[144 Pages Report] The global Healthcare Fraud Analytics Market is projected to USD 4.6 billion by 2025 from USD 1.2 billion in 2020, at a CAGR of 29.8%. The growth of this market is mainly due to a rise in the number of fraudulent activities in healthcare, combined with the increasing number of patients seeking medical insurance and rising pharmacy claim-related frauds. Emerging markets like APAC and Latin America provide significant growth opportunities in this market.
The high share of this market is attributed to the large number of people having health insurance, growing healthcare fraud, favorable government anti-fraud initiatives, the pressure to reduce healthcare costs, technological advancements, and greater product and service availability in this region. Moreover, a majority of leading players in the healthcare fraud detection market have their headquarters.
Fraud analytics solutions vary from vendor to vendor. Some vendors offer rule-based models while others offer AI-based technologies, but broadly, these solutions are classified based on the type of analytics used—descriptive analytics, predictive analytics, and prescriptive analytics. The prescriptive analytics segment registered the highest growth in the healthcare fraud analytics market during the forecast period. The high adoption of this technology is attributed to its advantages, such as rapid detection and investigation of suspects, claimants, and claim-level behavior from unstructured and/or semi-structured data.
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The research report categorizes the healthcare fraud analytics market into the following segments and subsegments:
Healthcare fraud analytics market, by Solution Type
- Descriptive Analytics
- Predictive Analytics
- Prescriptive Analytics
Healthcare fraud analytics market, by Delivery model
Healthcare fraud analytics market, by application
- Insurance Claims Review
- Postpayment Review
- Prepayment Review
- Pharmacy Billing Misuse
- Payment Integrity
- Other applications*
- *Other applications include identity management and case management
Healthcare fraud analytics market, by End User
- Public & Government Agencies
- Private Insurance Payers
- Third-party service providers
Healthcare fraud analytics market, by Region
- North America
- Rest of Europe (RoE)
- Asia Pacific (APAC)
- Latin America
- Middle East and Africa
Key Market players
The healthcare fraud detection market is consolidated and competitive in nature. Major players in this market include IBM Corporation (US), Optum (US), SAS Institute (US), Change Healthcare (US), EXL Service Holdings (US), Cotiviti (US), Wipro Limited (India), Conduent (US), HCL (India), Canadian Global Information Technology Group (Canada), DXC Technology Company (US), Northrop Grumman Corporation (US), LexisNexis Group (US), and Pondera Solutions (US).
Key Questions Addressed in the Report:
- Who are the top 10 players operating in the global healthcare fraud analytics market?
- What are the drivers, restraints, opportunities, and challenges in the market?
- What are the industry and technology trends in the market?
- What are the growth trends in the healthcare fraud analytics market at the segmental and overall market levels?
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