Healthcare Fraud Detection Market to 2025 - Global Analysis and Forecasts by Delivery Model (On-Premise Delivery Models and On-Demand Delivery Models), By Component (Services and Software), By Type (Predictive Analytics, Prescriptive Analytics and Descriptive Analytics), By Application (Insurance Claims Review, Payment Integrity and Other Applications), and End-User (Public/Government Agencies, Private Insurance Payers, Private Insurance Payers and Employers)
Healthcare fraud are difficult to detect and are generally go unnoticed, therefore detection of such fraudulent claims is necessary, as they increase burden on the society. The use of fraud detection solution enable healthcare firms in accounting, and auditing by predictive data methodologies. Careful account auditing can reveal suspicious providers and policy holders and detect potential fraudulent cases before it occurs.
Large number of fraudulent activities in healthcare, rising number of patients opting health insurance, prepayment review model, increasing pressure of fraud and abuse on healthcare spending is expected to drive the growth of the market. Moreover, increasing adoption of cloud-based analytics, emergence of social media and its impact on the healthcare industry, artificial intelligence (AI) in healthcare fraud detection is expected to provide opportunity for the growth of healthcare fraud detection market during the forecast period.
The "Global Healthcare Fraud Detection Market Analysis to 2025" is a specialized and in-depth study of the healthcare fraud detection industry with a focus on the global market trend. The report aims to provide an overview of global healthcare fraud detection market with detailed market segmentation by delivery model, component, type, application, end user, and geography. The global healthcare fraud detection market is expected to witness high growth during the forecast period. The report provides key statistics on the market status of the leading market players and offers key trends and opportunities in the market.
The healthcare fraud detection market is segmented based on delivery model as, on-premise delivery models and on-premise delivery models. On the basis of component healthcare fraud detection market is segmented into services and software. Based on type, healthcare fraud detection market is segmented into predictive analytics, prescriptive analytics and descriptive analytics. On the basis of application, healthcare fraud detection market is segmented into insurance claims review, payment integrity and other applications. Based on the end user the market is segmented as public/government agencies, private insurance payers, third-party service providers and employers.
The report provides a detailed overview on the industry including both qualitative and quantitative information. It provides overview and forecast of the global healthcare fraud detection market based on delivery model, component, type, application, and end user. It also provides market size and forecast till 2025 for overall healthcare fraud detection market with respect to five major regions, namely; North America, Europe, Asia-Pacific (APAC), Middle East and Africa (MEA) and South & Central America. The market by each region is later sub-segmented by respective countries and segments. The report covers analysis and forecast of 13 countries globally along with current trend and opportunities prevailing in the region.
North America is anticipated to hold largest share of the healthcare fraud detection market, followed by Europe. Factors such as rise in the number of people adopting health insurance, rising cases of healthcare fraud, favorable government initiatives to combat healthcare fraud, rising pressure to reduce healthcare costs, and greater product and service availability are expected to drive market growth in this region. Moreover, Asia Pacific is expected to grow at a fastest rate during the analysis period due to increasing awareness, improving healthcare infrastructure and growing investment in the healthcare technology.
The report analyzes factors affecting market from both demand and supply side and further evaluates market dynamics effecting the market during the forecast period i.e., drivers, restraints, opportunities, and future trend. The report also provides exhaustive PEST analysis for all five regions namely; North America, Europe, APAC, MEA and South & Central America after evaluating political, economic, social and technological factors effecting the market in these regions.
The report also includes the profiles of key healthcare fraud detection companies along with their SWOT analysis and market strategies. In addition, the report focuses on leading industry players with information such as company profiles, products and services offered, financial information of last 3 years, key development in past five years. Some of the key players influencing the market Verscend Technologies, Inc., Fair Isaac Corporation, SAS Institute Inc., SCIOInspire, Corp., Wipro Limited, IBM Corporation, Conduent, Inc., HCL Technologies Limited, CGI Group Inc., and McKesson Corporation.
