The "Healthcare Fraud Analytics Market by Solution Type (Descriptive, Predictive, Prescriptive), Application (Insurance Claim, Payment Integrity), Delivery (On-premise, Cloud), End User (Government, Employers, Payers), COVID-19 Impact - Global Forecast to 2026" report has been added to ResearchAndMarkets.com's offering.
The global healthcare fraud analytics market is projected to reach USD 5.0 billion by 2026 from USD 1.5 billion in 2021, at a CAGR of 26.7% during the forecast period.
Market growth can be attributed to a large number of fraudulent activities in healthcare, the increasing a number of patients seeking health insurance, high returns on investment, and the rising number of pharmacy claims-related frauds. However, the dearth of skilled personnel is expected to restrain the growth of this market.
The on-demand segment is expected to grow at the highest CAGR during the forecast period.
On the basis of the delivery model, the healthcare fraud analytics market is segmented into on-premise and on-demand models. The on-demand models include the cloud-based and web-based models. The on-demand segment is projected to register the highest CAGR during the forecast period. Factors such as on-demand self-serving analytics, the lack of up-front capital investments for hardware, extreme capacity flexibility, and a pay-as-you-go pricing model are driving the demand for on-demand fraud detection solutions.
The prepayment review model segment is projected to witness the highest growth during the forecast period.
On the basis of application, the healthcare fraud analytics market is segmented into insurance claims review, pharmacy billing misuse, payment integrity, and other applications. The insurance claims review segment is further divided into post payment and prepayment review, with the latter expected to register the highest growth during the forecast period.
This is mainly because the use of prepayment review protocols and analytics can help organizations proactively prevent fraud prior to payment, allowing rapid action to be taken. As a result, prepayment review solutions are expected to garner greater attention in the coming years.
North America accounted for the largest share of the healthcare fraud analytics market.
North America accounted for the largest share of this market in 2020 majorly due to the high penetration of health insurance in the region, a high number of healthcare fraud cases, favorable government initiatives to combat healthcare fraud, and wider product and service availability in this region. Moreover, a majority of leading players in the healthcare fraud analytics market have their headquarters in North America
Premium Insights
- Large Number of Fraudulent Activities in Healthcare to Drive Market Growth
- Descriptive Analytics Segment Accounted for the Largest Share of the Asian Healthcare Fraud Analytics Market in 2020
- US to Register the Highest Revenue Growth During Forecast Period
- North America Will Continue to Dominate the Market in 2026
- Developed Markets to Register Higher Growth During Forecast Period
Market Dynamics
Drivers
- Large Number of Fraudulent Activities in Healthcare
- Increased Number of Patients Seeking Health Insurance
- Prepayment Review Model
- High Returns on Investment
- Rise in Pharmacy Claims-Related Fraud
Restraints
- Limitations in the Data Capturing Process in Medicaid Services
Opportunities
- Adoption of Healthcare Fraud Analytics in Developing Countries
- Emergence of Social Media and Its Impact on the Healthcare Industry
- Role of Ai in Healthcare Fraud Detection
Challenges
- Dearth of Skilled Personnel
- Time-Consuming Deployment and the Need for Frequent Upgrades
Industry Trends
- Mergers and Acquisitions: The Most Adopted Strategy
- Technological Advancements
- New Use Case: Opioid Epidemic Crisis
- End-User Trends: Adoption of Healthcare Fraud Analytics Solutions by Pharmacy Benefit Managers
Companies Mentioned
- CGI Inc.
- Change Healthcare
- Codoxo
- Conduent Incorporated
- Cotiviti, Inc.
- DXC Technology
- Exlservice Holdings, Inc.
- Fair Isaac Corporation
- Fraudlens, Inc.
- Friss
- H2O.Ai
- HCL Technologies Limited
- Healthcare Fraud Shield
- HMS Holdings Corp.
- IBM Corporation
- Lexisnexis (A Part of Relx Group)
- Multiplan
- Northrop Grumman Corporation
- Optum, Inc. (A Part of UnitedHealth Group)
- OSP Labs
- Pondera Solutions, Inc. (A Subsidiary of Thomson Reuters Corporation)
- Qlarant, Inc.
- SAS Institute Inc.
- Sharecare, Inc. (A Subsidiary of Falcon Capital Acquisition Corp.)
- Wipro Limited
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View source version on businesswire.com: https://www.businesswire.com/news/home/20211027005893/en/
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