Healthcare Fraud Analytics Market

The "Healthcare Fraud Analytics Market by Solution Type (Descriptive, Predictive, Prescriptive), Application (Insurance Claim, Payment Integrity), Delivery (On-premise, Cloud), End User (Government, Employers, Payers), COVID-19 Impact - Global Forecast to 2026", is projected to reach USD 5.0 billion by 2026 from USD 1.5 billion in 2021, at a CAGR of 26.7% during the forecast period. Market growth can be attributed to a large number of fraudulent activities in healthcare, increasing number of patients seeking health insurance, high returns on investment, and the rising number of pharmacy claims-related frauds. However, the dearth of skilled personnel is expected to restrain the growth of this market.

Browse 155 market data Tables and 32 Figures spread through 176 Pages and in-depth TOC on "Healthcare Fraud Analytics Market by Solution Type (Descriptive, Predictive, Prescriptive), Application (Insurance Claim, Payment Integrity), Delivery (On-premise, Cloud), End User (Government, Employers, Payers), COVID-19 Impact - Global Forecast to 2026"
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The prescriptive analytics segment is expected to grow at the highest CAGR during the forecast period

Fraud analytics solutions vary from vendor to vendor. Some vendors offer rule-based models while others offer AI-based technologies, but broadly, these solutions are classified based on the type of analytics used—descriptive analytics, predictive analytics, and prescriptive analytics. The prescriptive analytics segment registered the highest growth in the healthcare fraud analytics market during the forecast period. The high adoption of this technology is attributed to its advantages, such as rapid detection and investigation of suspects, claimants, and claim-level behavior from unstructured and/or semi-structured data.

The public & government agencies segment is expected to account for the largest share of the healthcare fraud analytics market

Based on end user, the healthcare fraud detection market is segmented into public & government agencies, private insurance payers, employers, and third-party service providers. The public & government agencies segment accounted for the largest share of the healthcare fraud analytics market in 2019. The increasing cost burden due to healthcare fraud is proving to be a financial threat to public and government agencies globally. These factors are compelling payer organizations associated with these agencies to adopt analytics solutions to avoid losses incurred due to FWA and improper payments, which is driving the market growth.

North America is expected to account for the highest CAGR for players operating in the healthcare fraud analytics market

The North American healthcare fraud analytics market is expected to grow at the highest CAGR from 2021 to 2026. Factors such as the high number of cases of healthcare fraud, including pharmacy-related fraud, favorable government initiatives, technological advancements, and the availability of solutions in this region are expected to drive the growth of the North American market during the forecast period.

Major players in this market include IBM Corporation (US), Optum, Inc. (US), Cotiviti, Inc. (US), Change Healthcare (US), Fair Isaac Corporation (US), SAS Institute Inc. (US), EXLService Holdings, Inc. (US), Wipro Limited (India), Conduent, Incorporated (US), CGI Inc. (Canada), HCL Technologies Limited (India), Qlarant, Inc. (US), DXC Technology (US), Northrop Grumman Corporation (US), LexisNexis (US), Healthcare Fraud Shield (US), Sharecare, Inc. (US), FraudLens, Inc. (US), HMS Holding Corp. (US), Codoxo (US), H20.ai (US), Pondera Solutions, Inc. (US), FRISS (The Netherlands), Multiplan (US), FraudScope (US), and OSP Labs (US).

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