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Global Healthcare Fraud Analytics Market Size study, by Solution Type (Descriptive Analytics, Predictive Analytics, Prescriptive Analytics), by Delivery Model (On-premise, Cloud-based), by Application (Insurance Claims Review, Pharmacy Billing Misuse, Payment Integrity, Other applications), by End User (Public & Government Agencies, Private Insurance Payers, Third-party service providers, Employers), and Regional Forecasts 2021-2027

  • BIZ4670724
  • 200 Pages
  • November 2021
  • Healthcare
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Global healthcare fraud analytics market is valued approximately at USD 1.2 billion in 2020 and is anticipated to grow with a healthy growth rate of about 26.7% over the forecast period 2021-2027. Healthcare fraud analytics is the fraud detection solutions and software that assist in early detection of frauds in healthcare sector such as errors in claim submissions, duplication of claims, prescription fraud by pharmacists and health insurance frauds. The global healthcare fraud analytics market is being driven by large number of fraudulent activities in healthcare and increased number of patients seeking health insurance. Furthermore, role of AI in healthcare fraud detection will provide new opportunities for the global healthcare fraud analytics industry. There has been a significant rise in the population seeking health insurance in different countries across the globe. For instance, as per Statista, 297 million people in the United States had health insurance, as of 2020, an increase from approximately 257 million health insured people in 2010. Also, health insurance sector market size in India was about USD 4.94 billion in 2018 which is expected to reach USD 26.72 billion by 2030. Such growth in the demand for health insurance is expected to increase the demand and adoption of healthcare fraud analytics which is likely to promote the marker growth. However, limitations in the data capturing process in Medicaid services may impede market growth over the forecast period of 2021-2027.

The regional analysis of the global healthcare fraud analytics market is considered for the key regions such as Asia Pacific, North America, Europe, Latin America, and Rest of the World. North America accounts for the largest share in terms of market revenue in the global healthcare fraud analytics market over the forecast period 2021-2027. Factors such as growing incidences of healthcare fraud, large number of people seeking health insurance, pressure to reduce healthcare costs, favorable government anti-fraud initiatives, greater service and product availability, technological advancements, etc. contribute towards the largest market share of the region in the forecast years.

Major market player included in this report are:

International Business Machines Corporation (IBM)

Optum, Inc. (Optum)

SAS Institute, Inc. (SAS)

Change Healthcare

EXL Service Holdings, Inc.

Cotiviti

Wipro Limited

Conduent, Inc.

Hindustan Computers Limited Technologies Limited (HCL)

Canadian Global Information Technology Group Inc. (CGI)

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 Solution Type:

Descriptive Analytics

Predictive Analytics

Prescriptive Analytics

By Delivery Model:

On-premise

Cloud-based

By Application:

Insurance Claims Review

Pharmacy Billing Misuse

Payment Integrity

Other applications

By End User:

Public & Government Agencies

Private Insurance Payers

Third-party service providers

Employers

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 – 2018, 2019

Base year – 2020

Forecast period – 2021 to 2027.

Target Audience of the Global Healthcare Fraud Analytics 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, 2019-2027 (USD Billion)

1.2.1. Healthcare Fraud Analytics Market, by Region, 2019-2027 (USD Billion)

1.2.2. Healthcare Fraud Analytics Market, by Solution Type, 2019-2027 (USD Billion)

1.2.3. Healthcare Fraud Analytics Market, by Delivery Model, 2019-2027 (USD Billion)

1.2.4. Healthcare Fraud Analytics Market, by Application, 2019-2027 (USD Billion)

1.2.5. Healthcare Fraud Analytics Market, by End User, 2019-2027 (USD Billion)

1.3. Key Trends

1.4. Estimation Methodology

1.5. Research Assumption

Chapter 2. Global Healthcare Fraud Analytics 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 Healthcare Fraud Analytics Market Dynamics

