GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET 2019-2028

Lifesciences | Healthcare IT

GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET 2019-2028

Market By Type, Application, End-user And Geography | Forecast 2019-2028

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Triton Market Research predicts that the global market for healthcare fraud analytics and detection would witness a CAGR of 23.63% over the forecast period 2019-2028. The market that was assessed to be worth $812.15 million in the year 2019, is predicted to generate a revenue of approximately $5480.25 million by 2028.



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The healthcare fraud analytics and detection market has witnessed a steady growth owing to a surge in demand for healthcare expenditure and raised demand for health insurance. Healthcare fraud detection is becoming increasingly essential because healthcare frauds are not easily understandable. There are currently three types of analytics named descriptive, predictive and prescriptive analytics, that are used for fraud detection technology.

Triton Market Research’s report on the healthcare fraud analytics and detection market provides in-depth insights into the market. The detailed analysis of the market includes key market insights, Porter’s five force analysis and market attractiveness index.

Factors such as the rising demand for healthcare expenditure is driving the overall market growth. Emerging countries are witnessing an increase in healthcare expenditure, thereby impacting the fraud detection market, owing to the rise in insurance facilities provided to healthcare payers. According to the National Healthcare Anti-Fraud Association (NHCAA), $2.27 trillion were spent on healthcare and around 4 billion health insurance claims were recorded in the United States.

Moreover, a rise in the number of consumers opting for healthcare insurance is fueling the market growth. In developing countries, like India, the number of health insurances being claimed is increasing, and this trend may continue in the near future. As per the United States Census Bureau, the percentage of people with health insurance coverage, for all or part of 2017, was 91.2%, in the United States. Most of the people across developing countries are becoming aware of the insurance claims, and there is a considerable rise in the number of people opting for health insurance.

However, high costs levied on fraud detection software are hampering the market growth. The initial venture and cost of retaining fraud detection systems are high due to the incorporation of quality hardware.



Key geographies covered in the global healthcare fraud analytics and detection market are:

           North America: United States and Canada

           Europe: United Kingdom, France, Germany, Spain, Italy, Russia and Rest of Europe 

           Asia-Pacific: China, Japan, India, Australia, South Korea, ASEAN Countries and Rest of Asia-Pacific

           Latin America: Brazil, Mexico and Rest of Latin America

           Middle East and Africa: Saudi Arabia, Turkey, United Arab Emirates, South Africa and Rest of Middle East & Africa

The segmentation analysis of the healthcare fraud analytics and detection market includes:

           Market by Type:

o          Descriptive Analysis

o          Predictive Analysis

o          Prescriptive Analysis

           Market by Application:

o          Review of Insurance Claims

o          Payment Integrity

           Market by End-user:

o          Private Insurance Payers

o          Government Agencies

o          Other End-users

The key companies profiled in the report include Northrop Grumman Corporation, UnitedHealth Group (Optum Inc), Intelligent Business Machines Corporation, Pondera Solutions, RELX Group Plc, EXL, SAS Institute Inc, McKesson Corporation, Change Healthcare, CGI Inc, Cotiviti Inc, OSP Labs, DXC Technology Company and Fair Issac Corporation.

