El mercado de análisis de fraude sanitario se valoró en 1.331,09 millones de dólares en 2019 y se prevé que alcance los 8.707,73 millones de dólares en 2027; se espera que crezca a una tasa compuesta anual del 27,0% de 2020 a 2027.
El fraude en la atención médica es un tipo de delito de cuello blanco que incluye la presentación de informes de atención médica deshonestos. afirma obtener ganancias. La mayoría del fraude en la atención médica es cometido por grupos del crimen organizado y una pequeña minoría de proveedores de atención médica fraudulentos. Los tipos más comunes de fraude en la atención médica incluyen la facturación de servicios o procedimientos más costosos, la tergiversación de tratamientos no cubiertos, fraudes de seguros y otros. El crecimiento del mercado mundial de análisis de fraude en atención médica se atribuye al creciente número de casos de fraude en todas las industrias y al crecimiento de la industria de seguros médicos en los EE. UU. Sin embargo, las preocupaciones con respecto a los análisis de fraude sanitario son el principal factor que obstaculiza el crecimiento del mercado.
Se espera que el mercado mundial de análisis de fraude sanitario experimente un crecimiento sustancial después de la pandemia. El COVID-19 ha afectado a las economías e industrias de varios países debido a cierres, prohibiciones de viaje y cierres de empresas. La crisis de la COVID-19 ha sobrecargado los sistemas de salud pública en muchos países y ha puesto de relieve la gran necesidad de realizar inversiones sostenibles en los sistemas de salud. A medida que avanza la pandemia de COVID-19, se espera que la industria de la salud experimente una caída en su crecimiento. El segmento de ciencias biológicas prospera debido a la mayor demanda de productos de diagnóstico in vitro y al aumento de las actividades de investigación y desarrollo en todo el mundo. Sin embargo, el segmento de tecnologías médicas e imágenes está experimentando una caída en las ventas debido a un menor número de cirugías realizadas y a retrasos o prolongaciones en la adquisición de equipos. Además, se espera que las consultas virtuales realizadas por profesionales de la salud se conviertan en el modelo principal de prestación de atención después de la pandemia. Dado que la telesalud está transformando la prestación de atención, la salud digital seguirá prosperando en los próximos años. Además, también se espera que la interrupción de los ensayos clínicos y el consiguiente retraso en el lanzamiento de medicamentos allanen el camino para ensayos totalmente virtuales en el futuro. Se espera que surjan nuevas tecnologías como el ARNm y que cambien la industria farmacéutica y también se espera que el mercado sea testigo de una mayor integración vertical y empresas conjuntas en los próximos años.
Regiones lucrativas para el mercado global de análisis de fraude sanitario
Perspectivas del mercadoLa creciente industria de seguros médicos en los EE. UU. impulsará el crecimiento del mercado global de análisis de fraude en la atención médica
El fraude en seguros médicos es un engaño deliberado cometido contra una compañía o agente de seguros para obtener ganancias financieras. Los fraudes son cometidos en diferentes puntos de transacción por parte de los solicitantes, asegurados, terceros reclamantes o profesionales de la salud que ofrecen servicios a los reclamantes. A veces, los agentes de seguros, así como los empleados de la empresa, también pueden cometer fraude de seguros. Los fraudes comunes en los seguros de salud incluyen la manipulación de reclamos legítimos, la exageración de los hechos en una solicitud de seguro, la presentación de reclamos por enfermedades o lesiones que nunca ocurrieron y la simulación de accidentes.
En el En Estados Unidos existen más de 900 compañías de seguros de salud que ofrecen cobertura médica. Además, el número de personas con cobertura de seguro médico en Estados Unidos es elevado. Según el informe Cobertura de seguro médico en Estados Unidos: 2018, en el año 2018, aproximadamente el 91,5% de la población tiene seguro médico. El informe también mencionó que, en 2018, la cobertura de seguro médico privado era más frecuente en EE. UU. que la cobertura pública, alrededor del 67,3% de la población tenía cobertura de seguro médico privado y el 34,4% tenía cobertura pública. Entre los subtipos, el seguro basado en el empleador fue la cobertura de seguro médico más común y representó el 55,1 % de la población.
Debido a la creciente industria de seguros médicos y al creciente número de seguros médicos fraudes, se espera que la demanda de soluciones de análisis de fraudes en atención médica aumente durante el período de pronóstico.
Información basada en soluciones
En términos de solución, El mercado mundial de análisis de fraude sanitario se segmenta en análisis predictivo, análisis descriptivo y análisis prescriptivo. En 2019, el segmento de análisis predictivo tuvo la mayor participación del mercado. Además, se estima que el mismo segmento registrará la CAGR más alta durante el período de pronóstico.
