NORTH AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET 2019-2028

Lifesciences | Healthcare IT

NORTH AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET 2019-2028

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

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According to an analysis by Triton Market Research, the healthcare fraud analytics and detection market in North America is likely to augment at a CAGR of 23.61% over the forthcoming period between 2019 and 2028.


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The countries evaluated in the North American healthcare fraud analytics and detection market are:

           Canada

           The United States

In the United States, many organizations are increasingly adopting analytical solutions to comply with standard regulations to prevent fraudulent claims. The federal healthcare programs like Medicare and Medicaid are implemented to improve the healthcare system and minimize the loss of insurers caused due to fraud claims. Established in 1985, the NHCAA (National Health Care Anti-Fraud Association) is a leading national organization that aims to combat healthcare fraud. With the rising initiatives like Medicare, Medicaid and other healthcare programs, coupled with the presence of better healthcare infrastructure, the US healthcare fraud analytics and detection market is anticipated to display immense growth over the years.

The Canadian Life and Health Insurance Association is creating consumer awareness regarding health and dental benefits fraud. This organization accounts for over $860 billion in assets in the country, employing over 155,000 people in Canada. As per the data it has collected, the fraudulent claims range from 2% to 10%, which means, per year, around $600 million to $3.4 billion are being stolen. Thus, the increasing awareness by the associations and growing incidents of healthcare frauds are likely to fuel the demand for healthcare fraud detection solutions, resulting in the growth of the studied market.

DXC Technology is a company implementing digital transformations for companies, by integrating mainstream IT with digital solutions for better business outcomes. The company was established in 2017, with the merger of two companies, namely, CSC and the Enterprise Services business of Hewlett Packard Enterprise. It is headquartered in Virginia, US. Fraud Analytics Suite is a product provided by the company that can help in identifying suspicious claims.

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Table of Content

1.    NORTH AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET - SUMMARY

2.    INDUSTRY OUTLOOK

2.1. MARKET DEFINITION

2.2. KEY INSIGHTS

2.2.1.   PRESCRIPTIVE ANALYSIS IS ANTICIPATED TO GROW AT HIGHEST CAGR

2.2.2.   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.    NORTH AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET OUTLOOK - BY TYPE

3.1. DESCRIPTIVE ANALYSIS

3.2. PREDICTIVE ANALYSIS

3.3. PRESCRIPTIVE ANALYSIS

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

4.1. REVIEW OF INSURANCE CLAIMS

4.2. PAYMENT INTEGRITY

5.    NORTH AMERICA  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.    NORTH AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET – REGIONAL OUTLOOK

6.1. UNITED STATES

6.2. CANADA

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

TABLE 2: MARKET ATTRACTIVENESS INDEX

TABLE 3: VENDOR SCORECARD

TABLE 4: NORTH AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY COUNTRY, 2019-2028 (IN $ MILLION)

TABLE 5: NORTH AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY TYPE, 2019-2028 (IN $ MILLION)

TABLE 6: NORTH AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY APPLICATION, 2019-2028 (IN $ MILLION)

TABLE 7: NORTH AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY END-USER, 2019-2028 (IN $ MILLION)

List of Figures

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

FIGURE 2: PORTER’S FIVE FORCE ANALYSIS

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

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

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

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

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

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

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

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

FIGURE 11: NORTH AMERICA 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)

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