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Table of Content

1.    GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET - SUMMARY

2.    INDUSTRY OUTLOOK

2.1. MARKET DEFINITION

2.2. KEY INSIGHTS

2.2.1.   ASIA-PACIFIC IS THE LEADING REGIONAL MARKET

2.2.2.   PRESCRIPTIVE ANALYSIS IS ANTICIPATED TO GROW AT A HIGHEST CAGR

2.2.3.   GROWING PRESSURE TO INCREASE OPERATIONAL EFFICIENCY AND REDUCE HEALTHCARE SPENDING

2.3. PORTER’S FIVE FORCE ANALYSIS

2.3.1.   THREAT OF NEW ENTRANTS

2.3.2.   THREAT OF SUBSTITUTE

2.3.3.   BARGAINING POWER OF SUPPLIERS

2.3.4.   BARGAINING POWER OF BUYERS

2.3.5.   THREAT OF COMPETITIVE RIVALRY

2.4. MARKET ATTRACTIVENESS INDEX

2.5. VENDOR SCORECARD

2.6. IMPACT OF COVID-19 ON HEALTHCARE FRAUD ANALYTICS AND DETECTION

2.7. MARKET DRIVERS

2.7.1.   SURGE IN HEALTHCARE EXPENDITURE

2.7.2.   SWELL IN THE NUMBER OF PATIENTS OPTING FOR HEALTH INSURANCE

2.8. MARKET RESTRAINTS

2.8.1.   UNWILLINGNESS TO ADOPT HEALTHCARE FRAUD ANALYTICS

2.9. MARKET OPPORTUNITIES

2.9.1.   INCREASE IN FALSE ACTIVITIES IN HEALTHCARE

2.10. MARKET CHALLENGES

2.10.1. HIGH COST OF FRAUD DETECTION AND PREVENTION SOLUTIONS

3.    GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET OUTLOOK - BY TYPE

3.1. DESCRIPTIVE ANALYSIS

3.2. PREDICTIVE ANALYSIS

3.3. PRESCRIPTIVE ANALYSIS

4.    GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET OUTLOOK - BY APPLICATION

4.1. REVIEW OF INSURANCE CLAIMS

4.2. PAYMENT INTEGRITY

5.    GLOBAL  HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET OUTLOOK - BY END-USER

5.1. PRIVATE INSURANCE PAYERS

5.2. GOVERNMENT AGENCIES

5.3. OTHER END-USERS

6.    GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET – REGIONAL OUTLOOK

6.1. NORTH AMERICA

6.1.1.   MARKET BY TYPE

6.1.2.   MARKET BY APPLICATION

6.1.3.   MARKET BY END-USER

6.1.4.   COUNTRY ANALYSIS

6.1.4.1. UNITED STATES

6.1.4.2. CANADA

6.2. EUROPE

6.2.1.   MARKET BY TYPE

6.2.2.   MARKET BY APPLICATION

6.2.3.   MARKET BY END-USER

6.2.4.   COUNTRY ANALYSIS

6.2.4.1. UNITED KINGDOM

6.2.4.2. GERMANY

6.2.4.3. FRANCE

6.2.4.4. SPAIN

6.2.4.5. ITALY

6.2.4.6. RUSSIA

6.2.4.7. REST OF EUROPE

6.3. ASIA-PACIFIC

6.3.1.   MARKET BY TYPE

6.3.2.   MARKET BY APPLICATION

6.3.3.   MARKET BY END-USER

6.3.4.   COUNTRY ANALYSIS

6.3.4.1. CHINA

6.3.4.2. JAPAN

6.3.4.3. INDIA

6.3.4.4. SOUTH KOREA

6.3.4.5. ASEAN COUNTRIES

6.3.4.6. AUSTRALIA & NEW ZEALAND

6.3.4.7. REST OF ASIA-PACIFIC

6.4. LATIN AMERICA

6.4.1.   MARKET BY TYPE

6.4.2.   MARKET BY APPLICATION

6.4.3.   MARKET BY END-USER

6.4.4.   COUNTRY ANALYSIS

6.4.4.1. BRAZIL

6.4.4.2. MEXICO

6.4.4.3. REST OF LATIN AMERICA

6.5. MIDDLE EAST AND AFRICA

6.5.1.   MARKET BY TYPE

6.5.2.   MARKET BY APPLICATION

6.5.3.   MARKET BY END-USER

6.5.4.   COUNTRY ANALYSIS

6.5.4.1. UNITED ARAB EMIRATES

6.5.4.2. TURKEY

6.5.4.3. SAUDI ARABIA

6.5.4.4. SOUTH AFRICA

6.5.4.5. REST OF MIDDLE EAST & AFRICA

7.    COMPETITIVE LANDSCAPE

7.1. CGI INC

7.2. DXC TECHNOLOGY COMPANY

7.3. EXL

7.4. INTELLIGENT BUSINESS MACHINES CORPORATION

7.5. MCKESSON CORPORATION

7.6. NORTHROP GRUMMAN CORPORATION

7.7. OSP LABS

7.8. SAS INSTITUTE INC

7.9. RELX GROUP PLC

7.10. UNITEDHEALTH GROUP (OPTUM INC)

7.11. COTIVITI INC

7.12. CHANGE HEALTHCARE

7.13. FAIR ISSAC CORPORATION

7.14. PONDERA SOLUTIONS

8.    METHODOLOGY & SCOPE

8.1. RESEARCH SCOPE

8.2. SOURCES OF DATA

8.3. RESEARCH METHODOLOGY

List of table

TABLE 1: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY GEOGRAPHY, 2019-2028 (IN $ MILLION)

TABLE 2: MARKET ATTRACTIVENESS INDEX

TABLE 3: VENDOR SCORECARD

TABLE 4: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY TYPE, 2019-2028 (IN $ MILLION)

