Global Healthcare Fraud Detection Market: Information by Type (Descriptive Analytics, Predictive Analytics and Prescriptive Analytics), by Component (Services and Software), by Delivery Model (On-Premise and Cloud-Based), by Application (Insurance Claims Review and Payment Integrity), by End User (Private Insurance Payers, Public/Government Agencies and Third Party Service Providers) and by Region (North America, Europe, Asia-Pacific and the Middle East & Africa) - Forecast till 2024
Healthcare Fraud Detection Software Market Overview
The problem of fraudulent claims is intensifying in the healthcare sector and is a burden to society. Healthcare fraud detection generally involves account auditing and detective investigation for fraudulent activities. Some of the common healthcare fraud cases include billing for services that are not provided, separate billing for laboratory tests performed together to claim higher reimbursements, usage of healthcare cards by others, and many more. Such fraudulent activities are detected by using statistical, analytical, deep learning, and predictive modeling methods. The healthcare sector is witnessing more payment breaches than ever before due to which the adoption of healthcare fraud detection solutions has gained enormous importance. Market Research Future (MRFR) has launched a new report on the global Healthcare Fraud Detection Software Market and has indicated that the market is primed to capture a CAGR of 26.7% over the forecast period of 2018-2023. The healthcare fraud detection market was valued at USD 639.07 Mn in 2017.
Misinterpretation, as well as intentional deceit in facts related to payments, have given rise to the need for robust fraud detection systems. Various healthcare organizations across the globe are augmenting their anti-fraud initiatives with proprietary detection technologies. Deployment of such solutions helps to reduce common falsification activities such as multiple claims filed by different providers for same patient, intentional misrepresentation of dates, duration, frequency, or description of services provided. As greater number of patients are seeking healthcare insurance, the chance of healthcare fraudulent activities are also increasing manifold.
On the other hand, despite various benefits aligned with fraud detection solutions, their implementation is restricted by time-consuming deployment process and the need for frequent software upgrades.
Healthcare Fraud Detection Software Market Segmentation
The healthcare fraud detection market has been segmented based on component, delivery model, type, application, end-user.
By component, the healthcare fraud detection market has been segmented into services and software.
By delivery model, the healthcare fraud detection market has been segmented into on-premise delivery models and on-demand delivery models.
By type, the healthcare fraud detection market has been segmented into descriptive analytics, predictive analytics, and prescriptive analytics. Descriptive analytics is the base for effective application of predictive or prescriptive analytics and the descriptive analytics segment is thus anticipated to lead the market.
By application, the healthcare fraud detection market has been segmented into insurance claims review and payment integrity. The insurance claims review segment has been further segmented into post-payment review and prepayment review.
By end-user, the healthcare fraud detection market has been segmented into private insurance payers, government agencies, employers, and others.
Healthcare Fraud Detection Software Market Regional Analysis
Region-wise, the healthcare fraud detection market has been segmented into the Americas, the Middle East & Africa (MEA), Europe, and Asia Pacific (APAC).
The Americas is governing the global fraud detection market. The rising number of fraudulent activities in the region, along with government initiatives to curb frauds in the healthcare sector is boosting the growth of the market. Increased spending on healthcare IT, the presence of major players in the region, and technological advancements in the region are other driving factors.
The spiraling rise in the number of healthcare forgery and corruption incidents in Europe has significantly driven the healthcare fraud detection market in the region. The governments in the region are endeavoring to integrate IT into the healthcare infrastructure and are outlaying significant amounts on the same.
APAC healthcare fraud detection market is slated to expand at a torrid pace over the forecast period. Swiftly developing healthcare sector, surging incidence rate of cybercrimes in the region, and increased investment in healthcare IT are propelling the growth of the market in APAC.
The MEA market is likely to capture the least share of the market over the forecast period. The majority of the market growth is anticipated to be cornered towards the Middle East, where investments are being poured in for the development of the healthcare sector due to rising incidences of health insurance frauds.
