Healthcare Fraud Analytics Market

Healthcare Fraud Analytics Market by Solution Type (Descriptive, Predictive, Prescriptive), Application (Insurance Claim (Postpayment, Prepayment), Payment Integrity), Delivery (On-premise, Cloud), End User (Insurance, Government) - Global Forecast to 2025

Report Code: HIT 5868 Jan, 2020, by marketsandmarkets.com

[144 Pages Report]The healthcare fraud analytics market is projected to reach USD 4.6 billion by 2025 from USD 1.2 billion in 2020, at a CAGR of 29.8%. Market growth can be attributed to the large number of fraudulent activities in healthcare; the increasing number of patients seeking health insurance; high returns on investment; and rising pharmacy claim-related frauds. However, the dearth of skilled personnel is likely to restrain the growth of this market.

Healthcare Fraud Detection Market

The descriptive analytics segment dominated the healthcare fraud analytics market in 2019

The market is segmented based on solution type, delivery model, application, and end user. Based on the solution type, the descriptive analytics segment accounted for the largest share of the market in 2019. Descriptive analytics forms the base for the effective application of predictive or prescriptive analytics. Hence, these analytics use the basics of descriptive analytics and integrate them with additional sources of data in order to produce meaningful insights.

By application, the insurance claims review segment accounted for the largest share of the market in 2019

On the basis of application, the market is segmented into insurance claims review, pharmacy billing misuse, payment integrity, and other applications. In 2019, the insurance claims review segment dominated the healthcare fraud analytics market. The increasing number of patients seeking health insurance, the rising number of fraudulent claims, and the growing adoption of the prepayment review model are expected to drive the growth of this segment in the coming years.

Healthcare Fraud Detection Market

North America will dominate the healthcare fraud analytics market from 2020–2025

Geographically, the global healthcare fraud analytics market is segmented into North America, Europe, the Asia Pacific, Latin America, and the Middle East and Africa. North America accounted for the largest share of the market in 2019. The high share of the North American market is attributed to the large number of people having health insurance, growing healthcare fraud, favorable government anti-fraud initiatives, the pressure to reduce healthcare costs, technological advancements, and greater product and service availability in this region. Moreover, a majority of leading players in the healthcare fraud detection market have their headquarters in North America.

Key Market players

The healthcare fraud detection market is consolidated and competitive in nature. Major players in this market include IBM Corporation (US), Optum (US), SAS Institute (US), Change Healthcare (US), EXL Service Holdings (US), Cotiviti (US), Wipro Limited (India), Conduent (US), HCL (India), Canadian Global Information Technology Group (Canada), DXC Technology Company (US), Northrop Grumman Corporation (US), LexisNexis Group (US), and Pondera Solutions (US).

Scope of the Report:

Report Metric

Details

Market Size available for years

2018–2025

Base Year Considered

2019

Forecast period

2020–2025

Forecast Unit

Value (USD Billion)

Segments covered

Solution Type, Delivery Model, Application, End User

Geographies covered

  • North America
    • US
    • Canada
  • Europe
    • Germany
    • UK
    • France
    • Rest of Europe (RoE)
  • Asia Pacific
  • Latin America
  • Middle East and Africa

Companies Covered

International Business Machines Corporation (IBM) (US), Optum, Inc. (Optum) (US), SAS Institute, Inc. (SAS) (US), Change Healthcare(US), EXL Service Holdings, Inc. (EXL) (US), Cotiviti (US), Wipro Limited (Wipro) (India), Conduent, Inc. (Conduent) (US), Hindustan Computers Limited Technologies Limited (HCL) (India), Canadian Global Information Technology Group Inc. (CGI) (Canada), DXC Technology Company (DXC) (US), Northrop Grumman Corporation (Northrop Grumman) (US), LexisNexis Group (LexisNexis) (US), Pondera Solutions (Pondera) (US), WhiteHatAI (US), Healthcare Fraud Shield (US), FraudLens (US), HMS (US), and FraudScope (US).

