About Healthcare Fraud Analytics
Healthcare Fraud Analytics are services which basically help investigate or find any financial fraud in Healthcare payment or insurance claims, etc. The services include account auditing, healthcare report analysis, and others. The healthcare fraud analytics comprises of both software and services. Major analytics tools used include predictive, prescriptive and descriptive with predictive analytics becoming the most popular choice in industry. The increase in Healthcare insurance penetration, rising number of claims and patients has fuelled the growth of the healthcare fraud analytics. The recent Pandemic has especially sharply increased the demand of the healthcare fraud analytics services. Geographically, North America is the biggest market of Healthcare fraud analytics.
Attributes | Details |
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Study Period | 2018-2030 |
Base Year | 2023 |
Unit | Value (USD Million) |
CAGR | 20.3% |
Analyst at AMA Research estimates that United States Players will contribute the maximum growth to Global Healthcare Fraud Analytics market throughout the forecasted period. Established and emerging Players should take a closer view at their existing organizations and reinvent traditional business and operating models to adapt to the future.
SAS Institute Inc. (United States), CGI Inc. (Canada), IBM Corporation (United States), Cotiviti, Inc. (United States), SCIOInspire, Corp. (United States), Optum, Inc. (United States), DXC Technology (United States), McKesson Corporation (United States), HCL Technologies Limited (India) and Wipro Limited (India) are some of the key players that are part of study coverage. Additionally, the Players which are also part of the research coverage are Pondera Solutions, LLC (United States), Relx Group PLC (United Kingdom) and ClarisHealth (United States).
Segmentation Overview
AMA Research has segmented the market of Global Healthcare Fraud Analytics market by Type (Predictive Analytics, Prescriptive Analytics and Descriptive Analytics), Application (Insurance Claims Review, Pharmacy Billing Misuse, Payment Integrity, Identity & Case Management and Others) and Region.
On the basis of geography, the market of Healthcare Fraud Analytics has been segmented into South America (Brazil, Argentina, Rest of South America), Asia Pacific (China, Japan, India, South Korea, Taiwan, Australia, Rest of Asia-Pacific), Europe (Germany, France, Italy, United Kingdom, Netherlands, Rest of Europe), MEA (Middle East, Africa), North America (United States, Canada, Mexico). If we see Market by End Use, the sub-segment i.e. Private Insurance Payers will boost the Healthcare Fraud Analytics market. Additionally, the rising demand from SMEs and various industry verticals gives enough cushion to market growth. If we see Market by Component, the sub-segment i.e. Software will boost the Healthcare Fraud Analytics market. Additionally, the rising demand from SMEs and various industry verticals gives enough cushion to market growth.
Influencing Trend:
Predictive Analytics is rising in Popularity
Market Growth Drivers:
Expansion of Health and Medical Insurance Market and Rising Health related Expenditure
Challenges:
High Initial Cost for Setting Infrastructure
Restraints:
Lack of Data in Rural Areas
Opportunities:
Integration of Artificial Intelligence for Better Performance
Market Leaders and their expansionary development strategies
In 2020, Centene Corporation, a provider of managed healthcare solutions has announced acquisition of an analytics company called Apixio, Inc. This is to bolster Centene’s predictive analytics capabilities, unstructured data analysis and help in developing algorithms which provide appropriate insights and solutions. It will also help Centene to improve its value based healthcare payment mechanism.
In 2020, ClarisHealth, a firm providing integrated payment solutions for healthcare has announced launch of Pareo Fraud Detection, which is an artificial intelligence enabled healthcare fraud detection system. The solution investigated and provides solution in real time on which provider is suspicious or needs to be investigated.
Key Target Audience
Healthcare Fraud Analytics Providers, New Entrants/Investors, Venture Capitalists and Private Equity Firms, Analysts and Strategic Business Planners and End-Use Industries
About Approach
To evaluate and validate the market size various sources including primary and secondary analysis is utilized. AMA Research follows regulatory standards such as NAICS/SIC/ICB/TRCB, to have a better understanding of the market. The market study is conducted on basis of more than 200 companies dealing in the market regional as well as global areas with the purpose to understand the companies positioning regarding the market value, volume, and their market share for regional as well as global.
Further to bring relevance specific to any niche market we set and apply a number of criteria like Geographic Footprints, Regional Segments of Revenue, Operational Centres, etc. The next step is to finalize a team (In-House + Data Agencies) who then starts collecting C & D level executives and profiles, Industry experts, Opinion leaders, etc., and work towards appointment generation.
The primary research is performed by taking the interviews of executives of various companies dealing in the market as well as using the survey reports, research institute, and latest research reports. Meanwhile, the analyst team keeps preparing a set of questionnaires, and after getting the appointee list; the target audience is then tapped and segregated with various mediums and channels that are feasible for making connections that including email communication, telephonic, skype, LinkedIn Group & InMail, Community Forums, Community Forums, open Survey, SurveyMonkey, etc.