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Healthcare Fraud Detection Market Competitive Landscape
International Business Machines Corporation (IBM), Wipro, HCL Technologies, SAS Institute, Northrop Grumman, McKesson, Fair Isaac, Scio Health Analytics, Pondera Solutions, Conduent, Optum, Verscend Technologies, LexisNexis, DXC Technology, and CGI Group are the eminent players in the healthcare fraud detection market.
Healthcare Fraud Detection Industry Updates
August 2019 - Deep Labs, am AI-driven technology company partnered with Visual Connections, provider of a spectrum of cutting-edge IT services and solutions, to develop AI-driven healthcare fraud detection system.
National Healthcare Anti-Fraud Association opines that most of such frauds are committed by a small number of healthcare providers and mostly by organized crime groups.
Healthcare fraud detection market has found impetus in the fact that healthcare fraud results in higher costs for patients, reduces profit margins of payers, and causes havoc for taxpayer dollars that support public health insurance companies.According to experts, though the size of the U.S. healthcare industry is nearly $2.7 trillion, much of the revenue is wasted through mismanagement and fraud.
Apparently, fraudulent billing leads to nearly 3%-10% of annual healthcare costs in the U.S. To restrain this increasing tendency for healthcare fraud, government as well as private agencies are resorting to solutions based on AI and predictive analysis that is expected to add impetus to Healthcare Fraud Detection Software Market.
The global healthcare fraud detection market is expected to register a CAGR of 28.83% to reach USD 3,787.68 million by 2024.Different segments of healthcare fraud detection market and growth implications:The healthcare fraud detection market has been segmented into type, component, application, delivery model and end user.Healthcare fraud detection market classification on the basis of descriptive analytics, prescriptive analytics and predictive analytics.
It reflects total revenue generated per patient, monthly sales growth and yearly pricing changes, thus precise maintenance of related records.
Since the information can analyze the revenue cycle it is considered an efficient means of healthcare fraud.Predictive analytics is yet another type of fraud detection technique that is built upon past data which includes fraud or non-fraud indicators as well as different elements such as bill amount, number of patients, treatment characteristics, years of experience of the doctor, reporting lags and the number of patient visits.On the basis of component, the market has been bifurcated into services and software.
The global Healthcare Fraud Detection Market is expected to reach USD 2,242.7 Million by 2022 from USD 631.0 Million in 2017, at a CAGR of 28.9%.
The Research report provides a detailed overview of the major drivers, restraints, challenges, opportunities, current market trends, and strategies impacting the Healthcare Fraud Detection Market, along with revenue estimates & forecasts and market share analysis.The growth of the market is attributed to a large number of fraudulent activities in healthcare; increasing number of patients seeking health insurance; the prepayment review model; growing pressure of fraud, waste, and abuse on healthcare spending; and high returns on investment.Download PDF Brochure: https://www.marketsandmarkets.com/pdfdownloadNew.asp?id=221837663 Healthcare Fraud Detection Market segmentation: Based on Type Based on Component Based on Delivery Model Based on Application Based on End Users Based on RegionsThe Major Players Opearting in the Healthcare Fraud Detection Market:Key players in the Healthcare Fraud Detection Market include IBM (US), Optum (US), SAS (US), McKesson (US), SCIO (US), Verscend (US), Wipro (India), Conduent (US), HCL (India), CGI (Canada), DXC (US), Northrop Grumman (US), LexisNexis (US), and Pondera (US).IBM was the leading player in the global Healthcare Fraud Detection Market.
The company has a strong presence in North America, Europe, Asia, and Latin America.The company has a strong presence in the commercial and government healthcare payer markets.
Moreover, it has a strong sales and distribution network in more than 175 countries.
IBM invests heavily in research activities to continuously improve its product portfolio.The company focuses on inorganic strategies like acquisitions and partnerships.
For instance, in April 2016, IBM acquired Truven (US), a provider of cloud-based healthcare data, analytics, and insights.
