Healthcare Fraud Detection Market Size 2021 By Share, Industry Statistics, Trends Evaluation, Business Challenges and Investment Opportunities Analysis till 2027

 

The Global Healthcare Fraud Detection Market is expected to increase enormously by 2027. Healthcare fraud has led to a significant addition of expenses in the healthcare system. As per GAO (General Accounting Office), ‘federal spending on major health care programs to grow from 5.9% of GDP in the fiscal year 2020 to 8% of GDP in the fiscal year 2050.

The demand for healthcare fraud detection is increasing on account of rising patients number applying for health insurance, an increase in the number of frauds in pharmacy bills and government initiative to reduce heathcare fraud etc. Social media influence on the healthcare industry, speedy acceptance of cloud-based analytical solutions, AI effects in the healthcare services, and increase in the number of fraud identity management software, would further propel the market growth. However, some of the restraints the market witness includes lack of skilled personnel, reluctance to adopt healthcare fraud analytics paired with high upfront cost of deployment.

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COVID-19 proposes an occupational risk to healthcare workers; thousands of healthcare workers worldwide have been infected by COVID-19. The prevention of the intra-hospital spreading of communicable infections has become a major concern for governmental bodies and healthcare institutions. Data privacy and confidentiality has become a serious concern for both individuals and organizations operating in the healthcare sector. Healthcare data are considered more sensitive, compared to other types of data, as any data tampering can lead to faulty treatment, with fatal and irreversible losses to patients. For instance, programs such as the Medicare Fraud Strike Force (OIG 2017), endorsed to help reduce fraud, but continued efforts are necessary to better alleviate the effects of fraud in the healthcare sector.

Based on components, the market is fragmented into Services and Software. For instance, healthcare cloud has launched patient analytics software for the tracking of patient outcomes and utilizes extensive database and proprietary analytics to recommend procedures based on patient comorbidities. Based on delivery models, the market is bifurcated into on-premises and on-demand delivery model. On-premise delivery model is expected to record highest growth owing to high flexibility, pay-as-you-go pricing, and the lack of upfront capital investments for hardware. As per Nutanix in 2019, the healthcare’s cloud spends on Azure and AWS was 93% and 11% respectively. Based on solutions type, the market is divided into descriptive analytics, predictive analytics, and prescriptive analytics. Descriptive analytics holds the major share owing to its high assistance in predictive and prescriptive analytics. For instance, Vidence and NTT DATA announced a partnership to deliver predictive analytics in oncology. This collaboration will make use of a combination of medical imaging scans, clinical and outcomes data to build a predictive model that will improve treatment regimens.

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Based on applications, the market is segmented into insurance claims, payment integrity, pharmacy bill and others. Care Shield insurance announced the launch of Care Shield, which will cover numerous medical expenses and the protection of No Claim Bonus (NCB) benefit from lapsing. Based on end-user, the market is fragmented into private insurance payers, government agencies, third-party service providers, and others. Government agencies hold the largest share on account of rising fraudulent activities coupled with the emerging need for data theft prevention. For instance, Criminal Division, Fraud Section’s Health Care Fraud (HCF) Unit is comprised of more than 70 prosecutors whose core mission is to prosecute health care fraud-related cases involving patient harm and huge financial loss.

For a better understanding of the adoption of Healthcare Fraud Analytics, the market is analyzed based region/ countries including North America (US, Canada, and the Rest of North America), Europe (Germany, France, Italy, Spain, UK and Rest of Europe), Asia-Pacific (China, Japan, India, Australia, and Rest of APAC), and Rest of World. As per the National Healthcare Anti-Fraud Association (NHCAA), health care fraud costs the U.S. nearly US$68 billion every year. Some of the major players operating in the market include IBM Corporation, Optum, Inc., COTIVITI, INC., McKesson Corporation, Fair Isaac Corporation, SAS Institute Inc., SCIO Inspire, Corp., Conduent, Inc., HCL Technologies Limited, CGI Inc., DXC Technology Company, and Northrop Grumman, etc. Several M&As along with partnerships have been undertaken by these players to boost their presence in different regions.

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Global Healthcare Fraud Detection Market Segmentation

Market Insight, by Component

·       Services

·       Software

Market Insight, by Delivery Models

·       On-Premise Delivery

·       On-Demand Delivery

Market Insight, by Solutions Type

·       Descriptive Analytics

·       Predictive Analytics

·       Prescriptive Analytics

Market Insight, by Application

·       Insurance Claims

·       Payment Integrity

·       Pharmacy Bill

·       Others

Market Insight, by End-User

·       Private Insurance Payers

·       Government Agencies

·       Third-party service providers

·       Others

Market Insight, by Region

·       North America Healthcare Fraud Detection Market

o   United States

o   Canada

o   Rest of North America

·       Europe Healthcare Fraud Detection Market

o   France

o   United Kingdom

o   Germany

o   Spain

o   Italy

o   Rest of Europe

·       Asia-Pacific Healthcare Fraud Detection Market

o   China

o   Japan

o   India

o   Australia

o   Rest of Asia-Pacific

·       Rest of World Healthcare Fraud Detection Market

Company Profiled

·       IBM Corporation

·       Optum, Inc.

·       COTIVITI, INC.

·       McKesson Corporation

·       Fair Isaac Corporation

·       SAS Institute Inc.

·       SCIO Inspire, Corp.

·       Conduent, Inc.

·       HCL Technologies Limited

·       CGI Inc.

·       DXC Technology Company

·       Northrop Grumman