The healthcare fraud analytics market 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. The growth of the healthcare fraud analytics market can largely be attributed to factors such as 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.
The healthcare fraud analytics market is consolidated and competitive in nature. 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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IBM Corporation was the leading player in the healthcare fraud analytics market in 2018. The company provides a wide range of healthcare fraud detection products in the market. IBM has a strong presence in the commercial and government healthcare payer markets. Moreover, it has a strong sales and distribution network in more than 175 countries. In order to maintain its leading position in the market, the company focuses on inorganic strategies such as acquisitions and partnerships. IBM acquired Red Hat, the leading provider of enterprise and open source solutions, to complement its cloud platform. Since the demand for cloud services in healthcare fraud detection is on the rise, this acquisition has significantly helped the company in targeting new customers and expanding its growth as a leading provider of cloud services in the insurance sector.
Optum is one of the leading players in the healthcare payment integrity services market, a market that directly impacts the volume of fraud analytics in healthcare. In order to leverage growth opportunities in the healthcare fraud detection market, the company has focused on inorganic growth strategies in the past. This includes its collaboration with other top players such as the SAS Institute and companies like Availity LLC, to improve its accuracy in fraud detection and reduce claim-processing errors. At present, Optum is focusing on emerging countries such as India, with the introduction of its solutions in the Indian market.
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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