Healthcare Fraud Analytics Market 2021: Industry Growth Factors, Global Share, Development Trends and Key Players Analysis- Conduent, DXC Technology, Scioinspire, FICO, Optum, SAS Institute, Pondera Solutions, Lexisnexis Risk Solutions, Whitehatai, Cotivi

The healthcare fraud analytics market was valued at US$ 1,331.09 million in 2019 and is expected to grow at a CAGR of 27.0% from 2020 to 2027 to reach US$ 8,707.73 million by 2027.

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Healthcare fraud is a kind of white-collar crime that includes the filing of dishonest health care claims to turn a profit. The most common types of health care fraud include billing for more expensive services or procedures, misrepresenting non-covered treatments, insurance frauds, and others. The global healthcare fraud analytics market driven by factors such as include rising number of healthcare fraudulent cases across the globe and growing health insurance industry are expected to boost the market growth over the years. However, concerns regarding healthcare fraud analytics is likely to have negative impact on the growth of the market in the coming years.

Market Insights
Rising Number of Healthcare Fraudulent Cases across the Globe
Healthcare fraud is an illicit line of work which is committed by small minority of dishonest health care providers and organized crime groups. The healthcare fraud includes health insurance fraud, drug fraud, prescription drug diversion medical identification theft and others.

As per the Global Health Care Anti-Fraud Network, each year approximately US$ 260 billion (180 billion euros) or about 6 percent of the global total health care expenditure is lost to fraud. This amount is equal to the GDP of a country like Finland or Malaysia.

There are groups who have conducted frauds in government-sponsored health programs, private health insurers and the property and casualty insurers. For instance the Armenian Power Organized Crime Group operated a medical clinic in Miami and paid individuals to refer patients of staged accidents and billing private insurance carriers for treatments that were not necessary or for treatments that was no provided.

Furthermore, Annual healthcare spending across the European Union is around one trillion Euros. However, European Healthcare Fraud and Corruption Network (EHFCN) estimated that every year, around 56 billion Euros are lost due to healthcare fraud and corruption.

Additionally, healthcare frauds are also identified and detected in Asia Pacific region. Fraudulent dispensing is seen to be increasing in Japanese pharmacies. For instance, in June 2019, one of the major Japanese drug wholesaler Alfresa Holdings Corp. found fraudulent billing for dispensing fees at a pharmacy operated by its subsidiary.

Solution Insights
The healthcare fraud analytics market, by solution, is segmented into predictive analytics, descriptive analytics, and prescriptive analytics. In 2019, the predictive analytics accounted for the largest market share in the global healthcare fraud analytics market by solution owing to the ability of identifying patterns of fraudulent cases, the market for predictive analytics is estimated to grow during the forecast period.

Mode of Delivery Insights
The healthcare fraud analytics market, by mode of delivery, is segmented into on-premise delivery models, and on-demand delivery models. The on-premise delivery models segment held the largest share of the market in 2019. However, on-demand delivery models segment is estimated to register the highest CAGR in the market during the forecast period.

Application Insights
Based on application, the healthcare fraud analytics market is segmented into insurance claims review, pharmacy billing misuse, payment integrity, medical identity theft and other applications. The insurance claims segment held the largest share of the market in 2019 owing to increasing number of fraud health insurance claims and increasing adoption of AI analytics by the insurance companies, the market for insurance claims review is expected to grow during the forecast period. Moreover, the same segment is estimated to register the highest CAGR in the market during the forecast period.


End User Insights
Based on end user, the healthcare fraud analytics market is segmented into government agencies, private insurance payers, third-party service providers, and employers. The government agencies segment held the largest share of the market in 2019. The same segment is estimated to register the highest CAGR in the market during the forecast period owing to increasing number of healthcare frauds in the government agencies.


Strategic Insights
Merger & acquisition strategy is commonly adopted by companies to expand their footprint worldwide and meet the growing demand. This strategy is most commonly adopted by the market players in order to enhance its product portfolio.

The market players operating in the healthcare fraud analytics market adopt the strategy of expansion and investment in research and development to enlarge customer base across the world, which also permits the players to maintain their brand name globally.

Global Healthcare Fraud Analytics Market - By Solution
Predictive Analytics
Descriptive Analytics
Prescriptive Analytics

Global Healthcare Fraud Analytics Market - By Mode of Delivery

On-Premise Delivery Models
Cloud Based Delivery Models

Global Healthcare Fraud Analytics Market - By Application

Insurance Claims Review
Pharmacy Billing Misuse
Payment Integrity
Identity Theft
Other Applications

Global Healthcare Fraud Analytics Market - By End User

Government Agencies
Private Insurance Payers
Third-party Service Providers
Employers

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