1 Introduction
1.1 Scope of Study
1.2 The Insight Partners Research Report Guidance
2 Key Takeaways
3 Healthcare Fraud Detection Market Landscape
3.1 Market Overview
3.2 Market Segmentation
3.2.1 Healthcare Fraud Detection Market - By Delivery Model
3.2.2 Healthcare Fraud Detection Market - By Component
3.2.3 Healthcare Fraud Detection Market - By Type
3.2.4 Healthcare Fraud Detection Market - By Application
3.2.5 Healthcare Fraud Detection Market - By End User
3.2.6 Healthcare Fraud Detection Market - By Region
3.2.6.1 By Country
3.3 PEST Analysis
3.3.1 North America - PEST Analysis
3.3.2 Europe - PEST Analysis
3.3.3 Asia Pacific - PEST Analysis
3.3.4 Middle East and Africa - PEST Analysis
3.3.5 South and Central America - PEST Analysis
4 Healthcare Fraud Detection Market - Key Industry Dynamics
4.1 Key Market Drivers
4.2 Key Market Restraints
4.3 Key Market Opportunities
4.4 Future Trends
4.5 Impact Analysis
5 Healthcare Fraud Detection Market - Global Analysis
5.1 Global Healthcare Fraud Detection Market Overview
5.2 Global Healthcare Fraud Detection Market Revenue Forecasts and Analysis (US$ Mn)
5.3 Market Positioning/Market Share
5.4 Performance of Key Players
5.5 Expert Opinions
6 Healthcare Fraud Detection Market -Global Regulatory Scenario
7 Healthcare Fraud Detection Market Revenue and Forecasts to 2025 - Delivery Model (US$ Mn)
7.1 Overview
7.2 Delivery Model Market Forecasts and Analysis
7.3 On-Premise Delivery Models Market
7.3.1 Overview
7.3.2 On-Premise Delivery Models Market Revenue Forecasts and Analysis (US$ Mn)
7.4 On-Demand Delivery Models Market
7.4.1 Overview
7.4.2 On-Demand Delivery Models Market Revenue Forecasts and Analysis (US$ Mn)
8 Healthcare Fraud Detection Market Revenue and Forecasts to 2025 - Component (US$ Mn)
8.1 Overview
8.2 Component Market Forecasts and Analysis
8.3 Services Market
8.3.1 Overview
8.3.2 Services Market Revenue Forecasts and Analysis (US$ Mn)
8.4 Software Market
8.4.1 Overview
8.4.2 Software Market Revenue Forecasts and Analysis (US$ Mn)
9 Healthcare Fraud Detection Market Revenue and Forecasts to 2025 - Type (US$ Mn)
9.1 Overview
9.2 Type Market Forecasts and Analysis
9.3 Predictive Analytics Market
9.3.1 Overview
9.3.2 Predictive Analytics Market Revenue Forecasts and Analysis (US$ Mn)
9.4 Prescriptive Analytics Market
9.4.1 Overview
9.4.2 Prescriptive Analytics Market Revenue Forecasts and Analysis (US$ Mn)
9.5 Descriptive Analytics Market
9.5.1 Overview
9.5.2 Descriptive Analytics Market Revenue Forecasts and Analysis (US$ Mn)
10 Healthcare Fraud Detection Market Revenue and Forecasts to 2025 - Application (US$ Mn)
10.1 Overview
10.2 Application Market Forecasts and Analysis
10.3 Insurance Claims Review Market
10.3.1 Overview
10.3.2 Insurance Claims Review Market Revenue Forecasts and Analysis (US$ Mn)
10.4 Payment Integrity Market
10.4.1 Overview
10.4.2 Payment Integrity Market Revenue Forecasts and Analysis (US$ Mn)
10.5 Other Applications Market
10.5.1 Overview
10.5.2 Other Applications Market Revenue Forecasts and Analysis (US$ Mn)
11 Healthcare Fraud Detection Market Revenue and Forecasts to 2025 - End User (US$ Mn)
11.1 Overview
11.2 End User Market Forecasts and Analysis
11.3 Public/Government Agencies Market
11.3.1 Overview
11.3.2 Public/Government Agencies Market Revenue Forecasts and Analysis (US$ Mn)
11.4 Private Insurance Payers Market
11.4.1 Overview
11.4.2 Private Insurance Payers Market Revenue Forecasts and Analysis (US$ Mn)
11.5 Third-Party Service Providers Market
11.5.1 Overview
11.5.2 Third-Party Service Providers Market Revenue Forecasts and Analysis (US$ Mn)
11.6 Employers Market
11.6.1 Overview
11.6.2 Employers Market Revenue Forecasts and Analysis (US$ Mn)
12 North America Healthcare Fraud Detection Market Revenue and Forecasts to 2025 - Country Analysis
12.1 North America Healthcare Fraud Detection Market Overview
12.2 North America Healthcare Fraud Detection Market Revenue Forecasts and Analysis (US$ Mn)
