About Healthcare Fraud Detection
Healthcare fraud detection is specially designed to prevent healthcare frauds, abuse, and waste so that any unauthorized payment and benefits can be avoided. They are usually used to avoid misrepresenting dates, falsification of data by physicians, and submitting claims for services not provided among others. An increasing number of patients seeking health insurance is the vital factor escalating the market growth, also the rising prepayment review model, increasing returns on investment, increase in pharmacy claims-related fraud, increasing population adapting health insurance and rising need for solutions that have biometric sensors to identify frauds are the major factors among others driving the healthcare fraud detection market. Moreover, the increasing adoption of healthcare fraud analytics in developing countries, the rising emergence of social media and its impact on the healthcare industry and the role of AI in healthcare fraud detection will further create new opportunities for healthcare fraud detection
Attributes | Details |
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Study Period | 2018-2030 |
Base Year | 2023 |
Unit | Value (USD Million) |
The market is highly competitive with the active presence of dominant players. The companies are exploring the market by adopting mergers & acquisitions, expansions, investments, new service launches and collaborations as their preferred strategies. The players are exploring new geographies through expansions and acquisitions to avail a competitive advantage through combined synergies. Analyst at AMA Research estimates that Global Players will contribute the maximum growth to Global Healthcare Fraud Detection 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.
IBM (United States), Optum (United States), HCL Technologies Limited (India), CGI Group Inc. (Canada), RELX Group plc (United Kingdom), Wipro Limited (India), SAS (US), McKesson (United States), SCIO (United Stats) and Verscend (United States) are some of the key players that are part of study coverage. Additionally, the Players which are also part of the research coverage are ExlService Holdings Inc. (Ireland), DXC (United States), Northrop Grumman (United States), LexisNexis (United States) and Pondera (United States).
Segmentation Overview
AMA Research has segmented the market of Global Healthcare Fraud Detection market by Type (Descriptive Analytics, Predictive Analytics and Prescriptive Analytics), Application (Insurance Claims Review, Payment Integrity and Other) and Region.
On the basis of geography, the market of Healthcare Fraud Detection 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 Components, the sub-segment i.e. Service will boost the Healthcare Fraud Detection market. Additionally, the rising demand from SMEs and various industry verticals gives enough cushion to market growth. If we see Market by End Users, the sub-segment i.e. Private Insurance Payers will boost the Healthcare Fraud Detection market. Additionally, the rising demand from SMEs and various industry verticals gives enough cushion to market growth. If we see Market by Delivery Mode, the sub-segment i.e. On-Premises Delivery Models will boost the Healthcare Fraud Detection market. Additionally, the rising demand from SMEs and various industry verticals gives enough cushion to market growth.
Influencing Trend:
Increasing use of data mining and machine learning techniques to detect fraud.
Market Growth Drivers:
Increasing number of patients seeking health insurance and Increasing returns on investment
Challenges:
High cost of healthcare fraud detection technologies
Restraints:
Lack of skilled and trained profession
Opportunities:
Machine learning (ML) and artificial intelligence (AI) techniques to look at claims data and find fraudulent activity. and Enhanced data visualization tools and techniques
Market Leaders and their expansionary development strategies
In May 2023, Mastercard and HealthLock say they’ve teamed to help consumers avoid medical bill fraud and claim errors. The partnership, announced Monday (May 22), gives Mastercard health savings account and flexible spending account users access to Healthlock’s platform, which lets them monitor all healthcare claims in one place, prevent fraud, potentially reduce bills and reverse rejected claims.
In June 2023, Verisk Launches Next Generation of Insurance Fraud Analytics in Israel with Kyndryl Technology. The new solution leverages Kyndryl’s powerful computing resources and Verisk’s deep domain expertise to quickly analyze new auto claims for bodily injury (compulsory insurance in Israel) and detect indications of fraud. Insurance fraud in Israel costs insurers hundreds of millions of New Israeli Shekel (NIS) per year, resulting in higher premiums for policyholders.
Key Target Audience
Health Insurance Companies, Government Agencies, Fraud Detection & Analytics Companies, Hospitals and Clinics and Others
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.