3.1. Healthcare Fraud Analytics Market Impact Analysis (2019-2027)

3.1.1. Market Drivers

3.1.1.1. Large number of fraudulent activities in healthcare

3.1.1.2. Increased number of patients seeking health insurance

3.1.2. Market Restraint

3.1.2.1. Limitations in the data capturing process in Medicaid services

3.1.3. Market Opportunities

3.1.3.1. Role of AI in healthcare fraud detection

Chapter 4. Global Healthcare Fraud Analytics 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 (2018-2027)

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 Healthcare Fraud Analytics Market, by Solution Type

a. Market Snapshot

5.1. Global Healthcare Fraud Analytics Market by Solution Type, Performance - Potential Analysis

5.2. Global Healthcare Fraud Analytics Market Estimates & Forecasts by Solution Type 2018-2027 (USD Billion)

5.3. Healthcare Fraud Analytics Market, Sub Segment Analysis

5.3.1. Descriptive Analytics

5.3.2. Predictive Analytics

5.3.3. Prescriptive Analytics

Chapter 6. Global Healthcare Fraud Analytics Market, by Delivery Model

b. Market Snapshot

6.1. Global Healthcare Fraud Analytics Market by Delivery Model, Performance - Potential Analysis

6.2. Global Healthcare Fraud Analytics Market Estimates & Forecasts by Delivery Model 2018-2027 (USD Billion)

6.3. Healthcare Fraud Analytics Market, Sub Segment Analysis

6.3.1. On-premise

6.3.2. Cloud-based

Chapter 7. Global Healthcare Fraud Analytics Market, by Application

c. Market Snapshot

7.1. Global Healthcare Fraud Analytics Market by Application, Performance - Potential Analysis

7.2. Global Healthcare Fraud Analytics Market Estimates & Forecasts by Application 2018-2027 (USD Billion)

7.3. Healthcare Fraud Analytics Market, Sub Segment Analysis

7.3.1. Insurance Claims Review

7.3.2. Pharmacy Billing Misuse

7.3.3. Payment Integrity

7.3.4. Other applications

Chapter 8. Global Healthcare Fraud Analytics Market, by End User

d. Market Snapshot

8.1. Global Healthcare Fraud Analytics Market by End User, Performance - Potential Analysis

8.2. Global Healthcare Fraud Analytics Market Estimates & Forecasts by End User 2018-2027 (USD Billion)

8.3. Healthcare Fraud Analytics Market, Sub Segment Analysis

8.3.1. Public & Government Agencies

8.3.2. Private Insurance Payers

8.3.3. Third-party service providers

8.3.4. Employers

Chapter 9. Global Healthcare Fraud Analytics Market, Regional Analysis

9.1. Healthcare Fraud Analytics Market, Regional Market Snapshot

9.2. North America Healthcare Fraud Analytics Market

9.2.1. U.S. Healthcare Fraud Analytics Market

9.2.1.1. Solution Type breakdown estimates & forecasts, 2018-2027

9.2.1.2. Delivery Model breakdown estimates & forecasts, 2018-2027

9.2.1.3. Application breakdown estimates & forecasts, 2018-2027

9.2.1.4. End User breakdown estimates & forecasts, 2018-2027

9.2.2. Canada Healthcare Fraud Analytics Market

9.3. Europe Healthcare Fraud Analytics Market Snapshot

9.3.1. U.K. Healthcare Fraud Analytics Market

9.3.2. Germany Healthcare Fraud Analytics Market

9.3.3. France Healthcare Fraud Analytics Market

9.3.4. Spain Healthcare Fraud Analytics Market

9.3.5. Italy Healthcare Fraud Analytics Market

9.3.6. Rest of Europe Healthcare Fraud Analytics Market