12.3 North America Market Forecasts and Analysis - By Delivery Model (US$ Mn)
12.4 North America Market Forecasts and Analysis - By Component (US$ Mn)
12.5 North America Market Forecasts and Analysis - By Type (US$ Mn)
12.6 North America Market Forecasts and Analysis - By Application (US$ Mn)
12.7 North America Market Forecasts and Analysis - By End User (US$ Mn)
12.8 North America Market Forecasts and Analysis - By Country
12.9 US Market Overview
12.9.1 US Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Delivery Model (US$ Mn)
12.9.2 US Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Component (US$ Mn)
12.9.3 US Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Type (US$ Mn)
12.9.4 US Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Application (US$ Mn)
12.9.5 US Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By End User (US$ Mn)
12.10 Canada Market Overview
12.10.1 Canada Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Delivery Model (US$ Mn)
12.10.2 Canada Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Component (US$ Mn)
12.10.3 Canada Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Type (US$ Mn)
12.10.4 Canada Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Application (US$ Mn)
12.10.5 Canada Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By End User (US$ Mn)
12.11 Mexico Market Overview
12.11.1 Mexico Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Delivery Model (US$ Mn)
12.11.2 Mexico Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Component (US$ Mn)
12.11.3 Mexico Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Type (US$ Mn)
12.11.4 Mexico Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Application (US$ Mn)
12.11.5 Mexico Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By End User (US$ Mn)
13 Europe Healthcare Fraud Detection Market Revenue and Forecasts to 2025 - Country Analysis
13.1 Europe Healthcare Fraud Detection Market Overview
13.2 Europe Healthcare Fraud Detection Market Revenue Forecasts and Analysis (US$ Mn)
13.3 Europe Market Forecasts and Analysis - By Delivery Model (US$ Mn)
13.4 Europe Market Forecasts and Analysis - By Component (US$ Mn)
13.5 Europe Market Forecasts and Analysis - By Type (US$ Mn)
13.6 Europe Market Forecasts and Analysis - By Application (US$ Mn)
13.7 Europe Market Forecasts and Analysis - By End User (US$ Mn)
13.8 Europe Market Forecasts and Analysis - By Country
13.9 UK Market Overview
13.9.1 UK Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Delivery Model (US$ Mn)
13.9.2 UK Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Component (US$ Mn)
13.9.3 UK Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Type (US$ Mn)
13.9.4 UK Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Application (US$ Mn)
13.9.5 UK Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By End User (US$ Mn)
13.10 Germany Market Overview
13.10.1 Germany Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Delivery Model (US$ Mn)
13.10.2 Germany Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Component (US$ Mn)
13.10.3 Germany Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Type (US$ Mn)
13.10.4 Germany Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Application (US$ Mn)
13.10.5 Germany Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By End User (US$ Mn)
13.11 France Market Overview
13.11.1 France Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Delivery Model (US$ Mn)
13.11.2 France Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Component (US$ Mn)
13.11.3 France Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Type (US$ Mn)
13.11.4 France Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Application (US$ Mn)
13.11.5 France Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By End User (US$ Mn)
14 Asia Pacific Healthcare Fraud Detection Market Revenue and Forecasts to 2025 - Country Analysis
14.1 Asia Pacific Healthcare Fraud Detection Market Overview
14.2 Asia Pacific Healthcare Fraud Detection Market Revenue Forecasts and Analysis (US$ Mn)
