Healthcare Fraud Analytics Market: Role of AI in Healthcare Fraud Detection

Posted by Kriti on May 27th, 2021

The research study involves four major activities in estimating the healthcare fraud analytics market. Exhaustive secondary research was conducted to collect information on the adoption of different technologies and their regional adoption. Data obtained through secondary research was further validated by industry experts through primary research. Furthermore, the market size estimates and forecast provided in this study are derived through a mix of the bottom-up approach (studying the FWA savings incurred by adopting analytics in USD billion) and top-down approach (parent market analysis & assessment of adoption/penetration trends, by solution type, delivery model, application, end user, and region). Thereafter, market breakdown and data triangulation methods were used to estimate the market size of segments and subsegments.

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Major Market Growth Drivers:

Market growth can be attributed to the large number of fraudulent activities in healthcare; the increasing number of patients seeking health insurance; high returns on investment; and rising pharmacy claim-related frauds. However, the dearth of skilled personnel is likely to restrain the growth of Healthcare Fraud Detection Market.

Revenue Growth Analysis:

[144 Pages Report]The healthcare fraud analytics market is projected to reach USD 4.6 billion by 2025 from USD 1.2 billion in 2020, at a CAGR of 29.8%.

Browse and in-depth TOC on" Healthcare Fraud Analytics Market"

105 – Tables
32 – Figures
144 – Pages

The descriptive analytics segment dominated the healthcare fraud analytics market in 2019

The Healthcare Fraud Detection Market is segmented based on solution type, delivery model, application, and end user. Based on the solution type, the descriptive analytics segment accounted for the largest share of the market in 2019. Descriptive analytics forms the base for the effective application of predictive or prescriptive analytics. Hence, these analytics use the basics of descriptive analytics and integrate them with additional sources of data in order to produce meaningful insights.

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By application, the insurance claims review segment accounted for the largest share of the Healthcare Fraud Detection Market in 2019

On the basis of application, the Healthcare Fraud Analytics Solutions Market is segmented into insurance claims review, pharmacy billing misuse, payment integrity, and other applications. In 2019, the insurance claims review segment dominated the healthcare fraud analytics market. The increasing number of patients seeking health insurance, the rising number of fraudulent claims, and the growing adoption of the prepayment review model are expected to drive the growth of this segment in the coming years.

North America will dominate the healthcare fraud analytics market from 2020–2025

Geographically, the global healthcare fraud detection market is segmented into North America, Europe, the Asia Pacific, Latin America, and the Middle East and Africa. North America accounted for the largest share of the market in 2019. The high share of the North American market is attributed to the large number of people having health insurance, growing healthcare fraud, favorable government anti-fraud initiatives, the pressure to reduce healthcare costs, technological advancements, and greater product and service availability in this region.

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Key Healthcare Fraud Analytics Solutions Market Players:

The key players operating in the global Healthcare Fraud Analytics Market areInternational Business Machines Corporation (IBM) (US), Optum, Inc. (Optum) (US), SAS Institute, Inc. (SAS) (US), Change Healthcare(US), EXL Service Holdings, Inc. (EXL) (US), Cotiviti (US), Wipro Limited (Wipro) (India), Conduent, Inc. (Conduent) (US), Hindustan Computers Limited Technologies Limited (HCL) (India), Canadian Global Information Technology Group Inc. (CGI) (Canada), DXC Technology Company (DXC) (US), Northrop Grumman Corporation (Northrop Grumman) (US), LexisNexis Group (LexisNexis) (US), Pondera Solutions (Pondera) (US), WhiteHatAI (US), Healthcare Fraud Shield (US), FraudLens (US), HMS (US), and FraudScope (US).