Healthcare Fraud Analytics Market Outlook 2030: Industry Insights & Opportunity Evaluation, 2019-2030
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Healthcare Fraud Analytics Market by Solution Type (Descriptive, Predictive, Prescriptive), Application (Insurance Claim (Postpayment, Prepayment), Payment Integrity), Delivery (On-premise, Cloud), End User (Insurance, Government) - Global Forecast to 2030
Product Overview
Healthcare fraud is difficult to detect and is generally go unnoticed; therefore, detection of such fraudulent claims is necessary, as they increase the burden on society. The use of fraud detection solution enables healthcare firms in accounting, and auditing by predictive data methodologies. Careful account auditing can reveal suspicious providers and policyholders and detect potential fraudulent cases before it occurs.
Market Overview
The healthcare fraud analytics market is projected to reach USD 6.2billion by 2030 from USD 1.4 billion in 2020, at a CAGR of 28.8%. Market growth can be attributed to the large number of fraudulent activities in healthcare; the increasing number of patients seeking health insurance; high returns on investment; and rising pharmacy claim-related frauds. However, the dearth of skilled personnel is likely to restrain the growth of this market.
The descriptive analytics segment dominated the healthcare fraud analytics market in 2019
The market is segmented based on solution type, delivery model, application, and end user. Based on the solution type, the descriptive analytics segment accounted for the largest share of the market in 2019. Descriptive analytics forms the base for the effective application of predictive or prescriptive analytics. Hence, these analytics use the basics of descriptive analytics and integrate them with additional sources of data in order to produce meaningful insights.
Market Dynamics
Drivers
Expanding Patient Pool Opting for Healthcare Insurance to Benefit the Market
Burgeoning patient pool opting for health care insurance, alarming rise in fraudulent events in the healthcare industry, and the rising pressure to track abuse and fraud in healthcare are some of the top growth boosters in the global market.
Restraints
Low Awareness Level in Emerging Countries to be a Restraint
Lower awareness level regarding healthcare fraud analytics solutions in emerging countries is expected to restrain the market growth in the near future.
North America will dominate the healthcare fraud analytics market from 2020–2030
Geographically, the global healthcare fraud analytics market is segmented into North America, Europe, the Asia Pacific, Latin America, and the Middle East and Africa. North America accounted for the largest share of the market in 2019. The high share of the North American market is attributed to the large number of people having health insurance, growing healthcare fraud, favorable government anti-fraud initiatives, the pressure to reduce healthcare costs, technological advancements, and greater product and service availability in this region. Moreover, a majority of leading players in the healthcare fraud detection market have their headquarters in North America.
Key Market players
The healthcare fraud detection market is consolidated and competitive in nature. Major players in this market include IBM Corporation (US), Optum (US), SAS Institute (US), Change Healthcare (US), EXL Service Holdings (US), Cotiviti (US), Wipro Limited (India), Conduent (US), HCL (India), Canadian Global Information Technology Group (Canada), DXC Technology Company (US), Northrop Grumman Corporation (US), LexisNexis Group (US), and Pondera Solutions (US).
Healthcare fraud analytics market, by Solution Type
• Descriptive Analytics
• Predictive Analytics
• Prescriptive Analytics
Healthcare fraud analytics market, by Selivery model
• On-premise
• On-demand
Healthcare fraud analytics market, by application
• Insurance Claims Review
o Postpayment Review
o Prepayment Review
• Pharmacy Billing Misuse
• Payment Integrity
• Other applications*
• *Other applications include identity management and case management
Healthcare fraud analytics market, by End User
• Public & Government Agencies
• Private Insurance Payers
• Third-party service providers
• Employers
Contents
1. Executive Summary
2. Global Healthcare Analytical Testing Services Market
2.1. Product Overview
2.2. Market Definition
2.3. Segmentation
2.4. Assumptions and Acronyms
3. Research Methodology
3.1. Research Objectives
3.2. Primary Research
3.3. Secondary Research
3.4. Forecast Model
3.5. Market Size Estimation
4. Average Pricing Analysis
5. Macro-Economic Indicators
6. Market Dynamics
6.1. Growth Drivers
6.2. Restraints
6.3. Opportunity
6.4. Trends
7. Correlation & Regression Analysis
7.1. Correlation Matrix
7.2. Regression Matrix
8. Recent Development, Policies & Regulatory Landscape
9. Risk Analysis
9.1. Demand Risk Analysis
9.2. Supply Risk Analysis
10. Global Healthcare Analytical Testing Services Market Analysis
10.1. Porters Five Forces
10.1.1. Threat of New Entrants
10.1.2. Bargaining Power of Suppliers
10.1.3. Threat of Substitutes
10.1.4. Rivalry
10.2. PEST Analysis
10.2.1. Political
10.2.2. Economic
10.2.3. Social
10.2.4. Technological
11. Global Healthcare Analytical Testing Services Market
11.1. Market Size & forecast, 2020A-2030F
11.1.1. By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
11.1.2. By Volume (Million Units) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12. Global Healthcare Analytical Testing Services Market: Market Segmentation
12.1. By Regions
