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.
Methodology/Research Approach
This research study involved the extensive usage of both primary and secondary data sources. The research process involved the study of various factors affecting the industry, including the government policy, market environment, competitive landscape, historical data, present trends in the market, technological innovation, upcoming technologies and the technical progress in related industry, and market risks, opportunities, market barriers and challenges. The following illustrative figure shows the market research methodology applied in this report.Research Programs/Design
Historical Data (2015-2019) |
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Influencing Factors |
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Market Forecast (2021-2026) |
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Market Size Estimation
Top-down and bottom-up approaches are used to validate the global Voluntary Carbon Offset market size market and estimate the market size for Company, regions segments, product segments and Application (end users).
The market estimations in this report are based on the marketed sale price of Voluntary Carbon Offset (excluding any discounts provided by the player, distributor, wholesaler or traders). The percentage splits, market share, and breakdowns of the product segments are derived on the basis of weights assigned to each of the segments on the basis of their utilization rate and average sale price. The regional splits of the overall Voluntary Carbon Offset market and its sub-segments are based on the percentage adoption or utilization of the given product in the respective region or country.
Major Company in the market is identified through secondary research and their market revenues determined through primary and secondary research. Secondary research included the research of the annual and financial reports of the top Company; whereas, primary research included extensive interviews of key opinion leaders and industry experts such as experienced front-line staff, directors, CEOs and marketing executives. The percentage splits, market share, Growth Rate and breakdowns of the product markets are determined through using secondary sources and verified through the primary sources.
All possible factors that influence the markets included in this research study have been accounted for, viewed in extensive detail, verified through primary research, and analyzed to get the final quantitative and qualitative data. The market size for top-level markets and sub-segments is normalized, and the effect of inflation, economic downturns, and regulatory & policy changes or other factors are not accounted for in the market forecast. This data is combined and added with detailed inputs and analysis from Market Intellix and presented in this report
The following figure shows an illustrative representation of the overall market size estimation process used for this study.
Market Breakdown and Data Triangulation
After complete market engineering with calculations for market statistics; market size estimations; market forecasting; market breakdown; and data triangulation, extensive primary research was conducted to gather information and verify and validate the critical numbers arrived at. In the complete market engineering process, both top-down and bottom-up approaches were extensively used, along with several data triangulation methods, to perform market estimation and market forecasting for the overall market segments and sub-segments listed in this report. Extensive qualitative and further quantitative analysis is also done from all the numbers arrived at in the complete market engineering process to list key information throughout the report.
Data Source
Secondary Sources
Secondary sources include such as press releases, annual reports, non-profit organizations, industry associations, governmental agencies and customs data, etc. This research study involves the usage of widespread secondary sources, directories, databases such as Bloomberg Business, Wind Info, Hoovers, Factiva (Dow Jones & Company), and TRADING ECONOMICS, and News Network, statista, Federal Reserve Economic Data, annual reports, BIS Statistics, ICIS; company house documents; CAS(American Chemical Society); investor presentations; and SEC filings of companies. Secondary research was used to identify and collect information useful for the extensive, technical, market-oriented, and Hospitals study of the Voluntary Carbon Offset market. It was also used to obtain important information about the top companies, market classification and segmentation according to industry trends to the bottom-most level, and key developments related to market and technology perspectives.
Market Size |
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Market Position of Top Company |
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Qualitative Analysis |
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Primary Sources
In the primary research process, various sources from both the supply and demand sides were interviewed to obtain qualitative and quantitative information for this report. The primary sources from the supply side include product Company (and their competitors), opinion leaders, industry experts, research institutions, distributors, dealer and traders, as well as the raw materials suppliers and producers, etc.
The primary sources from the demand side include industry experts such as business leaders, marketing and sales directors, technology and innovation directors, supply chain executive, end use (product buyers), and related key executives from various key companies and organizations operating in the global market.
Primary research was conducted to identify segmentation Type, product price range, product Application, key Company, raw materials supply and the downstream demand, industry status and outlook, and key market dynamics such as risks, influence factors, opportunities, market barriers, industry trends, and key player strategies.
Key Executives Interviewed
Key Data Information from Primary Sources
Primary Sources | Parameters | Key Data |
Market Segments(by Application, by Type) |
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Total Market |
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