Healthcare Fraud Analytics Market by Solution Type (Descriptive, Predictive, and Prescriptive), Deployment (On-premise and Cloud), Application, and Region - Global Industry Analysis, Opportunities and Forecast up to 2029

Healthcare Fraud Analytics Market Size

The global Healthcare Fraud Analytics market size was valued at $2.56 billion in 2023 and is projected to reach $9.76 billion by 2029, growing at a CAGR of 25.0% during the forecast period. 

Healthcare Fraud Analytics Market Dynamics

• Rise in the spending on the healthcare sector by the potential population, changing customer preferences, increasing investment in developing the healthcare infrastructure and developing patient demographics are contributing to the market's growth. 

• Additionally, the increasing prevalence of chronic disease and epidemic infections and the growing geriatric population base, who are vulnerable to diseases and disorders is pushing demand for healthcare insurance. This, in turn, escalates the risks of healthcare fraud, pushing the market growth.

• However, the growth of the market is hampered mainly due to a limited skilled workforce for utilizing the features and fraud analytics, higher cost of deployment especially for the small and medium enterprises, and growing risk of data security.

Healthcare Fraud Analytics Market Overview

Fraud is known as the unlawful action performed by the association prompting an infringement of guidelines determined to acquire a higher benefit. Fraud has been a typical term in numerous ventures though in medical services it incorporates unlawful or criminal trickery done in tranquilizing fabricating, nature of the item, clinical practice, and asserting health care coverage. Misrepresentation of hospital expenses, control of clinical records for expanded clinical repayment, off base analysis are a portion of the normal Fraud that occurs in the medical care area. This Fraud can't follow and regularly goes unreported prompting higher monetary misfortune to the protection and medical organizations. In this manner, the requirement for Fraud analytics comes right into it. Medical services extortion investigation helps the different medical services associations utilize prescient information approaches in bookkeeping and inspecting activities.

By Solution Type, the Descriptive Segment Emerge as the Dominant Segment

The Descriptive segment emerged as the dominant segment during the forecast period. The growth of the segment is attributed to the increasing use of descriptive analytics for analyzing various healthcare decisions and their consequences on service performance, clinical outcomes, and results. In healthcare applications, descriptive analytics forms the base for the effective application of prescriptive or predictive analytics. Henceforth, these analytics make use of the basics of descriptive analytics and integrate them with additional sources of data to produce meaningful insights.

By Geography, North America Region is Growing at a Faster Pace

North America accounted for the largest share of this market 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. The increasing fraud cases accounting for the large financial losses are pushing insurance companies to adopt healthcare fraud analytics solutions. As per the estimations of the National Health Care Anti-Fraud Association, healthcare fraud costs the US about USD 68 billion per annum. Growing government initiatives and support through Medicaid, Medicare, and other healthcare programs along with growing insurance firms in the US are propelling the demand for fraud analytics.

Some of the Key Players Profiled in the Report Include:

• CGI Group, Inc.
• Change Healthcare
• Cotiviti, Inc
• DXC Technology
• FraudScope
• HCL Technologies Limited
• IBM Corporation
• McKesson Corporation
• Northrop Grumman Corporation
• Optum, Inc
• Qlarant, Inc
• SAS Institute, Inc.
• Wipro Limited

What Can be Explored with this Research Report:

• Understand the key trends that will drive the market and the challenges it faces in the current market scenario.
• Identify growth opportunities.
• Porter’s five force analysis.
• In-depth analysis of market segments, and regions/countries predicted to observe promising growth.
• Historical and forecast size of the market in terms of revenue (USD Million).
• Company profiling with key products and solution offerings, key financial information, SWOT analysis, and business strategies adopted.

Market Segmentation:

The research report includes in-depth coverage of the industry analysis with size, share, and forecast for the below segments:

Market by, Solution Type:
• Descriptive
• Predictive
• Prescriptive

Market by, Deployment:
• On-premise
• Cloud

Market by, Application:
• Insurance Claim
• Payment Integrity
• Pharmacy Billing Misuse

Market by, Geography:

The Healthcare Fraud Analytics Market report also analyzes the major geographic regions and countries for the market. The regions and countries covered in the study include:

• North America (The United States, Canada, Mexico), Market Estimates, Forecast & Opportunity Analysis
• Europe (Germany, France, UK, Italy, Spain, Rest of Europe), Market Estimates, Forecast & Opportunity Analysis
• Asia Pacific (China, Japan, India, South Korea, Australia, New Zealand, Rest of Asia Pacific), Market Estimates, Forecast & Opportunity Analysis
• South America (Brazil, Argentina, Chile, Rest of South America), Market Estimates, Forecast & Opportunity Analysis
• Middle East & Africa (UAE, Saudi Arabia, Qatar, Iran, South Africa, Rest of Middle East & Africa), Market Estimates, Forecast & Opportunity Analysis.