Mercado global de análisis de fraude en atención médica, por solución: 2019 y 2027
Información basada en el modo de prestación
Según el modo de prestación, la atención sanitaria mundial El mercado de análisis de fraude está segmentado en modelos de entrega locales y modelos de entrega basados en la nube. El segmento de modelos de entrega local tuvo la mayor participación de mercado en 2019. Sin embargo, se estima que el segmento de modelos de entrega basados en la nube registrará la CAGR más alta durante el período de pronóstico.
Información basada en aplicaciones
Basado en la aplicación, el mercado global de análisis de fraude en atención médica se segmenta en revisión de reclamaciones de seguros, uso indebido de facturación de farmacias, integridad de pagos, robo de identidad médica y otras aplicaciones. El segmento de reclamaciones de seguros tuvo la mayor participación de mercado en 2019. Además, se estima que el mismo segmento registrará la CAGR más alta durante el período de pronóstico.
Información basada en el usuario final
En términos de usuario final, el mercado global de análisis de fraude en atención médica está segmentado en agencias gubernamentales, pagadores de seguros privados, proveedores de servicios externos y empleadores. El segmento de agencias gubernamentales tuvo la mayor participación del mercado en 2019, y se estima que el mismo segmento registrará la CAGR más alta durante el período de pronóstico.
Perspectivas estratégicas
Los actores del mercado global de análisis de fraude sanitario están adoptando estrategias de expansión y lanzamiento de productos para satisfacer las cambiantes demandas de los clientes en todo el mundo, lo que también les permite mantener su marca a nivel mundial.
Mercado global de análisis de fraude sanitario: por solución
- Análisis predictivo
- Análisis descriptivo
- Análisis prescriptivo
Mercado global de análisis de fraude sanitario: por modo de entrega
- Modelos de entrega local
- Modelos de entrega basados en la nube
Atención sanitaria global Mercado de análisis de fraude: por aplicación
- Revisión de reclamaciones de seguros
- Uso indebido de facturación de farmacia
- Integridad de pago
- Robo de identidad médica
- Otras aplicaciones
- Agencias gubernamentales
- Pagadores de seguros privados
- Proveedores de servicios externos
- América del Norte
- Estados Unidos
- Canadá
- México
< li>Europa - Francia
- Alemania
- Italia
- Reino Unido
- España
- Resto de Europa
- Asia Pacífico (APAC)
- China
- India
- Corea del Sur
- Japón
- Australia
- Resto de APAC
- Medio Oriente y Asia África (MEA)
- Sudáfrica
- Arabia Saudita
- EAU
- Resto de MEA
- Suramérica y Centroamérica (SCAM)
- Brasil
- Argentina
- Resto de SCAM
< /ul> - Conduent Inc.
- Tecnología DXC
- Scioinspire, Corp.
- Optum, Inc.
- SAS Institute
- Pondera Solutions
- Lexisnexis Risk Solutions
- Fair, Isaac and Company(FICO)
- Cotiviti, Inc.
- Whitehatai
Mercado global de análisis de fraude sanitario: por usuario final
- < li>Empleadores
Mercado global de análisis de fraude sanitario: por Geografía
Perfiles de la empresa
Report Coverage
Revenue forecast, Company Analysis, Industry landscape, Growth factors, and Trends
Segment Covered
This text is related
to segments covered.
Regional Scope
North America, Europe, Asia Pacific, Middle East & Africa, South & Central America
Country Scope
This text is related
to country scope.
Frequently Asked Questions
Healthcare fraud is a kind of white-collar crime that includes the filing of dishonest health care claims to turn a profit. The majority of health care fraud is committed by organized crime groups and a small minority of fraudulent health care providers. The most common types of health care fraud include billing for more expensive services or procedures, misrepresenting non-covered treatments, insurance frauds, and others.
factors such as rising number of healthcare fraudulent cases across the globe and growing health insurance industry are expected to boost the market growth over the years. Moreover, growing hospital industry is likely to have a positive impact on the growth of the market in coming years.
As per the Global Health Care Anti-Fraud Network, each year approximately US$ 260 billion (180 billion euros) or about 6 percent of the global total health care expenditure is lost to fraud. The number of healthcare frauds is increasing in the US. Some government and law enforcement agencies also estimated that healthcare frauds cost around 10% of the total annual health expenditure, which could be around US $300 billion.
The List of Companies – Global Healthcare Fraud Analytics Market
- Conduent Inc.
- DXC Technology
- Scioinspire, Corp.
- FICO
- Optum, Inc.
- SAS Institute
- Pondera Solutions
- Lexisnexis Risk Solutions
- Whitehatai
- Cotiviti, Inc.
The Insight Partners performs research in 4 major stages: Data Collection & Secondary Research, Primary Research, Data Analysis and Data Triangulation & Final Review.
