US Healthcare Fraud Analytics Market to Grow at a CAGR of 27.4% to reach US$ 3,483.12 Mn from 2019 to 2027

US Healthcare Fraud Analytics Market to 2027 - Country Analysis and Forecasts by Solution (Predictive Analytics, Descriptive Analytics, Prescriptive Analytics); Mode of Delivery (On-Premise Delivery Models, Cloud-Based Delivery Models); Application (Insurance Claims Review, Pharmacy Billing Misuse, Payment Integrity, Medical Identity Theft, Other Applications); End User (Government Agencies, Private Insurance Payers, Third-party Service Providers, Employers)

  • Report Code : TIPRE00009215
  • Category : Healthcare IT
  • Status : Published
  • No. of Pages : 77
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The US Healthcare Fraud Analytics market is expected to reach US$ 3,483.12 Mn in 2027 from US$ 517.28 Mn in 2019. The market is estimated to grow with a CAGR of 27.4% from 2020-2027.

The key factor that are responsible for the growth of market include increasing number of healthcare fraudulent cases in the us and growing health insurance industry in the us; however, concerns regarding healthcare fraud analytics may hinder the growth of the healthcare fraud analytics market during the forecast period.

The healthcare industry is susceptible to a wide range of frauds that will lead to financial losses. Healthcare fraud is a large contributor to unnecessary costs and the rise in spending in the US healthcare industry. The financial loss can be declined by deploying artificial intelligence (AI) tools to prevent and detect fraud. AI is capable of analyzing the huge amount of data generated in the healthcare organization and flags the fraud before it starts. The technology is adaptive enough to help tackle fraud at any of its stages. Thus the adoption of AI in healthcare fraud detection is likely to experience the positive outcomes in the coming future.

US Healthcare Fraud Analytics Market Revenue and Forecasts to 2027 (US$ Mn)

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Market Insights

Increasing Number of Healthcare Fraudulent Cases in the US

Most of the healthcare frauds are committed by the small number of fraudulent healthcare providers, and in some cases, by people who are pretending to be legitimate healthcare providers. Unfortunately, the actions of these few deceitful individuals ultimately harms the reputation of the most trusted and respected healthcare professionals. The number of healthcare frauds is increasing in the US. The Department of Justice (DoJ) in January 2019, announced that around US$2.5 billion of the total US$2.8 billion were recovered under the False Claims Act in the US. The most significant monetary recoveries in the year 2018 were from medical device and drug industries. Also, the National Health Care Anti-Fraud Association (NHCAA) estimated that every year, losses due to healthcare frauds are in the tens of billions of dollars. Some government and law enforcement agencies also estimated that healthcare frauds cost around 10% of the total annual health expenditure, which could be around US$ 300 billion. Thus, an increasing number of fraudulent healthcare cases is likely to demand healthcare fraud analytics solutions.

Solution Insights

US healthcare fraud analytics market by product is segmented into predictive analytics, descriptive analytics, and prescriptive analytics. In 2019, the predictive analytics segment held the largest market share of the healthcare fraud analytics market, by product. This segment is also anticipated to dominate the market in 2027 owing analytics detection and identification patterns which are potentially fraudulent and it then develops sets of rules to flag potentially fraudulent claims. Also, the segment is anticipated to witness growth at a significant rate during the forecast period.


US Healthcare Fraud Analytics, by Solution

,

2019 & 2027

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Mode of Delivery Insights

The US healthcare fraud analytics market by mode of delivery is segmented into on-premise delivery models, cloud-based delivery models. The US healthcare fraud analytics market is dominated by on-premise delivery models segment in 2019 with a considerable market share by mode of delivery. This segment is also predicted to dominate the market in 2027. However, cloud-based delivery models segment is anticipated to witness growth at a significant rate during the forecast period, 2019 to 2027, because it is an extremely manageable alternative which helps in the accessing real-time information.

Application Insights

The US healthcare fraud analytics market by application is segmented into insurance claims review, pharmacy billing misuse, payment integrity, medical identity theft, and other applications. In 2019, the insurance claims review held a largest market share of the healthcare fraud analytics market, by the application. This segment is also predicted to dominate the market in 2027 because it is very common and costly to the healthcare insurance system when fraud is detected and the number of health insurance frauds are increasing every year.

End User Insights

The US healthcare fraud analytics market by end user is segmented into government agencies, private insurance payers, third-party service providers, and employers. In 2019, the government agencies held a largest market share of the healthcare fraud analytics market, by the end user. This segment is also predicted to dominate the market in 2027 because data analytics solutions helped the government to detect and identify the Medicare claims for expensive cancer genetic tests, leading to the charges against 35 people.

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US Healthcare Fraud Analytics Market: Strategic Insights

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The companies operating in the   market have been implementing various strategies to grow in their corresponding markets; this has, in turn, enabled them to bring various changes in the market. The companies have utilized strategies such as product launches, of their product portfolio and acquisitions for the growth of their organizations.

US Healthcare Fraud Analytics – Market Segmentation

US Healthcare Fraud Analytics Market – By

Solution

  • Predictive Analytics
  • Descriptive Analytics
  • Prescriptive Analytics

US Healthcare Fraud Analytics Market – By Mode of Delivery

  • On-Premise Delivery Models
  • Cloud Based Delivery Models

US Healthcare Fraud Analytics Market – By Application

  • Insurance Claims Review
  • Pharmacy Billing Misuse
  • Payment Integrity
  • Identity Theft
  • Other Applications

Companies Mentioned

  • Conduent Inc.
  • DXC Technology
  • Scioinspire, Corp.
  • FICO
  • Optum, Inc.
  • SAS Institute
  • Pondera Solutions
  • Lexisnexis Risk Solutions
  • Whitehatai
  • Cotiviti, Inc
Report Coverage
Report Coverage

Revenue forecast, Company Analysis, Industry landscape, Growth factors, and Trends

Segment Covered
Segment Covered

This text is related
to segments covered.

Regional Scope
Regional Scope

North America, Europe, Asia Pacific, Middle East & Africa, South & Central America

Country Scope
Country Scope

This text is related
to country scope.

The List of Companies - US Healthcare Fraud Analytics Market

  1. Conduent Inc.
  2. DXC Technology
  3. Scioinspire, Corp.
  4. FICO
  5. Optum, Inc.
  6. SAS Institute
  7. Pondera Solutions
  8. Lexisnexis Risk Solutions
  9. Whitehatai
  10. Cotiviti, Inc

The Insight Partners performs research in 4 major stages: Data Collection & Secondary Research, Primary Research, Data Analysis and Data Triangulation & Final Review.

  1. Data Collection and Secondary Research:

As a market research and consulting firm operating from a decade, we have published many reports and advised several clients 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 organizations 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 the last 3 years are scrutinized and analyzed to understand the current market trends.

  1. 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/Sales 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:

Research Methodology

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.

  1. 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.

  • 3.2 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.

  • 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:

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.

  1. 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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