12.1.1. North America:(U.S. and Canada), By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.1.2. Latin America: (Brazil, Mexico, Argentina, Rest of Latin America), By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.1.3. Europe: (Germany, UK, France, Italy, Spain, BENELUX, NORDIC, Hungary, Poland, Turkey, Russia, Rest of Europe), By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.1.4. Asia-Pacific: (China, India, Japan, South Korea, Indonesia, Malaysia, Australia, New Zealand, Rest of Asia Pacific), By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.1.5. Middle East and Africa: (Israel, GCC, North Africa, South Africa, Rest of Middle East and Africa), By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.2. By Solution Type: Market Share (2020-2030F)
12.2.1. Descriptive Analytics, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.2.2. Predictive Analytics, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.2.3. Prescriptive Analytics, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.3. By Selivery model: Market Share (2020-2030F)
12.3.1. On-premise, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
12.3.2. On-demand, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
1.1. By Application: Market Share (2020-2030F)
1.1.1. Insurance Claims Review, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
1.1.2. Pharmacy Billing Misuse, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
1.1.3. Payment Integrity, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
1.1.4. Other, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
1.2. By End User: Market Share (2020-2030F)
1.2.1. Public & Government Agencies, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
1.2.2. Private Insurance Payers, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
1.2.3. Third-party service providers, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
1.2.4. Employers, By Value (USD Million) 2020-2030F; Y-o-Y Growth (%) 2021-2030F
13 Company Profile
13.1. IBM (US)
13.1.1. Company Overview
13.1.2. Company Total Revenue (Financials)
13.1.3. Market Potential
13.1.4. Global Presence
13.1.5. Key Performance Indicators
13.1.6. SWOT Analysis
13.1.7. Product Launch
13.2. Optum, Inc. (US)
13.3. SAS Institute, Inc. (SAS) (US)
13.4. Change Healthcare(US)
13.5. EXL Service Holdings, Inc. (EXL) (US)
13.6. Cotiviti (US)
13.7. Wipro Limited (Wipro) (India)
13.8. Conduent, Inc. (Conduent) (US)
13.9. Canadian Global Information Technology Group Inc. (CGI) (Canada)
13.10. DXC Technology Company (DXC) (US)
13.11. Other Prominent Players
14 Consultant Recommendation
**The above given segmentations and companies could be subjected to further modification based on in-depth feasibility studies conducted for the final deliverable.
Research Methodology:
Healthcare Fraud Analytics Market Size Estimation
To estimate market size and trends, we use a combination of top-down and bottom-up methods. This allows us to evaluate the market from various perspectives—by company, region, product type, and end users.
Our estimates are based on actual sales data, excluding any discounts. Segment breakdowns and market shares are calculated using weighted averages based on usage rates and average prices. Regional insights are determined by how widely a product or service is adopted in each area.
Key companies are identified through secondary sources like industry reports and company filings. We then verify revenue estimates and other key data points through primary research, including interviews with industry experts, company executives, and decision-makers.
We take into account all relevant factors that could influence the market and validate our findings with real-world input. Our final insights combine both qualitative and quantitative data to provide a well-rounded view. Please note, these estimates do not account for unexpected changes such as inflation, economic downturns, or policy shifts.
Data Source
Secondary Sources
This study draws on a wide range of secondary sources, including press releases, annual reports, non-profit organizations, industry associations, government agencies, and customs data. We also referred to reputable databases and directories such as Bloomberg, Wind Info, Hoovers, Factiva, Trading Economics, Statista, and others. Additional references include investor presentations, company filings (e.g., SEC), economic data, and documents from regulatory and industry bodies.
These sources were used to gather technical and market-focused insights, identify key players, analyze market segmentation and classification, and track major trends and developments across industries.
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Primary Sources
As part of our primary research, we interviewed a variety of stakeholders from both the supply and demand sides to gather valuable qualitative and quantitative insights.
On the supply side, we spoke with product manufacturers, competitors, industry experts, research institutions, distributors, traders, and raw material suppliers. On the demand side, we engaged with business leaders, marketing and sales heads, technology and innovation directors, supply chain executives, and end users across key organizations.
These conversations helped us better understand market segmentation, pricing, applications, leading players, supply chains, demand trends, industry outlook, and key market dynamics—including risks, opportunities, barriers, and strategic developments.
Key Data Information from Primary Sources
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