Healthcare Fraud Detection Market - Industry Analysis, size, Share and Upcoming Trends (2021-2027)

Research report presented by UnivDatos, Emphasis on Component (Services, Software); Delivery Models (On-Premises, On-Demand); Solutions (Descriptive Analytics, Predictive Analytics, Prescriptive Analytics); Application (Insurance Claims, Payment Integrity, Pharmacy Billing, Others); End-User (Insurance Company, Government Agencies, Third-party Service Providers, Others), and Geographical analysis (key regions and countries).

As per the research report, The Global Healthcare Fraud Detection Market is expected to increase enormously by 2027. Healthcare fraud has resulted in a substantial increase in healthcare costs. According to the GAO (General Accounting Office), "federal spending on major health-care services is expected to rise from 5.9% of GDP in fiscal year 2020 to 8% of GDP in fiscal year 2050. The need for healthcare fraud identification is growing due to a rise in the number of people filing for health benefits, an increase in the number of drug bill frauds, and government initiatives to eliminate healthcare fraud, among other factors. The impact of social media on the healthcare sector, the rapid adoption of cloud-based analytics solutions, the impact of artificial intelligence in healthcare facilities, and the rise in the number of fraud identity protection applications will all contribute to the market's expansion. However, the industry is constrained by a shortage of qualified professionals, a refusal to implement healthcare fraud analytics, and a high upfront implementation expense.

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COVID-19 presents a workplace danger to healthcare workers; the virus has affected thousands of healthcare workers around the world. The prevention of communicable infection transmission within hospitals has been a significant problem for federal agencies and healthcare organisations. Individuals and organisations in the healthcare industry are increasingly concerned about data privacy and confidentiality. Healthcare data is considered more vulnerable than other forms of data because tampering with it can result in defective medication, which can result in fatal and permanent losses for patients. Programs like the Medicare Fraud Strike Force (OIG 2017), for example, have been supported to help mitigate fraud, but more work is needed to further minimise the impact of fraud in the healthcare system.

The industry is divided into Services and Software based on components. For example, healthcare cloud has introduced patient monitoring tools to monitor patient conditions and suggest treatments based on patient comorbidities. It makes use of large database and proprietary analytics. The industry is divided into two types of distribution models: on-premises and on-demand. Because of its high availability, pay-as-you-go pricing, and lack of initial capital costs for hardware, the on-premise distribution model is projected to expand the most. According to Nutanix, healthcare spent 93 percent of its cloud budget on Azure and 11 percent on AWS in 2019. The market is divided into three categories based on the type of solution: descriptive analytics, predictive analytics, and prescriptive analytics. Because of its high assistance in predictive and prescriptive analytics, descriptive analytics retains the majority of the market. Vidence and NTT DATA, for example, recently announced a collaboration to provide predictive analytics in oncology. This partnership would use a mix of medical imaging tests, clinical evidence, and outcomes data to develop a statistical model that will help doctors better tailor treatment regimens.

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The industry is divided into insurance claims, reimbursement integrity, drug fee, among other uses. Care Shield insurance has announced the introduction of Care Shield, which will cover a variety of medical bills as well as secure No Claim Bonus (NCB) benefits from expiring. The sector is divided into individual insurance payers, federal departments, third-party service providers, and others based on end-user. Because of the rise in illegal practises and the growing need to deter data manipulation, government departments have the largest share. For example, the Health Care Fraud (HCF) Unit of the Criminal Division's Fraud Section has more than 70 attorneys whose primary task is to investigate health care fraud-related cases involving patient injury and significant financial damage.

The market is broken down by region/country, including North America (the United States, Canada, and the rest of North America), Europe (Germany, France, Italy, Spain, the United Kingdom, and the rest of Europe), Asia-Pacific (China, Japan, India, Australia, and the rest of APAC), and the rest of the world. Health care fraud costs the United States almost $68 billion a year, according to the National Healthcare Anti-Fraud Association (NHCAA). Some of the major players operating in the market include IBM Corporation, Optum, Inc., COTIVITI, INC., McKesson Corporation, Fair Isaac Corporation, SAS Institute Inc., SCIO Inspire, Corp., Conduent, Inc., HCL Technologies Limited, CGI Inc., DXC Technology Company, and Northrop Grumman, etc. Several M&As along with partnerships have been undertaken by these players to boost their presence in different regions.

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Global Healthcare Fraud Detection Market Segmentation

Market Insight, by Component

• Services
• Software

Market Insight, by Delivery Models

• On-Premise Delivery
• On-Demand Delivery

Market Insight, by Solutions Type

• Descriptive Analytics
• Predictive Analytics
• Prescriptive Analytics

Market Insight, by Application

• Insurance Claims
• Payment Integrity
• Pharmacy Bill
• Others

Market Insight, by End-User

• Private Insurance Payers
• Government Agencies
• Third-party service providers
• Others

Market Insight, by Region

• North America Healthcare Fraud Detection Market
  • United States
  • Canada
  • Rest of North America
• Europe Healthcare Fraud Detection Market
  • France
  • United Kingdom
  • Germany
  • Spain
  • Italy
  • Rest of Europe
• Asia-Pacific Healthcare Fraud Detection Market
  • China
  • Japan
  • India
  • Australia
  • Rest of Asia-Pacific
• Rest of World Healthcare Fraud Detection Market

Company Profiled

• IBM Corporation
• Optum, Inc.
• COTIVITI, INC.
• McKesson Corporation
• Fair Isaac Corporation
• SAS Institute Inc.
• SCIO Inspire, Corp.
• Conduent, Inc.
• HCL Technologies Limited
• CGI Inc.
• DXC Technology Company
• Northrop Grumman

Healthcare Fraud Detection Market can further be customized as per the requirement or any other market segment. Besides this, UMI understands that you may have your own business needs, hence feel free to connect with us to get a report that completely suits your requirements.