Healthcare Fraud Analytics Market: Role of AI in Healthcare Fraud Detection
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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analyst for a discussion on the above findings, click Speak to Analyst
Key Healthcare Fraud Analytics Solutions Market
Players:
The key players operating in the
global Healthcare Fraud Analytics Market are International 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).
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