The research report categorizes the healthcare fraud analytics market into the following segments and subsegments:

Healthcare fraud analytics market, by Solution Type

  • Descriptive Analytics
  • Predictive Analytics
  • Prescriptive Analytics

Healthcare fraud analytics market, by Selivery model

  • On-premise
  • On-demand

Healthcare fraud analytics market, by application

  • Insurance Claims Review
    • Postpayment Review
    • Prepayment Review
  • Pharmacy Billing Misuse
  • Payment Integrity
  • Other applications*
  • *Other applications include identity management and case management

Healthcare fraud analytics market, by End User

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

Healthcare fraud analytics market, by Region

  • North America
    • US
    • Canada
  • Europe
    • Germany
    • UK
    • France
    • Rest of Europe (RoE)
  • Asia Pacific (APAC)
    • Latin America
    • Middle East and Africa

Key Questions Addressed in the Report

  • Who are the top 10 players operating in the global healthcare fraud analytics market?
  • What are the drivers, restraints, opportunities, and challenges in the market?
  • What are the industry and technology trends in the market?
  • What are the growth trends in the healthcare fraud analytics market at the segmental and overall market levels?

Frequently Asked Questions (FAQ):

To speak to our analyst for a discussion on the above findings, click Speak to Analyst



Table of Contents

1 Introduction (Page No. - 16)
    1.1 Objectives of the Study
    1.2 Market Definition
    1.3 Market Scope
           1.3.1 Markets Covered
           1.3.2 Years Considered for the Study
    1.4 Currency
    1.5 Limitations
    1.6 Stakeholders

2 Research Methodology (Page No. - 20)
    2.1 Research Approach
           2.1.1 Secondary Sources
                    2.1.1.1 Key Data From Secondary Sources
           2.1.2 Primary Sources
                    2.1.2.1 Key Data From Primary Sources
    2.2 Market Size Estimation
    2.3 Market Breakdown and Data Triangulation
    2.4 Assumptions for the Study

3 Executive Summary (Page No. - 28)

4 Premium Insights (Page No. - 32)
    4.1 Healthcare Fraud Analytics Market Overview
    4.2 Asia Pacific: Market, By Solution Type and Application (2019)
    4.3 Market: Geographic Growth Opportunities
    4.4 Market: Regional Mix
    4.5 Market: Developing vs Developed Regions

5 Market Overview (Page No. - 36)
    5.1 Introduction
    5.2 Market Dynamics
           5.2.1 Drivers
                    5.2.1.1 Large Number of Fraudulent Activities in Healthcare
                    5.2.1.2 Increasing Number of Patients Seeking Health Insurance
                    5.2.1.3 Prepayment Review Model
                    5.2.1.4 High Returns on Investment
                    5.2.1.5 Rise in Pharmacy Claims-Related Fraud
           5.2.2 Restraints
                    5.2.2.1 Limitations in the Data Capturing Process in Medicaid Services
           5.2.3 Opportunities
                    5.2.3.1 Adoption of Healthcare Fraud Analytics in Developing Countries
                    5.2.3.2 Emergence of Social Media and Its Impact on the Healthcare Industry
                    5.2.3.3 Role of AI in Healthcare Fraud Detection
           5.2.4 Challenges
                    5.2.4.1 Dearth of Skilled Personnel
                    5.2.4.2 Time-Consuming Deployment and the Need for Frequent Upgrades

6 Industry Insights (Page No. - 42)
    6.1 Industry Trends
           6.1.1 Shifting Focus From On-Premise Models to Cloud-Based On-Demand Models
           6.1.2 Mergers and Acquisitions: the Most Adopted Strategy
           6.1.3 Technological Advancements
           6.1.4 New Use Case: Opioid Epidemic Crisis
           6.1.5 End-User Trends: Adoption of Healthcare Fraud Analytics Solutions By Pharmacy Benefit Managers

7 Healthcare Fraud Analytics Market, By Solution Type (Page No. - 45)
    7.1 Introduction
    7.2 Descriptive Analytics
           7.2.1 Descriptive Analytics Segment Accounted for the Largest Market Share
    7.3 Predictive Analytics
           7.3.1 Predictive Analytics Helps in Simulating Future Events & Trends That Can Enable Payers to Predict Preventable Events
    7.4 Prescriptive Analytics
           7.4.1 Prescriptive Models Offer Additional Advantages Relating to the Investigation of Suspicious Behavior to Generate Comprehensive Insights

8 Healthcare Fraud Analytics Market, By Delivery Model (Page No. - 52)
    8.1 Introduction
    8.2 On-Premise Delivery Models
           8.2.1 On-Premise Models Account for the Largest Share of the Market
    8.3 On-Demand Delivery Models
           8.3.1 Cloud-Based Delivery Models Offer Organizations Increased Scalability and Speed

9 Healthcare Fraud Analytics Market, By Application (Page No. - 58)
    9.1 Introduction
    9.2 Insurance Claims Review
           9.2.1 Postpayment Review
                    9.2.1.1 Postpayment Review Dominated the Healthcare Fraud Analytics Insurance Claims Review Market
           9.2.2 Prepayment Review
                    9.2.2.1 The Majority of Prepayment Models Use Predictive Analytics to Detect Fraud and Stop Fraudulent Claims Payments
    9.3 Pharmacy Billing Misuse
           9.3.1 Fraud, Waste, and Abuse Cases in Pharmacy and Prescription Drug Areas are Driving the Demand for Analytics
    9.4 Payment Integrity
           9.4.1 Changes in Regulatory Guidelines have Aided the Adoption of Payment Integrity Software
    9.5 Other Applications

10 Healthcare Fraud Analytics Market, By End User (Page No. - 69)
     10.1 Introduction
     10.2 Public & Government Agencies
             10.2.1 Public & Government Agencies Dominate the Healthcare Fraud Analytics Market, By End User
     10.3 Private Insurance Payers
             10.3.1 Private Insurance Payers are Focused on Deploying Analytics to Combat Increasing Monetary Losses
     10.4 Third-Party Service Providers
             10.4.1 Adoption of Fraud Analytics Solutions By Public Insurers Puts Private Bodies at Risk, Driving Attention Toward Outsourcing
     10.5 Employers
             10.5.1 Employers are Considering Fraud Analytics Solutions as A Step Toward Better Cost Management

11 Healthcare Fraud Analytics Market, By Region (Page No. - 76)
     11.1 Introduction
     11.2 North America
             11.2.1 US
                        11.2.1.1 US Dominates the Global Healthcare Fraud Analytics Market
             11.2.2 Canada
                        11.2.2.1 Growing Adoption of Data-Crunching Technologies Like Predictive Analytics to Drive Market Growth
     11.3 Europe
             11.3.1 Germany
                        11.3.1.1 Germany is the Fastest-Growing Market for Healthcare Fraud Analytics Solutions in Europe
             11.3.2 UK
                        11.3.2.1 Launch of Initiatives Such as Nhscfa Will Support the Market for Fraud Analytics Solutions in the UK
             11.3.3 France
                        11.3.3.1 Increasing Adoption of Information Technology for the Detection of Healthcare Fraud—A Key Factor Driving Market Growth
             11.3.4 Rest of Europe
     11.4 Asia Pacific
             11.4.1 APAC Market to Witness the Highest Growth in the Healthcare Fraud Analytics Market During the Forecast Period
     11.5 Latin America
             11.5.1 Volume of Claims Processing is Expected to Increase in Latin American Countries Owing to the Increasing Penetration of Health Insurance
     11.6 Middle East & Africa
             11.6.1 Healthcare Fraud is One of the Leading Crimes in South Africa

12 Competitive Landscape (Page No. - 105)
     12.1 Introduction
     12.2 Competitive Situation and Trends
             12.2.1 Mergers, Acquisitions, and Joint Ventures
             12.2.2 Collaborations, Partnerships, and Agreements
             12.2.3 Expansions
     12.3 Competitive Leadership Mapping
             12.3.1 Visionary Leaders
             12.3.2 Innovators
             12.3.3 Dynamic Differentiators
             12.3.4 Emerging Companies

13 Company Profiles (Page No. - 110)
(Business Overview, Products Offered, Recent Developments, MnM View)*
     13.1 IBM
     13.2 Optum (A Part of Unitedhealth Group)
     13.3 Cotiviti Holdings, Inc.
     13.4 Fair Isaac Corporation
     13.5 SAS Institute
     13.6 Change Healthcare
     13.7 EXL Service Holdings, Inc.
     13.8 Wipro
     13.9 Conduent, Inc.
     13.10 HCL Technologies
     13.11 CGI Group
     13.12 DXC Technology Company
     13.13 Northrop Grumman Corporation
     13.14 LexisNexis (A Part of Relx Group)
     13.15 Pondera Solutions
     13.16 Other Players Operating in the Healthcare Fraud Analytics Market
             13.16.1 WhiteHatAI
             13.16.2 Healthcare Fraud Shield
             13.16.3 FraudLens, Inc.
             13.16.4 HMS
             13.16.5 FraudScope, Inc.

*Business Overview, Products Offered, Recent Developments, MnM View Might Not Be Captured in Case of Unlisted Companies.

14 Appendix (Page No. - 137)
     14.1 Discussion Guide
     14.2 Knowledge Store: Marketsandmarkets’ Subscription Portal
     14.3 Available Customizations
     14.4 Related Reports
     14.5 Author Details


List of Tables (105 Tables)

Table 1 List of Stakeholders Interviewed for the Study
Table 2 Companies Offering Innovative Fraud Analytics Solutions
Table 3 Healthcare Fraud Analytics Market, By Solution Type, 2018–2025 (USD Million)
Table 4 Descriptive Analytics Solutions for Healthcare Fraud Detection
Table 5 Descriptive Analytics Market, By Region, 2018–2025 (USD Million)
Table 6 Descriptive Analytics Market, By Country, 2018–2025 (USD Million)
Table 7 Predictive Analytics Solutions for Healthcare Fraud Detection
Table 8 Predictive Analytics Market, By Region, 2018–2025 (USD Million)
Table 9 Predictive Analytics Market, By Country, 2018–2025 (USD Million)
Table 10 Prescriptive Analytics Solutions for Healthcare Fraud Detection
Table 11 Prescriptive Analytics Market, By Region, 2018–2025 (USD Million)
Table 12 Prescriptive Analytics Market, By Country, 2018–2025 (USD Million)
Table 13 Healthcare Fraud Analytics Market, By Delivery Model, 2018–2025 (USD Million)
Table 14 Key Vendors Offering On-Premise Solutions in the Market
Table 15 Market for On-Premise Delivery Models, By Region, 2018–2025 (USD Million)
Table 16 Market for On-Premise Delivery Models, By Country, 2018–2025 (USD Million)
Table 17 Key Vendors Providing On-Demand Solutions
Table 18 Market for On-Demand Delivery Models, By Region, 2018–2025 (USD Million)
Table 19 Market for On-Demand Delivery Models, By Country, 2018–2025 (USD Million)
Table 20 Market, By Application, 2018–2025 (USD Million)
Table 21 Deployment of Prepayment vs Postpayment Analytics Systems
Table 22 Market for Insurance Claims Review, By Type, 2018–2025 (USD Million)
Table 23 Market for Insurance Claims Review, By Region, 2018–2025 (USD Million)
Table 24 Market for Insurance Claims Review, By Country, 2018–2025 (USD Million)
Table 25 Market for Postpayment Claims Review, By Region, 2018–2025 (USD Million)
Table 26 Market for Postpayment Claims Review, By Country, 2018–2025 (USD Million)
Table 27 Market for Prepayment Claims Review, By Region, 2018–2025 (USD Million)
Table 28 Market for Prepayment Claims Review, By Country, 2018–2025 (USD Million)
Table 29 Market for Pharmacy Billing Misuse Applications, By Region, 2018–2025 (USD Million)
Table 30 Market for Pharmacy Billing Misuse Applications, By Country, 2018–2025 (USD Million)
Table 31 Market for Payment Integrity Applications, By Region, 2018–2025 (USD Million)
Table 32 Market for Payment Integrity Applications, By Country, 2018–2025 (USD Million)
Table 33 Healthcare Fraud Analytics Market for Other Applications, By Region, 2018–2025 (USD Million)
Table 34 Market for Other Applications, By Country, 2018–2025 (USD Million)
Table 35 Market, By End User, 2018–2025 (USD Million)
Table 36 Market for Public & Government Agencies, By Region, 2018–2025 (USD Million)
Table 37 Market for Public & Government Agencies, By Country, 2018–2025 (USD Million)
Table 38 Market for Private Insurance Payers, By Region, 2018–2025 (USD Million)
Table 39 Market for Private Insurance Payers, By Country, 2018–2025 (USD Million)
Table 40 Market for Third-Party Service Providers, By Region, 2018–2025 (USD Million)
Table 41 Healthcare Fraud Analytics Market for Third-Party Service Providers, By Country, 2018–2025 (USD Million)
Table 42 Market for Employers, By Region, 2018–2025 (USD Million)
Table 43 Market for Employers, By Country, 2018–2025 (USD Million)
Table 44 Market, By Region, 2018–2025 (USD Million)
Table 45 North America: Market, By Country, 2018–2025 (USD Million)
Table 46 North America: Market, By Delivery Model, 2018–2025 (USD Million)
Table 47 North America: Market, By Solution Type, 2018–2025 (USD Million)
Table 48 North America: Market, By Application, 2018–2025 (USD Million)
Table 49 North America: Market for Insurance Claims Review, By Type, 2018–2025 (USD Million)
Table 50 North America: Market, By End User, 2018–2025 (USD Million)
Table 51 US: Healthcare Fraud Analytics Market, By Delivery Model, 2018–2025 (USD Million)
Table 52 US: Market, By Solution Type, 2018–2025 (USD Million)
Table 53 US: Market, By Application, 2018–2025 (USD Million)
Table 54 US: Market for Insurance Claims Review, By Type, 2018–2025 (USD Million)
Table 55 US: Market, By End User, 2018–2025 (USD Million)
Table 56 Canada: Market, By Delivery Model, 2018–2025 (USD Million)
Table 57 Canada: Market, By Solution Type, 2018–2025 (USD Million)
Table 58 Canada: Market, By Application, 2018–2025 (USD Million)
Table 59 Canada: Market for Insurance Claims Review, By Type, 2018–2025 (USD Million)
Table 60 Canada: Market, By End User, 2018–2025 (USD Million)
Table 61 List of Some of the Ehfcn Member Organization Across Europe
Table 62 Europe: Market, By Country, 2018–2025 (USD Million)
Table 63 Europe: Healthcare Fraud Analytics Market, By Delivery Model, 2018–2025 (USD Million)
Table 64 Europe: Market, By Solution Type, 2018–2025 (USD Million)
Table 65 Europe: Market, By Application, 2018–2025 (USD Million)
Table 66 Europe: Market for Insurance Claims Review, By Type, 2018–2025 (USD Million)
Table 67 Europe: Market, By End User, 2018–2025 (USD Million)
Table 68 Germany: Market, By Delivery Model, 2018–2025 (USD Million)
Table 69 Germany: Market, By Solution Type, 2018–2025 (USD Million)
Table 70 Germany: Market, By Application, 2018–2025 (USD Million)
Table 71 Germany: Market for Insurance Claims Review, By Type, 2018–2025 (USD Million)
Table 72 Germany: Market, By End User, 2018–2025 (USD Million)
Table 73 UK: Market, By Delivery Model, 2018–2025 (USD Million)
Table 74 UK: Market, By Solution Type, 2018–2025 (USD Million)
Table 75 UK: Market, By Application, 2018–2025 (USD Million)
Table 76 UK: Market for Insurance Claims Review, By Type, 2018–2025 (USD Million)
Table 77 UK: Market, By End User, 2018–2025 (USD Million)
Table 78 France: Market, By Delivery Model, 2018–2025 (USD Million)
Table 79 France: Market, By Solution Type, 2018–2025 (USD Million)
Table 80 France: Healthcare Fraud Analytics Market, By Application, 2018–2025 (USD Million)
Table 81 France: Market for Insurance Claims Review, By Type, 2018–2025 (USD Million)
Table 82 France: Market, By End User, 2018–2025 (USD Million)
Table 83 RoE: Market, By Delivery Model, 2018–2025 (USD Million)
Table 84 RoE: Market, By Solution Type, 2018–2025 (USD Million)
Table 85 RoE: Market, By Application, 2018–2025 (USD Million)
Table 86 RoE: Market for Insurance Claims Review, By Type, 2018–2025 (USD Million)
Table 87 RoE: Market, By End User, 2018–2025 (USD Million)
Table 88 Asia Pacific: Market, By Delivery Model, 2018–2025 (USD Million)
Table 89 Asia Pacific: Market, By Solution Type, 2018–2025 (USD Million)
Table 90 Asia Pacific: Market, By Application, 2018–2025 (USD Million)
Table 91 Asia Pacific: Market for Insurance Claims Review, By Type, 2018–2025 (USD Million)
Table 92 Asia Pacific: Market, By End User, 2018–2025 (USD Million)
Table 93 Latin America: Healthcare Fraud Analytics Market, By Delivery Model, 2018–2025 (USD Million)
Table 94 Latin America: Market, By Solution Type, 2018–2025 (USD Million)
Table 95 Latin America: Market, By Application, 2018–2025 (USD Million)
Table 96 Latin America: Market for Insurance Claims Review, By Type, 2018–2025 (USD Million)
Table 97 Latin America: Market, By End User, 2018–2025 (USD Million)
Table 98 MEA: Market, By Delivery Model, 2018–2025 (USD Million)
Table 99 MEA: Market, By Solution Type, 2018–2025 (USD Million)
Table 100 MEA: Market, By Application, 2018–2025 (USD Million)
Table 101 MEA: Market for Insurance Claims Review, By Type, 2018–2025 (USD Million)
Table 102 MEA: Healthcare Fraud Analytics Market, By End User, 2018–2025 (USD Million)
Table 103 Mergers, Acquisitions, and Joint Ventures: January 2017–December 2019
Table 104 Collaborations, Partnerships, and Agreements: January 2017–December 2019
Table 105 Expansions: January 2017–December 2019


List of Figures (32 Figures)

Figure 1 Research Design
Figure 2 Breakdown of Primary Interviews: By Company Type, Designation, and Region
Figure 3 Data Triangulation Methodology
Figure 4 Healthcare Fraud Analytics Market, By Solution Type, 2020 vs 2025 (USD Million)
Figure 5 Market, By Delivery Model, 2020 vs 2025 (USD Million)
Figure 6 Market, By Application, 2020 vs 2025 (USD Million)
Figure 7 Market, By End User, 2020 vs 2025 (USD Million)
Figure 8 Geographical Snapshot of the Market
Figure 9 Large Number of Fraudulent Activities in Healthcare to Drive Market Growth
Figure 10 Descriptive Analytics Segment Accounted for the Largest Share of the APAC Market in 2019
Figure 11 APAC Market to Register the Highest Growth During the Forecast Period
Figure 12 North America Will Continue to Dominate the Market in 2025
Figure 13 Developing Regions to Register Higher Growth During the Forecast Period
Figure 14 Market: Drivers, Restraints, Opportunities, and Challenges
Figure 15 US National Healthcare Fraud and Opioid Takedown Trends
Figure 16 Incidence of Fraudulent Claims—Global Scenario (2017)
Figure 17 Major Mergers and Acquisitions in the Healthcare Fraud Analytics Market
Figure 18 North America: Market Snapshot
Figure 19 Europe: Market Snapshot
Figure 20 Asia Pacific: Market Snapshot
Figure 21 Key Developments in the Analytics Market Between January 2017 and December 2019
Figure 22 Market: Competitive Leadership Mapping, 2019
Figure 23 Company Snapshot: IBM
Figure 24 Company Snapshot: Fair Isaac Corporation
Figure 25 Company Snapshot: EXL Service Holdings, Inc.
Figure 26 Company Snapshot: Wipro Limited
Figure 27 Company Snapshot: Conduent, Inc.
Figure 28 Company Snapshot: HCL Technologies
Figure 29 Company Snapshot: CGI Group
Figure 30 Company Snapshot: DXC Technology Company
Figure 31 Company Snapshot: Northrop Grumman Corporation
Figure 32 Company Snapshot: Relx Group

The study involved four major activities in estimating the healthcare fraud analytics market. Exhaustive secondary research was conducted to collect information on the adoption of different technologies and their regional adoption. Data obtained through secondary research was further validated by industry experts through primary research. Furthermore, the market size estimates and forecast provided in this study are derived through a mix of the bottom-up approach (studying the FWA savings incurred by adopting analytics in USD billion) and top-down approach (parent market analysis & assessment of adoption/penetration trends, by solution type, delivery model, application, end user, and region). Thereafter, market breakdown and data triangulation methods were used to estimate the market size of segments and subsegments.

Secondary Research

Various secondary sources such as the National Health Care Anti-Fraud Association (NHCAA, US), Canadian Health Care Anti-Fraud Association (CHCAA), European Healthcare Fraud & Corruption Network (EHFCN), NHS Counter Fraud Authority (NHSCFA), Association of Certified Fraud Examiners (ACFE), and Healthcare Information and Management Systems Society (HIMSS), along with the annual reports, SEC filings, investor presentations, and press releases of key players, have been used to identify and collect information useful for the study of this market.

Primary Research

In the primary research process, various sources from both the supply and demand sides were interviewed to obtain qualitative and quantitative information for this report. Primary participants mainly include CEOs, consultants, subject-matter experts, SIU directors, claims processing personnel, general managers, and sales executives. The breakdown of profiles of primaries is shown in the figure below:

Healthcare Fraud Detection Market

To know about the assumptions considered for the study, download the pdf brochure

Market Size Estimation

The total market size for the healthcare fraud analytics market was arrived at after data triangulation from two different approaches, as mentioned below.

Parent Market Analysis

In order to arrive at the global market size, the global healthcare analytics market was considered. The percentage contribution of financial applications in the field of healthcare analytics was considered from the parent report and validated with the help of primaries and secondary sources to the extent available. Additionally, the percentage contribution of payment integrity and fraud analytics in the financial applications segment was considered from the parent report and validated with the help of primaries and secondary sources to the extent available.

Data Triangulation

After arriving at the overall market size—using the market size estimation processes as explained above—the market was split into several segments and subsegments. In order to complete the overall market engineering process and arrive at the exact statistics of each market segment and subsegment, the data triangulation and market breakdown procedures were employed, wherever applicable. The data was triangulated by studying various factors and trends from both the demand and supply sides.

Report Objectives

  • To define, describe, and forecast the global healthcare fraud analytics market with respect to solution type, delivery model, application, end user, and region
  • To provide detailed information regarding the major factors influencing the growth of the market (such as drivers, restraints, opportunities, and industry-specific challenges)
  • To strategically analyze micromarkets with respect to individual growth trends, future prospects, and contributions to the overall market
  • To analyze opportunities in the market for stakeholders and provide details of the competitive landscape for market leaders
  • To forecast the size of the market with respect to five main regions—North America, Europe, Asia Pacific, Latin America, and the Middle East and Africa
  • To strategically profile the key players in the global healthcare fraud analytics market and comprehensively analyze their core competencies
  • To track and analyze competitive developments such as mergers & acquisitions, geographical expansions, and partnership & collaboration activities of the leading players in the global market

Target Audience:

  • Healthcare IT Firms
  • Healthcare Analytic Vendors
  • Healthcare Payers
  • Pharmacy Benefit Managers
  • Venture Capitalists
  • Research and Consulting Firms
  • Healthcare Fraud Detection Service Providers

Available customizations

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

Geographic Analysis

  • Further breakdown of the RoE healthcare fraud analytics market into Spain, Italy, and other countries
  • Further breakdown of the APAC market into China, Japan, India, and other countries

Company Information

  • Detailed analysis and profiling of additional market players
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