Healthcare Fraud Detection Market

IBM (US) and McKesson (US) are the Leading Player in the Healthcare Fraud Detection Market

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.

Partnerships, agreements, collaborations, and contracts accounted for the largest share of the overall growth strategies followed by key players between 2014 and 2017. Some of the companies that adopted this strategy are IBM (US), Optum (US), McKesson (US), FICO (US), SAS (US), LexisNexis (US), DXC Technologies (US), Northrop Grumman (US), and Pondera (US).

The healthcare fraud detection market is highly competitive with several big and small players.

IBM is a leading player in the healthcare fraud detection market. The leading position of the company is attributed to its robust product portfolio. The company offers exhaustive healthcare fraud analytic solutions for application in healthcare. The company 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. IBM invests heavily in research activities to continuously improve its product portfolio. For instance, since 2005, the company has invested USD 24 billion in the development of its Big Data and Analytics software and services capabilities. IBM strives to deliver innovative and customer-centric products, which is evident from the fact that it has an ample number of patents (8,088 patents in 2016) to its name. Furthermore, in order to maintain its leading position in the market, the company focuses on inorganic strategies like acquisitions and partnerships. For instance, in April 2016, IBM acquired Truven (US), a provider of cloud-based healthcare data, analytics, and insights. This acquisition strengthened IBM’s product portfolio for fraud, waste, and abuse detection and customer base.

McKesson held the second position in the market among the leading players in 2016. The company has a strong presence in the US and Canadian markets. It has a strong customer base including more than 300 payer customers. The company focuses on inorganic growth strategies to strengthen its position in the market. In this regard, in February 2016, McKesson agreed with HealthQX (US) to help payers quickly design and scale complex bundled payment models and help ensure those innovative programs provide timely and accurate payment to providers. This helped the company strengthen its product offerings for payers and providers. The company’s fraud analytics portfolio includes products such as Investiclaim, ClaimsXten, McKesson, and McKesson Benchmark Analytics. This strong product portfolio has enabled the company to maintain its market share in the healthcare fraud detection market. Furthermore, the company also focuses on enhancing its market presence by geographic expansions.

Related 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

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Report Code
HIT 5868
RI Published ON
1/9/2018
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