Global Healthcare Fraud Analytics Market Based on Solution Type: (Descriptive Analytics, Predictive Analytics, Prescriptive Analytics) Based on Delivery Models: (Insurance Claims Review, Pharmacy Billing Misuse) Based on End-User: (Private Insurance Payers, Third-Party Service Providers, Other End-Users) and by Region and Companies - Industry Segment Outlook, Market Assessment, Competition Scenario, Trends and Forecast 2022-2032

Healthcare Fraud Analytics Market Overview:

The global healthcare fraud analytics market is projected to reach a valuation of USD 19,466.18 Mn by 2032 at a CAGR of 26.1%, from USD 1,914.83 Mn in 2022.

Fraud analytics is the effective application of data analytics and related business insights obtained using statistical, predictive, quantitative, cognitive, comparative, and other new applied analytical models to detect and prevent healthcare fraud. Recent advancements in information technology have made it easier to collect various types of healthcare data. In today’s digital age, data has become an essential component of healthcare. Hospitals and healthcare institutions have begun gathering vast amounts of patient healthcare data as a result of rapid improvements in data sensing and acquisition technologies. Understanding and gaining knowledge from healthcare data needs the development of innovative analytical tools capable of transforming data into meaningful and actionable information.

General computer technologies have begun to transform the way medical care is delivered to patients. Analytics, in particular, is an important component of contemporary computing systems. When applied to healthcare data, analytical technologies have the potential to completely alter healthcare delivery. The significance of analytics in the healthcare sector is expected to only increase in the coming years. Typically, studying health data will allow us to uncover hidden patterns in the data. It will also assist clinicians in developing an individualized patient profile, and in properly calculating the likelihood of an individual patient suffering from a medical issue in the near future.

Global Healthcare Fraud Analytics Market Revenue (USD Mn), 2021–2031:

The number of people who have benefited from various healthcare initiatives has increased significantly over the years. A surge in geriatric populations, an increase in healthcare expenditures, as well as an increase in the number of various diseases, are some of the major factors driving the expansion of the healthcare fraud analytics market. During the 2017 open enrollment period, 12.2 million individuals signed up for or renewed their health insurance. Emerging economies such as Asia offer tremendous growth in health insurance coverage, owing to increased government initiatives, increased government and private spending on medical insurance promotion, and surging income levels. This expansion is assisted by the increasing cost of health insurance for the region’s middle-class, as well as a greater level of knowledge concerning the benefits of health insurance. According to a new regulatory guideline in the UAE, any national residing and working in the UAE must be medically insured. Such regulatory shifts in company purchasing behavior (from employer-based plans to granting individual spending allocations to employees) are shaping the region’s health insurance industry.

According to the conclusions of the US Department of Health and Human Services in 2018, national Medicaid data includes flaws that could impede the detection of fraud in the public sector. According to the Office of Inspector General (OIG, the U.S. Department of Health and Human Services), Medicaid data is frequently insufficient and erroneous, affecting the process of detecting fraudulent claims and resulting in the waste of billions of dollars due to fraud and abuse. This factor is expected to hamper the economic growth of this market.

The healthcare sector is evolving at a breakneck pace, and one of the primary contributors to this transition is the growing popularity of healthcare communication via social media. Not only has social media become a source of health information, but it also allows for two-way public dialogue between patients, physicians, and other third parties. This facilitates the creation of a big forum for global health discussions. On a daily basis, this large network of healthcare influencers, leaders, consumers, providers, organizations, and governmental institutions generates a massive amount of healthcare data. If this data is separated, divided, and evaluated properly, it has the potential to provide enormous value in terms of enhancing treatment efficiency and health outcomes. As a result, there is a demand for data aggregation and analysis tools, which presents opportunities for the healthcare fraud analytics market.

With increasing income levels, a spike in government initiatives, as well as more private and government investments in promoting medical insurance, emerging economies around the world present enormous growth potential. This market development is expected to accelerate as more people from middle-class households in the region gain access to economical health insurance options. In addition, individuals are becoming more aware of the various benefits of health insurance. On account of this, the healthcare fraud analytics market is expected to benefit from considerable growth opportunities in foreseeable future.

Key Market Players:

This research report on the global healthcare fraud analytics market includes major company profiles such as:

• IBM Corporation
• Change Healthcare
• SAS Institute Inc.
• Wipro Limited
• HCL Technologies Limited
• DXC Technology
• Healthcare Fraud Shield
• Northrop Grumman Corporation
• Pondera Solutions Inc.
• Others.

Detail Segmentation:

Global Healthcare Fraud Analytics Market Segmentation Based on Solution Type, Delivery Models, End-User, and Region

Based on Solution Type

• Descriptive Analytics
• Predictive Analytics
• Prescriptive Analytics

Based on Delivery Models

• Insurance Claims Review
• Pharmacy Billing Misuse
• Payment Integrity
• Other Delivery Models

Based on End-User

• Public & Government Agencies
• Private Insurance Payers
• Third-Party Service Providers
• Other End-Users

Based on Region

• North America
• Europe
• Asia-Pacific
• South America
• Middle East & Africa

For the Healthcare Fraud Analytics Market research study, the following years have been considered to estimate the market size: