HOME Top Market Reports Healthcare Fraud Detection Market by Type (Descriptive, Prescriptive), Application (Insurance Claim, Prepay, Post payment), Component (Service, Software), Delivery (On-premise, Cloud), End user (Insurance Payer, Private, Public) - Global Forecast to 2022

Healthcare Fraud Detection Market by Type (Descriptive, Prescriptive), Application (Insurance Claim, Prepay, Post payment), Component (Service, Software), Delivery (On-premise, Cloud), End user (Insurance Payer, Private, Public) - Global Forecast to 2022

By: marketsandmarkets.com
Publishing Date: January 2018
Report Code: HIT 5868

 

  Speak to Analyst Enquiry Before Buying Webinar
purchase report
download pdf  request for customisation


The healthcare fraud detection market is expected to reach USD 2,242.7 Million by 2022 from USD 504.4 Million in 2016, at a CAGR of 28.9%. The base year considered for the study is 2016 and the forecast period is from 2017 to 2022.

The objectives of this study are as follows:

  • To define, describe, and forecast the healthcare fraud detection market by type, component, delivery model, end user, and region
  • To provide detailed information regarding major factors influencing market growth (drivers, restraints, opportunities, and industry-specific challenges)
  • To analyze micromarkets with respect to individual growth trends, 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 market size of market segments with respect to the four key regions: North America, Europe, Asia, and the Rest of the World (RoW)
  • To profile the key players and comprehensively analyze their product portfolios, market positions, and core competencies
  • To track and analyze competitive developments in the healthcare fraud detection market, such as joint ventures, mergers and acquisitions, product launches and expansions

Research Methodology

The study estimates the healthcare fraud detection market size for 2017 and projects its demand till 2022. During the primary research process, various sources from both demand side and supply side were interviewed to obtain qualitative and quantitative information for the report. Primary sources from the demand side include various industry CEOs, vice presidents, marketing directors, technology and innovation directors, and related key executives from players in the healthcare fraud detection market. For the market estimation process, both top-down and bottom-up approaches were used to estimate and validate the market size of the healthcare fraud detection market as well as to estimate the market size of various other dependent submarkets. All possible parameters that affect the market covered in this research study have been accounted for, viewed in extensive detail, verified through primary research, and analyzed to get the final quantitative and qualitative data. This data was consolidated and added to detailed inputs and analysis from MarketsandMarkets and presented in this report.

Healthcare Fraud Detection Market

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

The healthcare fraud detection market is highly competitive with the presence of various players. Some of the major players operating in the market include IBM (US), Optum (US), SAS (US), McKesson (US), SCIO (US), Verscend (US), Wipro (India), Conduent (US), HCL (India), CGI (Canada), DXC (US), Northrop Grumman (US), LexisNexis (US), and Pondera (US).

Target Audience for this Report:

  • Healthcare IT firms
  • Healthcare analytics vendors
  • Healthcare payers
  • Venture capitalists
  • Research and consulting firms
  • Healthcare fraud detection service providers

Scope of the Report

This report categorizes the healthcare fraud detection market into following segments and subsegments:

By Type

  • Descriptive Analytics
  • Predictive Analytics
  • Prescriptive Analytics

By Component

  • Software
  • Services

By Delivery Model

  • On-premise
  • On-demand

By Application

  • Insurance claims review
  • Payment integrity
  • Other applications (case management and identity management)

By End User

  • Private insurance payers
  • Public/government agencies
  • Employers
  • Third party service providers

Healthcare Fraud Detection Market, by Region

  • North America
    • US
    • Canada
  • Europe
    • Germany
    • France
    • UK
    • RoE (Rest of Europe)
  • Asia
  • RoW

Available Customizations

With the given market data, MarketsandMarkets offers customizations as per the company‘s specific needs.

The following customization options are available for this report.

Company Information

Detailed analysis and profiling of additional market players (up to 5)

Table of Contents

1 Introduction (Page No. - 15)
    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. - 18)
    2.1 Research Data
           2.1.1 Secondary Data
                    2.1.1.1 Secondary Sources
           2.1.2 Primary Data
                    2.1.2.1 Primary Sources
                    2.1.2.2 Key Industry Insights
    2.2 Market Size Estimation
           2.2.1 Bottom-Up Approach
           2.2.2 Top-Down Approach
    2.3 Market Breakdown and Data Triangulation
    2.4 Assumptions for the Study

3 Executive Summary (Page No. - 26)

4 Premium Insights (Page No. - 30)
    4.1 Healthcare Fraud Detection: Market Overview
    4.2 Healthcare Fraud Detection, By Product and Service
    4.3 Healthcare Fraud Detection, By Type
    4.4 Healthcare Fraud Detection, By Delivery Model

5 Market Overview (Page No. - 33)
    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 Growing Pressure of Fraud, Waste, and Abuse on Healthcare Spending
                    5.2.1.5 High Returns on Investment
           5.2.2 Restraint
                    5.2.2.1 Reluctance to Adopt Healthcare Fraud Analytics in Emerging Countries
           5.2.3 Opportunities
                    5.2.3.1 Cloud-Based Analytics
                    5.2.3.2 Emergence of Social Media and Its Impact on the Healthcare Industry
                    5.2.3.3 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 Need for Frequent Upgrades

6 Healthcare Fraud Detection Market, By Component (Page No. - 39)
    6.1 Introduction
    6.2 Services
    6.3 Software

7 Fraud Detection Market, By Delivery Model (Page No. - 46)
    7.1 Introduction
    7.2 On-Premise Delivery Models
    7.3 On-Demand Delivery Models

8 Healthcare Fraud Detection Market, By Type (Page No. - 53)
    8.1 Introduction
    8.2 Descriptive Analytics
    8.3 Predictive Analytics
    8.4 Prescriptive Analytics

9 Healthcare Fraud Detection Market, By Application (Page No. - 63)
    9.1 Introduction
    9.2 Insurance Claims Review
           9.2.1 Postpayment Review
           9.2.2 Prepayment Review
    9.3 Payment Integrity
    9.4 Other Applications

10 Healthcare Fraud Detection Market, By End User (Page No. - 71)
     10.1 Introduction
     10.2 Private Insurance Payers
     10.3 Public/Government Agencies
     10.4 Third-Party Service Providers
     10.5 Employers

11 Healthcare Fraud Detection Market, By Region (Page No. - 78)
     11.1 Introduction
     11.2 North America
             11.2.1 US
             11.2.2 Canada
     11.3 Europe
             11.3.1 Germany
             11.3.2 UK
             11.3.3 France
             11.3.4 Rest of Europe
     11.4 Asia
     11.5 Rest of the World (RoW)

12 Competitive Landscape (Page No. - 112)
     12.1 Overview
     12.2 Market Player Ranking, 2016
     12.3 Competitive Scenario
             12.3.1 Agreements, Partnerships, Collaborations, and Contracts
             12.3.2 Expansions
             12.3.3 Acquisitions
             12.3.4 Product Launches

13 Company Profiles (Page No. - 118)
(Overview, Products Offered, Product Offering Scorecard, Business Strategy Scorecard, Recent Developments)*
     13.1 IBM
     13.2 Optum (A Part of Unitedhealth Group)
     13.3 Verscend Technologies
     13.4 Mckesson
     13.5 Fair Isaac (Fico)
     13.6 SAS Institute
     13.7 Scio Health Analytics
     13.8 Wipro
     13.9 Conduent
     13.10 HCL Technologies
     13.11 CGI Group
     13.12 DXC Technology
     13.13 Northrop Grumman
     13.14 Lexinexis (A Part of Relx Group)
     13.15 Pondera Solutions

*Details on Marketsandmarkets View, Overview, Products Offered, Product Offering Scorecard, Business Strategy Scorecard, and Recent Developments Might Not Be Captured in Case of Unlisted Companies.

14 Appendix (Page No. - 151)
     14.1 Insights From Industry Experts
     14.2 Discussion Guide
     14.3 Knowledge Store: Marketsandmarkets’ Subscription Portal
     14.4 Introducing RT: Real-Time Market Intelligence
     14.5 Available Customizations
     14.6 Related Reports
     14.7 Author Details


List of Tables (92 Tables)

Table 1 Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 2 Healthcare Fraud Detection Services Market, By Region, 2015–2022 (USD Million)
Table 3 North America: Healthcare Fraud Detection Services Market, By Country, 2015–2022 (USD Million)
Table 4 Europe: Healthcare Fraud Detection Services Market, By Country, 2015–2022 (USD Million)
Table 5 Healthcare Fraud Detection Software Market, By Region, 2015–2022 (USD Million)
Table 6 North America: Healthcare Fraud Detection Software Market, By Country, 2015–2022 (USD Million)
Table 7 Europe: Healthcare Fraud Detection Software Market, By Country, 2015–2022 (USD Million)
Table 8 Healthcare Fraud Detection Market, By Delivery Model, 2015–2022 (USD Million)
Table 9 Healthcare Fraud Detection Market for On-Premise Delivery Models, By Region, 2015–2022 (USD Million)
Table 10 North America: Healthcare Fraud Detection Market for On-Premise Delivery Models, By Country, 2015–2022 (USD Million)
Table 11 Europe: Healthcare Fraud Detection Market for On-Premise Delivery Models, By Country, 2015–2022 (USD Million)
Table 12 Healthcare Fraud Detection Market for On-Demand Delivery Models, By Region, 2015–2022 (USD Million)
Table 13 North America: Healthcare Fraud Detection Market for On-Demand Delivery Models, By Country, 2015–2022 (USD Million)
Table 14 Europe: Healthcare Fraud Detection Market for On-Demand Delivery Models, By Country, 2015–2022 (USD Million)
Table 15 Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 16 Descriptive Analytics Market, By Region, 2015–2022 (USD Million)
Table 17 North America: Descriptive Analytics Market, By Country, 2015–2022 (USD Million)
Table 18 Europe: Descriptive Analytics Market, By Country, 2015–2022 (USD Million)
Table 19 Predictive Analytics Market, By Region, 2015–2022 (USD Million)
Table 20 North America: Predictive Analytics Market, By Country, 2015–2022 (USD Million)
Table 21 Europe: Predictive Analytics Market, By Country, 2015–2022 (USD Million)
Table 22 Prescriptive Analytics Market, By Region, 2015–2022 (USD Million)
Table 23 North America: Prescriptive Analytics Market, By Country, 2015–2022 (USD Million)
Table 24 Europe: Prescriptive Analytics Market, By Country, 2015–2022 (USD Million)
Table 25 Healthcare Fraud Detection Market, By Application, 2015–2022 (USD Million)
Table 26 Healthcare Fraud Detection Market for Insurance Claims Review, By Type, 2015–2022 (USD Million)
Table 27 Healthcare Fraud Detection Market for Insurance Claims Review, By Region, 2015–2022 (USD Million)
Table 28 North America: Healthcare Fraud Detection Market for Insurance Claims Review, By Country, 2015–2022 (USD Million)
Table 29 Healthcare Fraud Detection Market for Postpayment Review, By Region, 2015–2022 (USD Million)
Table 30 Healthcare Fraud Detection Market for Prepayment Review, By Region, 2015–2022 (USD Million)
Table 31 Healthcare Fraud Detection Market for Payment Integrity, By Region, 2015–2022 (USD Million)
Table 32 Healthcare Fraud Detection Market for Other Applications, By Region, 2015–2022 (USD Million)
Table 33 Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 34 Healthcare Fraud Detection Market for Private Insurance Payers, By Region, 2015–2022 (USD Million)
Table 35 North America: Healthcare Fraud Detection Market for Private Insurance Payers, By Country, 2015–2022 (USD Million)
Table 36 Healthcare Fraud Detection Market for Public/Government Agencies, By Region, 2015–2022 (USD Million)
Table 37 North America: Healthcare Fraud Detection Market for Public/Government Agencies, By Country, 2015–2022 (USD Million)
Table 38 Healthcare Fraud Detection Market for Third-Party Service Providers, By Region, 2015–2022 (USD Million)
Table 39 North America: Healthcare Fraud Detection Market for Third-Party Service Providers, By Country, 2015–2022 (USD Million)
Table 40 Healthcare Fraud Detection Market for Employers, By Region, 2015–2022 (USD Million)
Table 41 North America: Healthcare Fraud Detection Market for Employers, By Country, 2015–2022 (USD Million)
Table 42 Healthcare Fraud Detection Market, By Region, 2015–2022 (USD Million)
Table 43 North America: Healthcare Fraud Detection Market, By Country, 2015–2022 (USD Million)
Table 44 North America: Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 45 North America: Healthcare Fraud Detection Software Market, By Delivery Model, 2015–2022 (USD Million)
Table 46 North America: Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 47 North America: Healthcare Fraud Detection Market, By Application, 2015–2022 (USD Million)
Table 48 North America: Insurance Claims Review Market, By Type, 2015–2022 (USD Million)
Table 49 North America: Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 50 US: Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 51 US: Healthcare Fraud Detection Software Market, By Delivery Model, 2015–2022 (USD Million)
Table 52 US: Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 53 US: Healthcare Fraud Detection Market, By Application, 2015–2022 (USD Million)
Table 54 US: Insurance Claims Review Market, By Type, 2015–2022 (USD Million)
Table 55 US: Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 56 Canada: Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 57 Canada: Healthcare Fraud Detection Software Market, By Delivery Model, 2015–2022 (USD Million)
Table 58 Canada: Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 59 Canada: Healthcare Fraud Detection Market, By Application, 2015–2022 (USD Million)
Table 60 Canada: Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 61 Europe: Healthcare Fraud Detection Market, By Country, 2015–2022 (USD Million)
Table 62 Europe: Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 63 Europe: Healthcare Fraud Detection Software Market, By Delivery Model, 2015–2022 (USD Million)
Table 64 Europe: Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 65 Europe: Healthcare Fraud Detection Market, By Application, 2015–2022 (USD Million)
Table 66 Europe: Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 67 Germany: Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 68 Germany: Healthcare Fraud Detection Software Market, By Delivery Model, 2015–2022 (USD Million)
Table 69 Germany: Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 70 Germany: Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 71 UK: Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 72 UK: Healthcare Fraud Detection Software Market, By Delivery Model, 2015–2022 (USD Million)
Table 73 UK: Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 74 UK: Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 75 France: Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 76 France: Healthcare Fraud Detection Software Market, By Delivery Model, 2015–2022 (USD Million)
Table 77 France: Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 78 France: Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 79 RoE: Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 80 RoE: Healthcare Fraud Detection Software Market, By Delivery Model, 2015–2022 (USD Million)
Table 81 RoE: Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 82 RoE: Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 83 Asia: Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 84 Asia: Healthcare Fraud Detection Software Market, By Delivery Model, 2015–2022 (USD Million)
Table 85 Asia: Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 86 Asia: Healthcare Fraud Detection Market, By Application, 2015–2022 (USD Million)
Table 87 Asia: Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 88 RoW: Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 89 RoW: Healthcare Fraud Detection Software Market, By Delivery Model, 2015–2022 (USD Million)
Table 90 RoW: Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 91 RoW: Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 92 Healthcare Fraud Detection Ranking Analysis, By Key Player, 2016


List of Figures (39 Figures)

Figure 1 Healthcare Fraud Detection Market
Figure 2 Research Design
Figure 3 Breakdown of Primary Interviews: By Company Type, Designation, and Region
Figure 4 Data Triangulation
Figure 5 Descriptive Analytics Segment to Dominate the Market, By Type, During the Forecast Period
Figure 6 Services Segment to Dominate the Market in 2017
Figure 7 On-Demand Delivery Models to Grow at the Highest Rate During the Forecast Period
Figure 8 Private Insurance Payers Segment to Hold the Largest Market Share in 2017
Figure 9 North America to Hold the Largest Share of the Global Market During 2017 to 2022
Figure 10 Large Number of Fraudulent Activities in Healthcare to Drive the Growth of the Market
Figure 11 Services Segment to Grow at the Highest CAGR Over the Forecast Period (2017 -2022)
Figure 12 Prescriptive Analytics to Witness High Growth Rate From 2017 to 2022
Figure 13 On-Premise Models to Account for the Largest Share of the Healthcare Fraud Detection in 2017
Figure 14 Healthcare Fraud Detection Market: Drivers, Restraints, Opportunities, and Challenges
Figure 15 Healthcare Spending as A Percentage of the GDP, By Country, 2015
Figure 16 Services Segment to Dominate the Healthcare Fraud Detection Market in 2017
Figure 17 On-Demand Segment to Register Highest Growth Rate During the Forecast Period (2017–2022)
Figure 18 North America to Dominate the Global Healthcare Fraud Detection Market for On-Premise Delivery Models (2017–2022)
Figure 19 Prescriptive Analytics to Witness Highest Growth During the Forecast Period
Figure 20 North America is Expected to Dominate the Global Descriptive Analytics Market (2017–2022)
Figure 21 Insurance Claims Review Segment to Dominate the Healthcare Fraud Detection Market in 2017
Figure 22 Payers to Dominate the Healthcare Fraud Detection Market During the Forecast Period
Figure 23 North America to Witness the Highest Growth in the Healthcare Fraud Detection Market During the Forecast Period
Figure 24 North America: Healthcare Fraud Detection Market Snapshot
Figure 25 Europe: Healthcare Fraud Detection Market Snapshot
Figure 26 Asia: Healthcare Fraud Detection Market Snapshot
Figure 27 RoW: Healthcare Fraud Detection Market Snapshot
Figure 28 Market Evolution Framework
Figure 29 IBM: Company Snapshot
Figure 30 Mckesson: Company Snapshot
Figure 31 Fico: Company Snapshot
Figure 32 SAS Institute: Company Snapshot
Figure 33 Wipro: Company Snapshot
Figure 34 Conduent: Company Snapshot
Figure 35 HCL: Company Snapshot
Figure 36 CGI Group: Company Snapshot
Figure 37 DXC Technology: Company Snapshot
Figure 38 Northrop Grumman: Company Snapshot
Figure 39 Relx Group: Company Snapshot

The healthcare fraud detection market is expected to reach USD 2,242.7 Million by 2022 from USD 631.0 Million in 2017, at a CAGR of 28.9%. Market growth can be attributed to the large number of fraudulent activities in healthcare; increasing number of patients seeking health insurance; the prepayment review model; growing pressure of fraud, waste, and abuse on healthcare spending; and high returns on investment.

This report segments the healthcare fraud detection market into type, component, delivery model, application, end user, and region. Based on type, the healthcare fraud detection market is segmented into descriptive, predictive, and prescriptive analytics. The descriptive analytics segment is expected to account for the largest share of the healthcare fraud detection market, by type, in 2017. However, prescriptive analytics is slated to grow at the highest CAGR due to its ability to ensure the synergistic integration of predictions and prescriptions.

Based on component, the healthcare fraud detection market is segmented into services and software. The services segment accounted for the largest share of the healthcare fraud detection market. With the increasing need for fraud analytics services and the introduction of technologically advanced healthcare fraud detection software, which requires extensive training to use as well as regular upgrades, the services segment is expected to grow at the highest CAGR during the forecast period.

Based on delivery model, the healthcare fraud detection market is segmented into on-demand and on-premise models. The on-demand healthcare fraud detection segment is expected to grow at the highest CAGR during the forecast period. The high growth of this segment is attributed to the lack of upfront capital investments for hardware, higher flexibility, and the pay-as-you-go pricing of this model, and increased demand for self-driven analytics.

Based on end user, the healthcare fraud detection market is segmented into private insurance payers, public/government agencies, employers, and third-party service providers. The private insurance payers segment is expected to account for the largest share of the global healthcare fraud detection market in 2017. The need to comply with stringent laws and the opportunity for substantial cost savings are some important factors driving private payers to invest in advanced fraud analytics.

Healthcare Fraud Detection Market

In 2017, North America is expected to dominate the market, followed by Europe. Factors such as increase in the number of people seeking health insurance, increasing cases of healthcare fraud, favorable government initiatives to combat healthcare fraud, rising pressure to reduce healthcare costs, technological advancements, and greater product and service availability in this region are expected to drive market growth in North America.

While the healthcare fraud detection market presents significant growth opportunities, market growth may be limited to a certain extent due to dearth of skilled personnel and time-consuming deployment and frequent upgrades.

The healthcare fraud detection market is highly competitive with several big and small players. Prominent players in the healthcare fraud detection market include IBM (US), Optum (US), SAS (US), McKesson (US), SCIO (US), Verscend (US), Wipro (India), Conduent (US), HCL (India), CGI (Canada), DXC (US), Northrop Grumman (US), LexisNexis (US), and Pondera (US).

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

Custom Market Research Services

We will customize the research for you, in case the report listed above does not meet with your exact requirements. Our custom research will comprehensively cover the business information you require to help you arrive at strategic and profitable business decisions.

Please visit https://www.marketsandmarkets.com/knowledge-process-outsourcing-services.asp to specify your custom Research Requirement

Connect With Us

Follow us on LinkedIn  Follow us on Facebook   Follow us on Twitter 
Live Chat Support


US : 1-888-600-6441
UK : 44-800-368-9399

Search reports



Access reports on all high
growth Healthcare IT Markets on KnowledgeStore
Request Demo