14.3 Asia Pacific Market Forecasts and Analysis - By Delivery Model (US$ Mn)
14.4 Asia Pacific Market Forecasts and Analysis - By Component (US$ Mn)
14.5 Asia Pacific Market Forecasts and Analysis - By Type (US$ Mn)
14.6 Asia Pacific Market Forecasts and Analysis - By Application (US$ Mn)
14.7 Asia Pacific Market Forecasts and Analysis - By End User (US$ Mn)
14.8 Asia Pacific Market Forecasts and Analysis - By Country
14.9 China Market Overview
14.9.1 China Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Delivery Model (US$ Mn)
14.9.2 China Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Component (US$ Mn)
14.9.3 China Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Type (US$ Mn)
14.9.4 China Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Application (US$ Mn)
14.9.5 China Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By End User (US$ Mn)
14.10 Japan Market Overview
14.10.1 Japan Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Delivery Model (US$ Mn)
14.10.2 Japan Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Component (US$ Mn)
14.10.3 Japan Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Type (US$ Mn)
14.10.4 Japan Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Application (US$ Mn)
14.10.5 Japan Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By End User (US$ Mn)
14.11 India Market Overview
14.11.1 India Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Delivery Model (US$ Mn)
14.11.2 India Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Component (US$ Mn)
14.11.3 India Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Type (US$ Mn)
14.11.4 India Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Application (US$ Mn)
14.11.5 India Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By End User (US$ Mn)
15 Middle East & Africa (MEA) Healthcare Fraud Detection Market Revenue and Forecasts to 2025 - Country Analysis
15.1 Middle East & Africa (MEA) Healthcare Fraud Detection Market Overview
15.2 Middle East & Africa (MEA) Healthcare Fraud Detection Market Revenue Forecasts and Analysis (US$ Mn)
15.3 Middle East & Africa (MEA) Market Forecasts and Analysis - By Delivery Model (US$ Mn)
15.4 Middle East & Africa (MEA) Market Forecasts and Analysis - By Component (US$ Mn)
15.5 Middle East & Africa (MEA) Market Forecasts and Analysis - By Type (US$ Mn)
15.6 Middle East & Africa (MEA) Market Forecasts and Analysis - By Application (US$ Mn)
15.7 Middle East & Africa (MEA) Market Forecasts and Analysis - By End User (US$ Mn)
15.8 Middle East & Africa (MEA) Market Forecasts and Analysis - By Country
15.9 UAE Market Overview
15.9.1 UAE Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Delivery Model (US$ Mn)
15.9.2 UAE Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Component (US$ Mn)
15.9.3 UAE Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Type (US$ Mn)
15.9.4 UAE Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Application (US$ Mn)
15.9.5 UAE Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By End User (US$ Mn)
15.10 Saudi Arabia Market Overview
15.10.1 Saudi Arabia Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Delivery Model (US$ Mn)
15.10.2 Saudi Arabia Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Component (US$ Mn)
15.10.3 Saudi Arabia Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Type (US$ Mn)
15.10.4 Saudi Arabia Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Application (US$ Mn)
15.10.5 Saudi Arabia Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By End User (US$ Mn)
15.11 South Africa Market Overview
15.11.1 South Africa Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Delivery Model (US$ Mn)
15.11.2 South Africa Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Component (US$ Mn)
15.11.3 South Africa Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Type (US$ Mn)
15.11.4 South Africa Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Application (US$ Mn)
