The healthcare fraud analytics market was valued at US$ 1,331.09 million in 2019 and it is projected to reach US$ 8,707.73 million in 2027; it is expected to grow at a CAGR of 27.0% from 2020 to 2027.
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. The growth of the global healthcare fraud analytics market is attributed to the increasing number of fraud cases across all industries, and growing health insurance industry in the US. However, concerns regarding healthcare fraud analytics is the major factor hindering the market growth.
The global healthcare fraud analytics market is expected to witness substantial growth post-pandemic. The COVID-19 has affected economies and industries in various countries due to lockdowns, travel bans, and business shutdowns. The COVID-19 crisis has overburdened public health systems in many countries and highlighted the strong need for sustainable investment in health systems. As the COVID-19 pandemic progresses, the healthcare industry is expected to see a drop in growth. The life sciences segment thrives due to increased demand for invitro diagnostic products and rising research and development activities worldwide. However, the medical technologies and imaging segment is witnessing drop in sales due to a smaller number of surgeries being carried out and delayed or prolonged equipment procurement. Additionally, virtual consultations by healthcare professionals are expected to become the mainstream care delivery model post-pandemic. With telehealth transforming care delivery, digital health will continue to thrive in coming years. In addition, disrupted clinical trials and the subsequent delay in drug launches is also expected to pave the way for entirely virtual trials in the future. New technologies such as mRNA is expected to emerge and shift the pharmaceutical industry and market is also expected to witness more vertical integration and joint ventures in coming years.
Lucrative Regions for Global Healthcare Fraud Analytics Market
- Sample PDF showcases the content structure and the nature of the information with qualitative and quantitative analysis.
- Sample PDF showcases the content structure and the nature of the information with qualitative and quantitative analysis.
Market Insights
Growing Health Insurance Industry in the US to Drive Global Healthcare Fraud Analytics Market Growth
Health insurance fraud is a deliberate deception committed against an insurance company or agent to achieve financial gain. Frauds are committed at different transaction points by the applicants, policyholders, third-party claimants, or healthcare professionals who offer services to claimants. Sometimes insurance agents, as well as company employees, may also commit insurance fraud. Common health insurance frauds include padding that is manipulating the legitimate claims, exaggerating the facts on an insurance application, submitting claims for diseases or injuries that never occurred, and staging accidents.
In the United States, there are more than 900 health insurance companies that offer medical coverage. Moreover, the number of people with health insurance coverage in the United States is high. As per the report Health Insurance Coverage in the United States: 2018, in the year 2018, approximately 91.5% of the population has health insurance. The report also mentioned that, in 2018, private health insurance coverage was more prevalent in the US than public coverage, about 67.3% of the population had private health insurance coverage and 34.4% had public coverage. Among the subtypes, employer-based insurance was the most common health insurance coverage accounting for 55.1 % of the population.
Owing to the growing health insurance industry and the rising number of health insurance frauds, the demand for healthcare fraud analytics solutions is expected to increase during the forecast period.
Solution - Based Insights
In terms of solution, the global healthcare fraud analytics market is segmented into predictive analytics, descriptive analytics, and prescriptive analytics. In 2019, the predictive analytics segment held largest share of the market. Moreover, the same segment is estimated to register the highest CAGR during the forecast period.
Global Healthcare Fraud Analytics Market, by Solution – 2019 and 2027
- Sample PDF showcases the content structure and the nature of the information with qualitative and quantitative analysis.
- Sample PDF showcases the content structure and the nature of the information with qualitative and quantitative analysis.
Mode of Delivery-Based Insights
Based on mode of delivery, the global healthcare fraud analytics market is segmented into on-premise delivery models, and cloud-based delivery models. The on-premise delivery models segment held the largest market share in 2019. However, cloud based delivery models segment is estimated to register the highest CAGR during the forecast period.
Application-Based Insights
Based on application, the global healthcare fraud analytics market is segmented into insurance claims review, pharmacy billing misuse, payment integrity, medical identity theft and other applications. The insurance claims segment held the largest market share in 2019. Also, the same segment is estimated to register the highest CAGR during the forecast period.
End User-Based Insights
In terms of end user, the global healthcare fraud analytics market is segmented into government agencies, private insurance payers, third-party service providers, and employers. The government agencies segment held the largest share of the market in 2019, and the same segment is estimated to register the highest CAGR during the forecast period.
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Healthcare Fraud Analytics Market: Strategic Insights
Market Size Value in US$ 1,331.09 Million in 2019 Market Size Value by US$ 8,707.73 Million by 2027 Growth rate CAGR of 27.0% from 2020-2027 Forecast Period 2020-2027 Base Year 2020
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We can optimize and tailor the analysis and scope which is unmet through our standard offerings. This flexibility will help you gain the exact information needed for your business planning and decision making.
Healthcare Fraud Analytics Market: Strategic Insights
| Market Size Value in | US$ 1,331.09 Million in 2019 |
| Market Size Value by | US$ 8,707.73 Million by 2027 |
| Growth rate | CAGR of 27.0% from 2020-2027 |
| Forecast Period | 2020-2027 |
| Base Year | 2020 |
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Akshay will walk you through a 15-minute call to present the report’s content and answer all queries if you have any.
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The global healthcare fraud analytics market players are adopting the product launch and expansion strategies to cater to changing customer demands worldwide, which also allows them to maintain their brand name globally.
Global Healthcare Fraud Analytics Market – by Solution
- Predictive Analytics
- Descriptive Analytics
- Prescriptive Analytics
Global Healthcare Fraud Analytics Market – by Mode of Delivery
- On-Premise Delivery Models
- Cloud Based Delivery Models
Global Healthcare Fraud Analytics Market – by Application
- Insurance Claims Review
- Pharmacy Billing Misuse
- Payment Integrity
- Medical Identity Theft
- Other Applications
Global Healthcare Fraud Analytics Market – by End- User
- Government Agencies
- Private Insurance Payers
- Third-party Service Providers
- Employers
Global Healthcare Fraud Analytics Market – by Geography
North America
- US
- Canada
- Mexico
Europe
- France
- Germany
- Italy
- UK
- Spain
- Rest of Europe
Asia Pacific (APAC)
- China
- India
- South Korea
- Japan
- Australia
- Rest of APAC
Middle East & Africa (MEA)
- South Africa
- Saudi Arabia
- UAE
- Rest of MEA
South America and Central America (SCAM)
- Brazil
- Argentina
- Rest of SCAM
Company Profiles
- Conduent Inc.
- DXC Technology
- Scioinspire, Corp.
- Optum, Inc.
- SAS Institute
- Pondera Solutions
- Lexisnexis Risk Solutions
- Fair, Isaac and Company(FICO)
- Cotiviti, Inc.
- Whitehatai
Report Coverage
Revenue forecast, Company Analysis, Industry landscape, Growth factors, and Trends
Segment Covered
Solution ; Mode of Delivery ; Application ; End User and Geography.
Regional Scope
North America, Europe, Asia Pacific, Middle East & Africa, South & Central America
Country Scope
Argentina, Australia, Brazil, Canada, China, France, Germany, India, Italy, Japan, Mexico, RoMEA, RoSCAM, Saudi Arabia, South Africa, South Korea, Spain, United Arab Emirates, United Kingdom, United States
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.
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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.
- 3.1 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.
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- 3.3 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.
- 3.4 Developing Base Number:
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- 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.
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