELIVERY MODE
18.2.3 MARKET BY APPLICATION
18.2.4 MARKET BY END-USER
18.3 KEY COUNTRIES
18.3.1 US: MARKET SIZE & FORECAST
18.3.2 CANADA: MARKET SIZE & FORECAST
19 EUROPE
19.1 MARKET OVERVIEW
19.2 MARKET SIZE & FORECAST
19.2.1 MARKET BY SOLUTION TYPE
19.2.2 MARKET BY DELIVERY MODE
19.2.3 MARKET BY APPLICATION
19.2.4 MARKET BY END-USER
19.3 KEY COUNTRIES
19.3.1 GERMANY: MARKET SIZE & FORECAST
19.3.2 UK: MARKET SIZE & FORECAST
19.3.3 FRANCE: MARKET SIZE & FORECAST
19.3.4 ITALY: MARKET SIZE & FORECAST
19.3.5 SPAIN: MARKET SIZE & FORECAST
20 APAC
20.1 MARKET OVERVIEW
20.2 MARKET SIZE & FORECAST
20.2.1 MARKET BY SOLUTION TYPE
20.2.2 MARKET BY DELIVERY MODE
20.2.3 MARKET BY APPLICATION
20.2.4 MARKET BY END-USER
20.3 KEY COUNTRIES
20.3.1 CHINA: MARKET SIZE & FORECAST
20.3.2 JAPAN: MARKET SIZE & FORECAST
20.3.3 SOUTH KOREA: MARKET SIZE & FORECAST
20.3.4 INDIA: MARKET SIZE & FORECAST
20.3.5 AUSTRALIA: MARKET SIZE & FORECAST
21 LATIN AMERICA
21.1 MARKET OVERVIEW
21.2 MARKET SIZE & FORECAST
21.2.1 MARKET BY SOLUTION TYPE
21.2.2 MARKET BY DELIVERY MODE
21.2.3 MARKET BY APPLICATION
21.2.4 MARKET BY END-USER
21.3 KEY COUNTRIES
21.3.1 BRAZIL: MARKET SIZE & FORECAST
21.3.2 MEXICO: MARKET SIZE & FORECAST
21.3.3 ARGENTINA: MARKET SIZE & FORECAST
22 MIDDLE EAST & AFRICA
22.1 MARKET OVERVIEW
22.2 MARKET SIZE & FORECAST
22.2.1 MARKET BY SOLUTION TYPE
22.2.2 MARKET BY DELIVERY MODE
22.2.3 MARKET BY APPLICATION
22.2.4 MARKET BY END-USER
22.3 KEY COUNTRIES
22.3.1 TURKEY: MARKET SIZE & FORECAST
22.3.2 SAUDI ARABIA: MARKET SIZE & FORECAST
22.3.3 SOUTH AFRICA: MARKET SIZE & FORECAST
23 COMPETITIVE LANDSCAPE
23.1 COMPETITION OVERVIEW
23.2 MARKET SHARE ANALYSIS
23.2.1 IBM
23.2.2 LEXISNEXIS RISK SOLUTIONS
23.2.3 OPTUM
23.2.4 SAS INSTITUTE
23.2.5 VERISK ANALYTICS
23.2.6 WIPRO
24 KEY COMPANY PROFILES
24.1 IBM
24.1.1 BUSINESS OVERVIEW
24.1.2 PRODUCT OFFERINGS
24.1.3 KEY STRATEGIES
24.1.4 KEY STRENGTHS
24.1.5 KEY OPPORTUNITIES
24.2 LEXISNEXIS RISK SOLUTIONS
24.3 OPTUM
24.4 SAS INSTITUTE
24.5 VERISK ANALYTICS
24.6 WIPRO
25 OTHER PROMINENT VENDORS
25.1 ALIVIA ANALYTICS
25.1.1 BUSINESS OVERVIEW
25.1.2 PRODUCT OFFERINGS
25.2 CGI
25.3 CODOXO
25.4 CONDUENT
25.5 COTIVITI
25.6 FRAUDLENS
25.7 FRISS
25.8 HEALTHCARE FRAUD SHIELD
25.9 NORTHROP GRUMMAN CORPORATION
25.10 OSP
25.11 QLARANT
25.12 QUALETICS DATA MACHINES
25.13 SHARECARE
26 REPORT SUMMARY
26.1 KEY TAKEAWAYS
26.2 STRATEGIC RECOMMENDATIONS
27 QUANTITATIVE SUMMARY
27.1 MARKET BY SOLUTION TYPE
27.1.1 NORTH AMERICA: MARKET BY SOLUTION TYPE
27.1.2 EUROPE: MARKET BY SOLUTION TYPE
27.1.3 APAC: MARKET BY SOLUTION TYPE
27.1.4 LATIN AMERICA: MARKET BY SOLUTION TYPE
27.1.5 MIDDLE EAST & AFRICA: MARKET BY SOLUTION TYPE
27.2 MARKET BY DELIVERY MODE
27.2.1 NORTH AMERICA: MARKET BY DELIVERY MODE
27.2.2 EUROPE: MARKET BY DELIVERY MODE
27.2.3 APAC: MARKET BY DELIVERY MODE
27.2.4 LATIN AMERICA: MARKET BY DELIVERY MODE
27.2.5 MIDDLE EAST & AFRICA: MARKET BY DELIVERY MODE
27.3 MARKET BY APPLICATION
27.3.1 NORTH AMERICA: MARKET BY APPLICATION
27.3.2 EUROPE: MARKET BY APPLICATION
27.3.3 APAC: MARKET BY APPLICATION
27.3.4 LATIN AMERICA: MARKET BY APPLICATION
27.3.5 MIDDLE EAST & AFRICA: MARKET BY APPLICATION
27.4 MARKET BY END-USER
27.4.1 NORTH AMERICA: MARKET BY END-USER
27.4.2 EUROPE: MARKET BY END-USER
27.4.3 APAC: MARKET BY END-USER
27.4.4 LATIN AMERICA: MARKET BY END-USER
27.4.5 MIDDLE EAST & AFRICA: MARKET BY END-USER
28 APPENDIX
28.1 ABBREVIATIONS
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