15.11.5 South Africa Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By End User (US$ Mn)
16 South and Central America Healthcare Fraud Detection Market Revenue and Forecasts to 2025 - Country Analysis
16.1 South and Central America Healthcare Fraud Detection Market Overview
16.2 South and Central America Healthcare Fraud Detection Market Revenue Forecasts and Analysis (US$ Mn)
16.3 South and Central America Market Forecasts and Analysis - By Delivery Model (US$ Mn)
16.4 South and Central America Market Forecasts and Analysis - By Component (US$ Mn)
16.5 South and Central America Market Forecasts and Analysis - By Type (US$ Mn)
16.6 South and Central America Market Forecasts and Analysis - By Application (US$ Mn)
16.7 South and Central America Market Forecasts and Analysis - By End User (US$ Mn)
16.8 South and Central America Market Forecasts and Analysis - By Country
16.9 Brazil Market Overview
16.9.1 Brazil Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Delivery Model (US$ Mn)
16.9.2 Brazil Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Component (US$ Mn)
16.9.3 Brazil Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Type (US$ Mn)
16.9.4 Brazil Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By Application (US$ Mn)
16.9.5 Brazil Healthcare Fraud Detection Market Revenue Forecasts and Analysis- By End User (US$ Mn)
17 Industry Landscape
17.1 Organic Growth Strategies
17.1.1 New Product Launches
17.1.2 Marketing & Promotional Activities
17.2 Inorganic Growth Strategies
17.2.1 Partnerships, Collaborations, and Joint Ventures
17.2.2 Mergers & Acquisitions
18 Healthcare Fraud Detection Market, Key Company Profiles
18.1 Verscend Technologies, Inc.
18.1.1 Key Facts
18.1.2 Business Description
18.1.3 Financial Overview
18.1.4 Product/Service Portfolio
18.1.5 SWOT Analysis
18.1.6 Key Developments
18.1.7 Company Clientele
18.2 Fair Isaac Corporation
18.2.1 Key Facts
18.2.2 Business Description
18.2.3 Financial Overview
18.2.4 Product/Service Portfolio
18.2.5 SWOT Analysis
18.2.6 Key Developments
18.2.7 Company Clientele
18.3 SAS Institute Inc.
18.3.1 Key Facts
18.3.2 Business Description
18.3.3 Financial Overview
18.3.4 Product/Service Portfolio
18.3.5 SWOT Analysis
18.3.6 Key Developments
18.3.7 Company Clientele
18.4 SCIOInspire, Corp.
18.4.1 Key Facts
18.4.2 Business Description
18.4.3 Financial Overview
18.4.4 Product/Service Portfolio
18.4.5 SWOT Analysis
18.4.6 Key Developments
18.4.7 Company Clientele
18.5 Wipro Limited
18.5.1 Key Facts
18.5.2 Business Description
18.5.3 Financial Overview
18.5.4 Product/Service Portfolio
18.5.5 SWOT Analysis
18.5.6 Key Developments
18.5.7 Company Clientele
18.6 IBM Corporation
18.6.1 Key Facts
18.6.2 Business Description
18.6.3 Financial Overview
18.6.4 Product/Service Portfolio
18.6.5 SWOT Analysis
18.6.6 Key Developments
18.6.7 Company Clientele
18.7 Conduent, Inc.
18.7.1 Key Facts
18.7.2 Business Description
18.7.3 Financial Overview
18.7.4 Product/Service Portfolio
18.7.5 SWOT Analysis
18.7.6 Key Developments
18.7.7 Company Clientele
18.8 HCL Technologies Limited
18.8.1 Key Facts
18.8.2 Business Description
18.8.3 Financial Overview
18.8.4 Product/Service Portfolio
18.8.5 SWOT Analysis
18.8.6 Key Developments
18.8.7 Company Clientele
18.9 CGI Group Inc.
18.9.1 Key Facts
18.9.2 Business Description
18.9.3 Financial Overview
18.9.4 Product/Service Portfolio
18.9.5 SWOT Analysis
18.9.6 Key Developments
18.9.7 Company Clientele
18.10 McKesson Corporation
18.10.1 Key Facts
18.10.2 Business Description
18.10.3 Financial Overview
18.10.4 Product/Service Portfolio
18.10.5 SWOT Analysis
18.10.6 Key Developments
18.10.7 Company Clientele
19 Appendix
19.1 About The Insight Partners
19.2 Glossary of Terms
19.3 Research Methodology
The List of Companies
1. Verscend Technologies, Inc.
2. Fair Isaac Corporation
3. SAS Institute Inc.
4. SCIOInspire, Corp.
5. Wipro Limited
6. IBM Corporation
7. Conduent, Inc.
8. HCL Technologies Limited
9. CGI Group Inc.
10. McKesson Corporation