Press release
Healthcare Fraud Analytics Market 2024-2033: Size, Share & Competitive Landscape
The healthcare fraud analytics market size is expected to see exponential growth in the next few years. It will grow to $9.66 billion in 2028 at a compound annual growth rate (CAGR) of 26.3%. The growth in the forecast period can be attributed to increasing sophistication of fraud schemes, integration of predictive analytics, regulatory evolution, global pandemic impact, enhanced patient identity verification.. Major trends in the forecast period include adoption of cloud-based analytics, user-friendly interfaces, automation in fraud investigations, real-time fraud detection, behavioral analytics..
Market Overview -
Healthcare fraud analytics refers to on-premise and on-demand analytical solutions that assist in identifying issues such as duplication/repetition of claims and errors in claim healthcare operations and applications. Healthcare fraud analytics aims to help healthcare companies to audit their accounts and find out fraudulent activities in various transactions. It identifies frauds related to billings, claims, prepayment, post payments, and payment integrity.
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Rise In Fraudulent Activities In The Healthcare Sector Drives The Healthcare Fraud Analytics Market
A large number of fraudulent activities in the healthcare sector contribute to the growth of the healthcare fraud analytics market. Medical providers, patients, and third parties who intentionally deceive the healthcare system into acquiring unlawful benefits can commit fraud based on deception or misrepresentation. These fraud and abuse involve kickbacks, billing, billing for services not provided, medical testing, and other fraudulent activities. For instance, according to Blue Cross Blue Shield Association, a US-based federation, in 2021, The National Heath Care Anti-Fraud Association estimated that health care fraud costs the nation about $68 billion annually, about 3 percent of the nation's $2.26 trillion in health care spending. Other estimates range as high as 10 percent of annual health care expenditure, or $230 billion. Thus, the increasing number of fraudulent activities in healthcare is contributing to the healthcare fraud market growth.
Competitive Landscape -
Major companies operating in the healthcare fraud analytics market report are International Business Machines Corporation, Optum Inc., Statistical Analysis Software Institute Inc., Change Healthcare, EXL Service Holdings Inc., Cotiviti Inc., DXC Technology Company, Wipro Limited, Conduent Incorporated, Consultants to Government and Industry Inc., HCL Technologies Limited, Qlarant Inc., Northrop Grumman Corporation, LEXIS-NEXIS Group, Healthcare Fraud Shield, Sharecare Inc., FraudLens Inc., HMS Holding Corp., Codoxo, H20. ai, Pondera Solutions Inc., Friss International B. V., MultiPlan Inc., FraudScope, Osp Labs Private Limited, Fair Isaac Corporation, Mckesson Corp, Relx Group PLC, FraudHunt, FraudGuardian
Rising Investments Transforming Healthcare Fraud Analytics Market
Major players in the healthcare fraud analytics market are focusing on investments to expand in the market. Rising investments in healthcare fraud analytics denote the increasing allocation of financial resources towards advanced analytical tools and technologies aimed at detecting and preventing fraudulent activities within the healthcare sector. For instance, in January 2021, Healthcare Fraud Shield, a US-based company that provides new and unique Fraud, Waste and Abuse (FWA) automated solutions to the healthcare industry, received a $50 million investment from Charlesbank Technology Opportunities Fund, a fund managed by Charlesbank Capital Partners, a New York-based middle market private investment firm. Through this investment, Healthcare Fraud Shield will be able to quickly create new features and implement the capabilities of its platform, such as the newly released AIShield product and the ground-breaking PreShield product, across insurance policies that cover millions of people.
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Key Segments -
The healthcare fraud analytics market covered in this report is segmented -
1) By Solution Type: Descriptive Analytics, Predictive Analytics, Prescriptive Analytics
2) By Delivery Model: On-Premise, On-Demand
3) By Application: Insurance Claims Review, Postpayment Review, Prepayment Review, Pharmacy Billing Misuse, Payment Integrity, Other Applications
4) By End User: Public & Government Agencies, Private Insurance Payers, Third-Party Service Providers
Key highlights covered in the report -
1. Detailed market size forecast and historical data analysis
2. Key drivers influencing market growth
3. Identification of upcoming trends and potential opportunities in the market
4. Analysis of major players strategies, to understand competitive dynamics and market positioning
5. Evaluation of regional dynamics
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