Table Of Content

1 Market Overview             
    1.1 Introduction         
    1.2 Research Objectives        
    1.3 Market Segmentation        
    1.4 Stakeholders         
    1.5 List of Acronyms         
               
2 Executive Summary             
               
3 Research Methodology            
    3.1 Identification of Data        
    3.2 Evaluation of Market Dynamics       
    3.3 Collaboration of Data        
    3.4 Verification and Analysis        
    3.5 Data Sources         
    3.6 Assumptions         
               
4 Market Dynamics             
    4.1 Market Drivers          
           4.1.1 Rising Number of the Geriatric Population
           4.1.2 Growth in Healthcare Expenditure
           4.1.3 Rise in Pharmacy Claims-Related Fraud
    4.2 Market Restraints         
           4.2.1 Limitations in the Data Capturing Process in Medicaid Services
    4.3 Market Opportunities        
           4.3.1 Increasing Private and Government Investment
    4.4 Market Challenges         
           4.4.1 Supply-Demand Fluctuations 
    4.5 Impact of COVID-19 on Healthcare Fraud Analytics Market     
               
5 Porter's Five Force Analysis            
    5.1 Bargaining Power of Suppliers        
    5.2 Bargaining Power of Buyers        
    5.3 Threat of New Entrants        
    5.4 Threat of Substitutes        
    5.5 Competitive Rivalry in the Market       
               
6 Global Healthcare Fraud Analytics Market by, Solution Type         
    6.1 Overview         
    6.2 Descriptive         
    6.3 Predictive         
    6.4 Prescriptive         
                
7 Global Healthcare Fraud Analytics Market by, Deployment         
    7.1 Overview         
    7.2 On-premise         
    7.3 Cloud          
               
8 Global Healthcare Fraud Analytics Market by, Application         
    8.1 Overview         
    8.2 Insurance Claim         
    8.3 Payment Integrity         
    8.4 Pharmacy Billing Misuse        
               
9 Global Healthcare Fraud Analytics Market by, Geography         
    9.1 Overview         
    9.2 North America         
             9.2.1 US 
             9.2.2 Canada 
             9.2.3 Mexico 
    9.3 Europe          
             9.3.1 Germany 
             9.3.2 France 
             9.3.3 UK 
             9.3.4 Italy 
             9.3.5 Spain 
             9.3.6 Rest of Europe
    9.4 Asia Pacific         
             9.4.1 China 
             9.4.2 Japan 
             9.4.3 India 
             9.4.4 South Korea
             9.4.5 Australia 
             9.4.6 New Zealand
             9.4.7 Rest of Asia Pacific
    9.5 South America         
             9.5.1 Brazil 
             9.5.2 Argentina
             9.5.3 Chile 
             9.5.4 Rest of South America
    9.6 Middle East & Africa        
             9.6.1 UAE 
             9.6.2 Saudi Arabia
             9.6.3 Qatar 
             9.6.4 Iran 
             9.6.5 South Africa
             9.6.6 Rest of Middle East & Africa
               
10 Key Developments             
               
11 Company Profiling              
    11.1 CGI Group, Inc.         
             11.1.1 Business Overview
             11.1.2 Product/Service Offering
             11.1.3 Financial Overview
             11.1.4 SWOT Analysis
             11.1.5 Key Activities
    11.2 Change Healthcare         
    11.3 Cotiviti, Inc         
    11.4 DXC Technology         
    11.5 FraudScope         
    11.6 HCL Technologies Limited        
    11.7 IBM Corporation         
    11.8 McKesson Corporation        
    11.9 Northrop Grumman Corporation       
    11.10 Optum, Inc         
    11.11 Qlarant, Inc         
    11.12 SAS Institute, Inc.         
    11.13 Wipro Limited