- Data Collection and Secondary Research:
As a market research and consulting firm operating from a decade, we have published and advised several client across the globe. First step for any study will start with an assessment of currently available data and insights from existing reports. Further, historical and current market information is collected from Investor Presentations, Annual Reports, SEC Filings, etc., and other information related to company’s performance and market positioning are gathered from Paid Databases (Factiva, Hoovers, and Reuters) and various other publications available in public domain.
Several associations trade associates, technical forums, institutes, societies and organization are accessed to gain technical as well as market related insights through their publications such as research papers, blogs and press releases related to the studies are referred to get cues about the market. Further, white papers, journals, magazines, and other news articles published in last 3 years are scrutinized and analyzed to understand the current market trends.
- Primary Research:
The primarily interview analysis comprise of data obtained from industry participants interview and answers to survey questions gathered by in-house primary team.
For primary research, interviews are conducted with industry experts/CEOs/Marketing Managers/VPs/Subject Matter Experts from both demand and supply side to get a 360-degree view of the market. The primary team conducts several interviews based on the complexity of the markets to understand the various market trends and dynamics which makes research more credible and precise.
A typical research interview fulfils the following functions:
- Provides first-hand information on the market size, market trends, growth trends, competitive landscape, and outlook
- Validates and strengthens in-house secondary research findings
- Develops the analysis team’s expertise and market understanding
Primary research involves email interactions and telephone interviews for each market, category, segment, and sub-segment across geographies. The participants who typically take part in such a process include, but are not limited to:
- Industry participants: VPs, business development managers, market intelligence managers and national sales managers
- Outside experts: Valuation experts, research analysts and key opinion leaders specializing in the electronics and semiconductor industry.
Below is the breakup of our primary respondents by company, designation, and region:
Once we receive the confirmation from primary research sources or primary respondents, we finalize the base year market estimation and forecast the data as per the macroeconomic and microeconomic factors assessed during data collection.
- Data Analysis:
Once data is validated through both secondary as well as primary respondents, we finalize the market estimations by hypothesis formulation and factor analysis at regional and country level.
- Macro-Economic Factor Analysis:
We analyse macroeconomic indicators such the gross domestic product (GDP), increase in the demand for goods and services across industries, technological advancement, regional economic growth, governmental policies, the influence of COVID-19, PEST analysis, and other aspects. This analysis aids in setting benchmarks for various nations/regions and approximating market splits. Additionally, the general trend of the aforementioned components aid in determining the market's development possibilities.
- Country Level Data:
Various factors that are especially aligned to the country are taken into account to determine the market size for a certain area and country, including the presence of vendors, such as headquarters and offices, the country's GDP, demand patterns, and industry growth. To comprehend the market dynamics for the nation, a number of growth variables, inhibitors, application areas, and current market trends are researched. The aforementioned elements aid in determining the country's overall market's growth potential.
- Company Profile:
The “Table of Contents” is formulated by listing and analyzing more than 25 - 30 companies operating in the market ecosystem across geographies. However, we profile only 10 companies as a standard practice in our syndicate reports. These 10 companies comprise leading, emerging, and regional players. Nonetheless, our analysis is not restricted to the 10 listed companies, we also analyze other companies present in the market to develop a holistic view and understand the prevailing trends. The “Company Profiles” section in the report covers key facts, business description, products & services, financial information, SWOT analysis, and key developments. The financial information presented is extracted from the annual reports and official documents of the publicly listed companies. Upon collecting the information for the sections of respective companies, we verify them via various primary sources and then compile the data in respective company profiles. The company level information helps us in deriving the base number as well as in forecasting the market size.
- Developing Base Number:
Aggregation of sales statistics (2020-2022) and macro-economic factor, and other secondary and primary research insights are utilized to arrive at base number and related market shares for 2022. The data gaps are identified in this step and relevant market data is analyzed, collected from paid primary interviews or databases. On finalizing the base year market size, forecasts are developed on the basis of macro-economic, industry and market growth factors and company level analysis.
- Data Triangulation and Final Review:
The market findings and base year market size calculations are validated from supply as well as demand side. Demand side validations are based on macro-economic factor analysis and benchmarks for respective regions and countries. In case of supply side validations, revenues of major companies are estimated (in case not available) based on industry benchmark, approximate number of employees, product portfolio, and primary interviews revenues are gathered. Further revenue from target product/service segment is assessed to avoid overshooting of market statistics. In case of heavy deviations between supply and demand side values, all thes steps are repeated to achieve synchronization.
We follow an iterative model, wherein we share our research findings with Subject Matter Experts (SME’s) and Key Opinion Leaders (KOLs) until consensus view of the market is not formulated – this model negates any drastic deviation in the opinions of experts. Only validated and universally acceptable research findings are quoted in our reports.
We have important check points that we use to validate our research findings – which we call – data triangulation, where we validate the information, we generate from secondary sources with primary interviews and then we re-validate with our internal data bases and Subject matter experts. This comprehensive model enables us to deliver high quality, reliable data in shortest possible time.
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