9.4. Asia-Pacific Healthcare Fraud Analytics Market Snapshot

9.4.1. China Healthcare Fraud Analytics Market

9.4.2. India Healthcare Fraud Analytics Market

9.4.3. Japan Healthcare Fraud Analytics Market

9.4.4. Australia Healthcare Fraud Analytics Market

9.4.5. South Korea Healthcare Fraud Analytics Market

9.4.6. Rest of Asia Pacific Healthcare Fraud Analytics Market

9.5. Latin America Healthcare Fraud Analytics Market Snapshot

9.5.1. Brazil Healthcare Fraud Analytics Market

9.5.2. Mexico Healthcare Fraud Analytics Market

9.6. Rest of The World Healthcare Fraud Analytics Market

Chapter 10. Competitive Intelligence

10.1. Top Market Strategies

10.2. Company Profiles

10.2.1. International Business Machines Corporation (IBM)

10.2.1.1. Key Information

10.2.1.2. Overview

10.2.1.3. Financial (Subject to Data Availability)

10.2.1.4. Product Summary

10.2.1.5. Recent Developments

10.2.2. Optum, Inc. (Optum)

10.2.3. SAS Institute, Inc. (SAS)

10.2.4. Change Healthcare

10.2.5. EXL Service Holdings, Inc.

10.2.6. Cotiviti

10.2.7. Wipro Limited

10.2.8. Conduent, Inc.

10.2.9. Hindustan Computers Limited Technologies Limited (HCL)

10.2.10. Canadian Global Information Technology Group Inc. (CGI)

Chapter 11. Research Process

11.1. Research Process

11.1.1. Data Mining

11.1.2. Analysis

11.1.3. Market Estimation

11.1.4. Validation

11.1.5. Publishing

11.2. Research Attributes

11.3. Research Assumption

List of Tables

TABLE 2. Global Healthcare Fraud Analytics Market, report scope

TABLE 3. Global Healthcare Fraud Analytics Market estimates & forecasts by region 2018-2027 (USD Billion)

TABLE 4. Global Healthcare Fraud Analytics Market estimates & forecasts by Solution Type 2018-2027 (USD Billion)

TABLE 5. Global Healthcare Fraud Analytics Market estimates & forecasts by Delivery Model 2018-2027 (USD Billion)

TABLE 6. Global Healthcare Fraud Analytics Market estimates & forecasts by Application 2018-2027 (USD Billion)

TABLE 7. Global Healthcare Fraud Analytics Market estimates & forecasts by End User 2018-2027 (USD Billion)

TABLE 8. Global Healthcare Fraud Analytics Market by segment, estimates & forecasts, 2018-2027 (USD Billion)

TABLE 9. Global Healthcare Fraud Analytics Market by region, estimates & forecasts, 2018-2027 (USD Billion)

TABLE 10. Global Healthcare Fraud Analytics Market by segment, estimates & forecasts, 2018-2027 (USD Billion)

TABLE 11. Global Healthcare Fraud Analytics Market by region, estimates & forecasts, 2018-2027 (USD Billion)

TABLE 12. Global Healthcare Fraud Analytics Market by segment, estimates & forecasts, 2018-2027 (USD Billion)

TABLE 13. Global Healthcare Fraud Analytics Market by region, estimates & forecasts, 2018-2027 (USD Billion)

TABLE 14. Global Healthcare Fraud Analytics Market by segment, estimates & forecasts, 2018-2027 (USD Billion)

TABLE 15. Global Healthcare Fraud Analytics Market by region, estimates & forecasts, 2018-2027 (USD Billion)

TABLE 16. Global Healthcare Fraud Analytics Market by segment, estimates & forecasts, 2018-2027 (USD Billion)

TABLE 17. Global Healthcare Fraud Analytics Market by region, estimates & forecasts, 2018-2027 (USD Billion)

TABLE 18. Global Healthcare Fraud Analytics Market by segment, estimates & forecasts, 2018-2027 (USD Billion)

TABLE 19. Global Healthcare Fraud Analytics Market by region, estimates & forecasts, 2018-2027 (USD Billion)

TABLE 20. Global Healthcare Fraud Analytics Market by segment, estimates & forecasts, 2018-2027 (USD Billion)

TABLE 21. Global Healthcare Fraud Analytics Market by region, estimates & forecasts, 2018-2027 (USD Billion)

TABLE 22. Global Healthcare Fraud Analytics Market by segment, estimates & forecasts, 2018-2027 (USD Billion)

TABLE 23. Global Healthcare Fraud Analytics Market by region, estimates & forecasts, 2018-2027 (USD Billion)

TABLE 24. U.S. Healthcare Fraud Analytics Market estimates & forecasts, 2018-2027 (USD Billion)

TABLE 25. U.S. Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 26. U.S. Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 27. Canada Healthcare Fraud Analytics Market estimates & forecasts, 2018-2027 (USD Billion)

TABLE 28. Canada Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 29. Canada Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 30. UK Healthcare Fraud Analytics Market estimates & forecasts, 2018-2027 (USD Billion)

TABLE 31. UK Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 32. UK Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 33. Germany Healthcare Fraud Analytics Market estimates & forecasts, 2018-2027 (USD Billion)

TABLE 34. Germany Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 35. Germany Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 36. France Healthcare Fraud Analytics Market estimates & forecasts, 2018-2027 (USD Billion)

TABLE 37. France Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 38. France Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 39. Spain Healthcare Fraud Analytics Market estimates & forecasts, 2018-2027 (USD Billion)

TABLE 40. Spain Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 41. Spain Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 42. Italy Healthcare Fraud Analytics Market estimates & forecasts, 2018-2027 (USD Billion)

TABLE 43. Italy Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 44. Italy Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 45. ROE Healthcare Fraud Analytics Market estimates & forecasts, 2018-2027 (USD Billion)

TABLE 46. ROE Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 47. ROE Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 48. China Healthcare Fraud Analytics Market estimates & forecasts, 2018-2027 (USD Billion)

TABLE 49. China Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 50. China Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 51. India Healthcare Fraud Analytics Market estimates & forecasts, 2018-2027 (USD Billion)

TABLE 52. India Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 53. India Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 54. Japan Healthcare Fraud Analytics Market estimates & forecasts, 2018-2027 (USD Billion)

TABLE 55. Japan Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 56. Japan Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 57. Australia Healthcare Fraud Analytics Market estimates & forecasts, 2018-2027 (USD Billion)

TABLE 58. Australia Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 59. Australia Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 60. South Korea Healthcare Fraud Analytics Market estimates & forecasts, 2018-2027 (USD Billion)

TABLE 61. South Korea Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 62. South Korea Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 63. ROPAC Healthcare Fraud Analytics Market estimates & forecasts, 2018-2027 (USD Billion)

TABLE 64. ROPAC Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 65. ROPAC Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 66. Brazil Healthcare Fraud Analytics Market estimates & forecasts, 2018-2027 (USD Billion)

TABLE 67. Brazil Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 68. Brazil Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 69. Mexico Healthcare Fraud Analytics Market estimates & forecasts, 2018-2027 (USD Billion)

TABLE 70. Mexico Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 71. Mexico Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 72. ROLA Healthcare Fraud Analytics Market estimates & forecasts, 2018-2027 (USD Billion)

TABLE 73. ROLA Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 74. ROLA Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 75. ROW Healthcare Fraud Analytics Market estimates & forecasts, 2018-2027 (USD Billion)

TABLE 76. ROW Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 77. ROW Healthcare Fraud Analytics Market estimates & forecasts by segment 2018-2027 (USD Billion)

TABLE 78. List of secondary sources used in the study of global Healthcare Fraud Analytics Market.

TABLE 79. List of primary sources used in the study of global Healthcare Fraud Analytics Market.

TABLE 80. Years considered for the study.

TABLE 81. Exchange rates considered.

 
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