TABLE 5: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY APPLICATION, 2019-2028 (IN $ MILLION)

TABLE 6: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY END-USER, 2019-2028 (IN $ MILLION)

TABLE 7: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY GEOGRAPHY, 2019-2028 (IN $ MILLION)

TABLE 8: NORTH AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY COUNTRY, 2019-2028 (IN $ MILLION)

TABLE 9: NORTH AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY TYPE, 2019-2028 (IN $ MILLION)

TABLE 10: NORTH AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY APPLICATION, 2019-2028 (IN $ MILLION)

TABLE 11: NORTH AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY END-USER, 2019-2028 (IN $ MILLION)

TABLE 12: EUROPE HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY COUNTRY, 2019-2028 (IN $ MILLION)

TABLE 13: EUROPE HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY TYPE, 2019-2028 (IN $ MILLION)

TABLE 14: EUROPE HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY APPLICATION, 2019-2028 (IN $ MILLION)

TABLE 15: EUROPE HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY END-USER, 2019-2028 (IN $ MILLION)

TABLE 16: ASIA-PACIFIC HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY COUNTRY, 2019-2028 (IN $ MILLION)

TABLE 17: ASIA-PACIFIC HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY TYPE, 2019-2028 (IN $ MILLION)

TABLE 18: ASIA-PACIFIC HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY APPLICATION, 2019-2028 (IN $ MILLION)

TABLE 19: ASIA-PACIFIC HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY END-USER, 2019-2028 (IN $ MILLION)

TABLE 20: LATIN AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY COUNTRY, 2019-2028 (IN $ MILLION)

TABLE 21: LATIN AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY TYPE, 2019-2028 (IN $ MILLION)

TABLE 22: LATIN AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY APPLICATION, 2019-2028 (IN $ MILLION)

TABLE 23: LATIN AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY END-USER, 2019-2028 (IN $ MILLION)

TABLE 24: MIDDLE EAST AND AFRICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY COUNTRY, 2019-2028 (IN $ MILLION)

TABLE 25: MIDDLE EAST AND AFRICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY TYPE, 2019-2028 (IN $ MILLION)

TABLE 26: MIDDLE EAST AND AFRICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY APPLICATION, 2019-2028 (IN $ MILLION)

TABLE 27: MIDDLE EAST AND AFRICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY END-USER, 2019-2028 (IN $ MILLION)

List of Figures

FIGURE 1: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY TYPE, 2018 & 2028 (IN %)

FIGURE 2: PORTER’S FIVE FORCE ANALYSIS

FIGURE 3: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY DESCRIPTIVE ANALYSIS, 2019-2028 (IN $ MILLION)

FIGURE 4: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY PREDICTIVE ANALYSIS, 2019-2028 (IN $ MILLION)

FIGURE 5: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY PRESCRIPTIVE ANALYSIS, 2019-2028 (IN $ MILLION)

FIGURE 6: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY REVIEW OF INSURANCE CLAIMS, 2019-2028 (IN $ MILLION)

FIGURE 7: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY PAYMENT INTEGRITY, 2019-2028 (IN $ MILLION)

FIGURE 8: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY PRIVATE INSURANCE PAYERS, 2019-2028 (IN $ MILLION)

FIGURE 9: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY GOVERNMENT AGENCIES, 2019-2028 (IN $ MILLION)

FIGURE 10: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY OTHER END-USERS, 2019-2028 (IN $ MILLION)

FIGURE 11: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, REGIONAL OUTLOOK, 2018 & 2028 (IN %)

FIGURE 12: UNITED STATES HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 13: CANADA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 14: UNITED KINGDOM HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 15: GERMANY HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 16: FRANCE HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 17: SPAIN HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 18: ITALY HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 19: RUSSIA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 20: REST OF EUROPE HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 21: CHINA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 22: JAPAN HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 23: INDIA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 24: SOUTH KOREA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 25: ASEAN COUNTRIES HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 26: AUSTRALIA & NEW ZEALAND HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 27: REST OF ASIA-PACIFIC HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 28: BRAZIL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 29: MEXICO HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 30: REST OF LATIN AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 31: UNITED ARAB EMIRATES HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 32: TURKEY HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 33: SAUDI ARABIA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 34: SOUTH AFRICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

FIGURE 35: REST OF MIDDLE EAST & AFRICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2019-2028 (IN $ MILLION)

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