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Global Medical Payment Fraud Detection Market Size study, by Type (Descriptive Analytics, Predictive Analytics, Prescriptive Analytics), by Delivery Model (On-premises, Cloud-based), by Component (Software, Services), by Source of Services (In-house, Outsourced), by End-User (Private Insurance Payers, Public/Government Agencies, Third-Party Service Providers) and Regional Forecasts 2020-2027

  • BIZ4302305
  • 200 Pages
  • April 2021
  • Healthcare
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Global Medical Payment Fraud Detection Market is valued approximately at USD 1.0 billion in 2019 and is anticipated to grow with a healthy growth rate of more than 25.3% over the forecast period 2020-2027. The healthcare industry is highly regulated, and the cost is monitored closely. Also, the healthcare fraud is the critical issue for the government and there is great need for more effective detection method, which lessen the number of risks and errors in the sector. More often, the emergence of frauds is more frequent in payment of medical bills and other payable cost. Therefore, medical payment fraud detection solutions are used to prevent the healthcare fraud, waste, and abuse. These solutions are completely a falsification or deliberate duplicity of facts by healthcare professionals or patients that can led to unauthorized benefits to hackers. Therefore, the rising pressure of fraud in the healthcare sector, increasing number of patients opting for health insurance, and abuse on healthcare spending are the few factors responsible for the high CAGR of the market during the forecast period. As per the survey of the National Health Care Anti-Fraud Association, there is a surge of 25% increment in healthcare frauds & errors were recorded in 2015, as compared to 6.9% total since 2008, and is reached to almost nearly 52% in 2018. Similarly, as per the Federal Bureau of Investigation estimated that 3% to 10% of healthcare billings are illegal in the United States, with the annual expenditure on healthcare each year. As the incidences of healthcare frauds increases, financial burden also increases on healthcare companies thus, the healthcare groups are opting for medical fraud detection system. This, turn, is expected to impel the growth prospect of medical payment fraud detection market around the world. However, the dearth of skilled professionals and unwillingness to implement these fraud analytic solutions in developing countries are the few factors limiting the market growth over the forecast period of 2020-2027.

The regional analysis of the global Medical Payment Fraud Detection market is considered for the key regions such as Asia Pacific, North America, Europe, Latin America, and Rest of the World. North America is the leading/significant region across the world in terms of market share owing to the intensified penetration of fraud detection solution on the back of growing frauds cases, and the presence of large number of market vendors in the region. Whereas, Asia-Pacific is anticipated to exhibit the highest growth rate / CAGR over the forecast period 2020-2027. Factors such as rising government support and initiatives to reduce the rate of healthcare frauds, followed by the improving healthcare infrastructure in developing countries, such as China and India, would create lucrative growth opportunities for the market growth in the Asia-Pacific region.

Major market player included in this report are:

LexisNexis Risk Solutions

International Business Machines Corporation

Optuminsight

OSP Labs

DXC Technology Company

Unitedhealth Group

SAS Institute

Fair Isaac Corporation

EXL Service Holdings, Inc.

CGI Group

The objective of the study is to define market sizes of different segments & countries in recent years and to forecast the values to the coming eight years. The report is designed to incorporate both qualitative and quantitative aspects of the industry within each of the regions and countries involved in the study. Furthermore, the report also caters the detailed information about the crucial aspects such as driving factors & challenges which will define the future growth of the market. Additionally, the report shall also incorporate available opportunities in micro markets for stakeholders to invest along with the detailed analysis of competitive landscape and product offerings of key players. The detailed segments and sub-segment of the market are explained below:

By Type:

Descriptive Analytics

Predictive Analytics

Prescriptive Analytics

By Delivery Model:

On-premises

Cloud-based

By Component:

Software

Services

By Source of Services:

In-house

Outsourced

By End-User:

Private Insurance Payers

Public/Government Agencies

Third-Party Service Providers

By Region:

North America

U.S.

Canada

Europe

UK

Germany

France

Spain

Italy

ROE

Asia Pacific

China

India

Japan

Australia

South Korea

RoAPAC

Latin America

Brazil

Mexico

Rest of the World

Furthermore, years considered for the study are as follows:

Historical year – 2017, 2018

Base year – 2019

Forecast period – 2020 to 2027

Target Audience of the Global Medical Payment Fraud Detection Market in Market Study:

Key Consulting Companies & Advisors

Large, medium-sized, and small enterprises

Venture capitalists

Value-Added Resellers (VARs)

Third-party knowledge providers

Investment bankers

Investors

Chapter 1. Executive Summary

1.1. Market Snapshot

1.2. Global & Segmental Market Estimates & Forecasts, 2018-2027 (USD Billion)

1.2.1. Medical Payment Fraud Detection Market, by Region, 2018-2027 (USD Billion)

1.2.2. Medical Payment Fraud Detection Market, by Type, 2018-2027 (USD Billion)

1.2.3. Medical Payment Fraud Detection Market, by Delivery Model, 2018-2027 (USD Billion)

1.2.4. Medical Payment Fraud Detection Market, by Component, 2018-2027 (USD Billion)

1.2.5. Medical Payment Fraud Detection Market, by Source of Services, 2018-2027 (USD Billion)

1.2.6. Medical Payment Fraud Detection Market, by End-User, 2018-2027 (USD Billion)

1.3. Key Trends

1.4. Estimation Methodology

1.5. Research Assumption

Chapter 2. Global Medical Payment Fraud Detection Market Definition and Scope

2.1. Objective of the Study

2.2. Market Definition & Scope

2.2.1. Scope of the Study

2.2.2. Industry Evolution

2.3. Years Considered for the Study

2.4. Currency Conversion Rates

Chapter 3. Global Medical Payment Fraud Detection Market Dynamics

3.1. Medical Payment Fraud Detection Market Impact Analysis (2018-2027)

3.1.1. Market Drivers

3.1.2. Market Challenges

3.1.3. Market Opportunities

Chapter 4. Global Medical Payment Fraud Detection Market Industry Analysis

4.1. Porter’s 5 Force Model

4.1.1. Bargaining Power of Suppliers

4.1.2. Bargaining Power of Buyers

4.1.3. Threat of New Entrants

4.1.4. Threat of Substitutes

4.1.5. Competitive Rivalry

4.1.6. Futuristic Approach to Porter’s 5 Force Model (2017-2027)

4.2. PEST Analysis

4.2.1. Political

4.2.2. Economical

4.2.3. Social

4.2.4. Technological

4.3. Investment Adoption Model

4.4. Analyst Recommendation & Conclusion

Chapter 5. Global Medical Payment Fraud Detection Market, by Type

5.1. Market Snapshot

5.2. Global Medical Payment Fraud Detection Market by Type, Performance - Potential Analysis

5.3. Global Medical Payment Fraud Detection Market Estimates & Forecasts by Type 2017-2027 (USD Billion)

5.4. Medical Payment Fraud Detection Market, Sub Segment Analysis

5.4.1. Descriptive Analytics

5.4.2. Predictive Analytics

5.4.3. Prescriptive Analytics

Chapter 6. Global Medical Payment Fraud Detection Market, by Delivery Model

6.1. Market Snapshot

6.2. Global Medical Payment Fraud Detection Market by Delivery Model, Performance - Potential Analysis

6.3. Global Medical Payment Fraud Detection Market Estimates & Forecasts by Delivery Model 2017-2027 (USD Billion)

6.4. Medical Payment Fraud Detection Market, Sub Segment Analysis

6.4.1. On-premises

6.4.2. Cloud-based

Chapter 7. Global Medical Payment Fraud Detection Market, by Component

7.1. Market Snapshot

7.2. Global Medical Payment Fraud Detection Market by Component, Performance - Potential Analysis

7.3. Global Medical Payment Fraud Detection Market Estimates & Forecasts by Component 2017-2027 (USD Billion)

7.4. Medical Payment Fraud Detection Market, Sub Segment Analysis

7.4.1. Software

7.4.2. Services

Chapter 8. Global Medical Payment Fraud Detection Market, by Source of Services

8.1. Market Snapshot

8.2. Global Medical Payment Fraud Detection Market by Source of Services - Potential Analysis

8.3. Global Medical Payment Fraud Detection Market Estimates & Forecasts by Source of Services 2017-2027 (USD Billion)

8.4. Medical Payment Fraud Detection Market, Sub Segment Analysis

8.4.1. In-house

8.4.2. Outsourced

Chapter 9. Global Medical Payment Fraud Detection Market, by End-User

9.1. Market Snapshot

9.2. Global Medical Payment Fraud Detection Market by End-User - Potential Analysis

9.3. Global Medical Payment Fraud Detection Market Estimates & Forecasts by End-User 2017-2027 (USD Billion)

9.4. Medical Payment Fraud Detection Market, Sub Segment Analysis

9.4.1. Private Insurance Payers

9.4.2. Public/Government Agencies

9.4.3. Third-Party Service Providers

Chapter 10. Global Medical Payment Fraud Detection Market, Regional Analysis

10.1. Medical Payment Fraud Detection Market, Regional Market Snapshot

10.2. North America Medical Payment Fraud Detection Market

10.2.1. U.S. Medical Payment Fraud Detection Market

10.2.1.1. Type breakdown estimates & forecasts, 2017-2027

10.2.1.2. Delivery Model breakdown estimates & forecasts, 2017-2027

10.2.1.3. Component breakdown estimates & forecasts, 2017-2027

10.2.1.4. Source of Services breakdown estimates & forecasts, 2017-2027

10.2.1.5. End-User breakdown estimates & forecasts, 2017-2027

10.2.2. Canada Medical Payment Fraud Detection Market

10.3. Europe Medical Payment Fraud Detection Market Snapshot

10.3.1. U.K. Medical Payment Fraud Detection Market

10.3.2. Germany Medical Payment Fraud Detection Market

10.3.3. France Medical Payment Fraud Detection Market

10.3.4. Spain Medical Payment Fraud Detection Market

10.3.5. Italy Medical Payment Fraud Detection Market

10.3.6. Rest of Europe Medical Payment Fraud Detection Market

10.4. Asia-Pacific Medical Payment Fraud Detection Market Snapshot

10.4.1. China Medical Payment Fraud Detection Market

10.4.2. India Medical Payment Fraud Detection Market

10.4.3. Japan Medical Payment Fraud Detection Market

10.4.4. Australia Medical Payment Fraud Detection Market

10.4.5. South Korea Medical Payment Fraud Detection Market

10.4.6. Rest of Asia Pacific Medical Payment Fraud Detection Market

10.5. Latin America Medical Payment Fraud Detection Market Snapshot

10.5.1. Brazil Medical Payment Fraud Detection Market

10.5.2. Mexico Medical Payment Fraud Detection Market

10.6. Rest of The World Medical Payment Fraud Detection Market

Chapter 11. Competitive Intelligence

11.1. Top Market Strategies

11.2. Company Profiles

11.2.1. LexisNexis Risk Solutions

11.2.1.1. Key Information

11.2.1.2. Overview

11.2.1.3. Financial (Subject to Data Availability)

11.2.1.4. Product Summary

11.2.1.5. Recent Developments

11.2.2. International Business Machines Corporation

11.2.3. Optuminsight

11.2.4. OSP Labs

11.2.5. DXC Technology Company

11.2.6. Unitedhealth Group

11.2.7. SAS Institute

11.2.8. Fair Isaac Corporation

11.2.9. EXL Service Holdings, Inc.

11.2.10. CGI Group

Chapter 12. Research Process

12.1. Research Process

12.1.1. Data Mining

12.1.2. Analysis

12.1.3. Market Estimation

12.1.4. Validation

12.1.5. Publishing

12.2. Research Attributes

12.3. Research Assumption

List of Tables

TABLE 1. Global Medical Payment Fraud Detection market, report scope

TABLE 2. Global Medical Payment Fraud Detection market estimates & forecasts by region 2017-2027 (USD Billion)

TABLE 3. Global Medical Payment Fraud Detection market estimates & forecasts by Type 2017-2027 (USD Billion)

TABLE 4. Global Medical Payment Fraud Detection market estimates & forecasts by Delivery Model 2017-2027 (USD Billion)

TABLE 5. Global Medical Payment Fraud Detection market estimates & forecasts by Component 2017-2027 (USD Billion)

TABLE 6. Global Medical Payment Fraud Detection market estimates & forecasts by Source of Services 2017-2027 (USD Billion)

TABLE 7. Global Medical Payment Fraud Detection market estimates & forecasts by End-User 2017-2027 (USD Billion)

TABLE 8. Global Medical Payment Fraud Detection market by segment, estimates & forecasts, 2017-2027 (USD Billion)

TABLE 9. Global Medical Payment Fraud Detection market by region, estimates & forecasts, 2017-2027 (USD Billion)

TABLE 10. Global Medical Payment Fraud Detection market by segment, estimates & forecasts, 2017-2027 (USD Billion)

TABLE 11. Global Medical Payment Fraud Detection market by region, estimates & forecasts, 2017-2027 (USD Billion)

TABLE 12. Global Medical Payment Fraud Detection market by segment, estimates & forecasts, 2017-2027 (USD Billion)

TABLE 13. Global Medical Payment Fraud Detection market by region, estimates & forecasts, 2017-2027 (USD Billion)

TABLE 14. Global Medical Payment Fraud Detection market by segment, estimates & forecasts, 2017-2027 (USD Billion)

TABLE 15. Global Medical Payment Fraud Detection market by region, estimates & forecasts, 2017-2027 (USD Billion)

TABLE 16. Global Medical Payment Fraud Detection market by segment, estimates & forecasts, 2017-2027 (USD Billion)

TABLE 17. Global Medical Payment Fraud Detection market by region, estimates & forecasts, 2017-2027 (USD Billion)

TABLE 18. Global Medical Payment Fraud Detection market by segment, estimates & forecasts, 2017-2027 (USD Billion)

TABLE 19. Global Medical Payment Fraud Detection market by region, estimates & forecasts, 2017-2027 (USD Billion)

TABLE 20. Global Medical Payment Fraud Detection market by segment, estimates & forecasts, 2017-2027 (USD Billion)

TABLE 21. Global Medical Payment Fraud Detection market by region, estimates & forecasts, 2017-2027 (USD Billion)

TABLE 22. Global Medical Payment Fraud Detection market by segment, estimates & forecasts, 2017-2027 (USD Billion)

TABLE 23. Global Medical Payment Fraud Detection market by region, estimates & forecasts, 2017-2027 (USD Billion)

TABLE 24. U.S. Medical Payment Fraud Detection market estimates & forecasts, 2017-2027 (USD Billion)

TABLE 25. U.S. Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 26. U.S. Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 27. Canada Medical Payment Fraud Detection market estimates & forecasts, 2017-2027 (USD Billion)

TABLE 28. Canada Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 29. Canada Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 30. UK Medical Payment Fraud Detection market estimates & forecasts, 2017-2027 (USD Billion)

TABLE 31. UK Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 32. UK Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 33. Germany Medical Payment Fraud Detection market estimates & forecasts, 2017-2027 (USD Billion)

TABLE 34. Germany Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 35. Germany Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 36. France Medical Payment Fraud Detection market estimates & forecasts, 2017-2027 (USD Billion)

TABLE 37. France Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 38. France Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 39. Spain Medical Payment Fraud Detection market estimates & forecasts, 2017-2027 (USD Billion)

TABLE 40. Spain Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 41. Spain Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 42. Italy Medical Payment Fraud Detection market estimates & forecasts, 2017-2027 (USD Billion)

TABLE 43. Italy Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 44. Italy Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 45. ROE Medical Payment Fraud Detection market estimates & forecasts, 2017-2027 (USD Billion)

TABLE 46. ROE Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 47. ROE Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 48. China Medical Payment Fraud Detection market estimates & forecasts, 2017-2027 (USD Billion)

TABLE 49. China Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 50. China Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 51. India Medical Payment Fraud Detection market estimates & forecasts, 2017-2027 (USD Billion)

TABLE 52. India Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 53. India Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 54. Japan Medical Payment Fraud Detection market estimates & forecasts, 2017-2027 (USD Billion)

TABLE 55. Japan Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 56. Japan Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 57. Australia Medical Payment Fraud Detection market estimates & forecasts, 2017-2027 (USD Billion)

TABLE 58. Australia Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 59. Australia Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 60. South Korea Medical Payment Fraud Detection market estimates & forecasts, 2017-2027 (USD Billion)

TABLE 61. South Korea Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 62. South Korea Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 63. ROPAC Medical Payment Fraud Detection market estimates & forecasts, 2017-2027 (USD Billion)

TABLE 64. ROPAC Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 65. ROPAC Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 66. Brazil Medical Payment Fraud Detection market estimates & forecasts, 2017-2027 (USD Billion)

TABLE 67. Brazil Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 68. Brazil Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 69. Mexico Medical Payment Fraud Detection market estimates & forecasts, 2017-2027 (USD Billion)

TABLE 70. Mexico Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 71. Mexico Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 72. ROLA Medical Payment Fraud Detection market estimates & forecasts, 2017-2027 (USD Billion)

TABLE 73. ROLA Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 74. ROLA Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 75. ROW Medical Payment Fraud Detection market estimates & forecasts, 2017-2027 (USD Billion)

TABLE 76. ROW Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 77. ROW Medical Payment Fraud Detection market estimates & forecasts by segment 2017-2027 (USD Billion)

TABLE 78. List of secondary sources, used in the study of global Medical Payment Fraud Detection market

TABLE 79. List of primary sources, used in the study of global Medical Payment Fraud Detection market

TABLE 80. Years considered for the study

TABLE 81. Exchange rates considered

 
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