Robust Growth Predicted for Healthcare Fraud Analytics Market, Worth $5 Billion by 2028, Research Report - Arizton

CHICAGO, May 9, 2023 /PRNewswire/ -- According to Arizton's latest research report, the healthcare fraud analytics market will grow at a CAGR of 20.45% during 2022-2028.

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Healthcare fraud analytics is highly competitive, with many players vying for a market share. Major players in the market include IBM, LexisNexis Risk Solutions, Optum, SAS Institute, Verisk Analytics, and Wipro. These companies offer a variety of fraud analytics solutions, including data mining, predictive analytics, and ML technologies to identify, detect, and prevent fraud.

Data mining is one of healthcare organizations' most popular fraud analytics tools. Data mining uses algorithms to analyze large datasets to detect suspicious activity. Predictive analytics uses predictive modeling techniques to identify patterns in the data that may indicate fraudulent activity. ML is used to train algorithms to recognize patterns and detect fraud.

One of the biggest trends in the healthcare fraud analytics market is the increasing use of AI and ML technologies. AI and ML technologies are used to automate the process of fraud detection and prevention. They enable healthcare organizations to process large volumes of data quickly and accurately, reducing the costs associated with manual fraud detection and prevention.

North America is expected to dominate the global healthcare fraud analytics market due to the presence of major healthcare fraud analytics players and government initiatives to prevent healthcare fraud. The APAC industry is expected to witness significant growth in the coming years due to the growing adoption of healthcare fraud analytics solutions and services by emerging countries such as India and China.

Healthcare Fraud Analytics Market Report Scope

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Market Trends & Drivers

Increasing Healthcare Fraudulent Activities
Healthcare fraud has been an ongoing problem in the healthcare industry for a long time. The increase in healthcare costs, the rise in technological advances, and a greater reliance on electronic data have all contributed to an increase in healthcare fraud. The healthcare fraud analytics market helps combat this issue by identifying fraudulent activities and helping organizations take proactive measures to prevent future fraud. Healthcare fraud analytics uses various analytic techniques to analyze large datasets and detect suspicious behavior patterns. These techniques can detect billing and coding errors, improper payments, and other forms of fraud. Healthcare fraud analytics also helps organizations identify trends in healthcare fraud and proactively address areas of risk. The increasing prevalence of healthcare fraud is driving the demand for healthcare fraud analytics solutions. Organizations increasingly invest in healthcare fraud analytics solutions to detect and prevent fraudulent activities and protect their financial and reputational interests.

The Increasing Number of Pharmacy Claims-Related Frauds
With the growth of the healthcare industry, fraud & abuse have become increasingly serious problems. Fraudsters are taking advantage of the complexity of the healthcare system and the lack of oversight to commit fraud. As a result, healthcare organizations are facing increasing pressure to protect their finances from fraudulent activities. The healthcare fraud analytics market is growing as healthcare organizations begin recognizing the need for advanced analytics solutions to detect and prevent fraud. Healthcare analytics solutions are used to identify suspicious transactions and activities that could indicate fraudulent behavior. These solutions help detect and prevent fraud by providing insights into fraud patterns, allowing organizations to take corrective action.

Key Insights

• Technological advances in healthcare product development are key to achieving high sales growth.
• Data sources such as claims, billing, and patient records are increasingly used to power fraud analytics solutions. Healthcare fraud analytics solutions must be tailored to the organization's specific needs to be effective.
• The rising preference for healthcare fraud analytics with ML and AI is the key driving factor of the global healthcare fraud analytics market.
• Based on geography, North America dominates the global healthcare fraud analytics market, followed by Europe, APAC, Latin America, and the Middle East & Africa.
• Arizton predicted North America could witness the highest growth over the forecast period, growing at a 23.39% CAGR.

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Key Company Profiles

• IBM
• LexisNexis Risk Solutions
• Optum
• SAS Institute
• Verisk Analytics
• Wipro

• Alivia Analytics
• CGI
• Codoxo
• Conduent
• COTIVITI
• FraudLens
• FRISS
• Healthcare Fraud Shield
• Northrop Grumman Corporation
• OSP
• Qlarant
• Qualetics Data Machines
• Sharecare

Market Segmentation

Solution Type

• Descriptive Analytics
• Predictive Analytics
• Prescriptive Analytics

Delivery Mode

• On-premises
• Cloud-based

Application

• Medical Provider Fraud
• Patient Fraud
• Prescription Fraud
• General Healthcare Fraud

End-user

• Public Health Insurance Companies
• Private Health Insurance Companies
• Third-party Service Providers
• Others

Geography

• North America
• The US
• Canada
• Europe
• Germany
• The UK
• France
• Italy
• Spain
• APAC
• China
• Japan
• South Korea
• India
• Australia
• Latin America
• Brazil
• Mexico
• Argentina
• Middle East & Africa
• Turkey
• Saudi Arabia
• South Africa

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Table of Content

1 RESEARCH METHODOLOGY 

2 RESEARCH OBJECTIVES 

3 RESEARCH PROCESS 

4 SCOPE & COVERAGE 

4.1 MARKET DEFINITION 

4.1.1 INCLUSIONS 

4.1.2 EXCLUSIONS 

4.1.3 MARKET ESTIMATION CAVEATS 

4.2 BASE YEAR 

4.3 SCOPE OF THE STUDY 

4.3.1 MARKET SEGMENTATION BY SOLUTION TYPE 

4.3.2 MARKET SEGMENTATION BY DELIVERY MODE 

4.3.3 MARKET SEGMENTATION BY APPLICATION 

4.3.4 MARKET SEGMENTATION BY END-USER 

4.3.5 MARKET SEGMENTATION BY GEOGRAPHY 

5 REPORT ASSUMPTIONS & CAVEATS 

5.1 KEY CAVEATS 

5.2 CURRENCY CONVERSION 

5.3 MARKET DERIVATION 

6 MARKET AT A GLANCE 

7 PREMIUM INSIGHTS 

7.1 OVERVIEW 

8 INTRODUCTION 

8.1 OVERVIEW 

9 MARKET OPPORTUNITIES & TRENDS 

9.1 INVESTMENT IN INFORMATION & COMMUNICATION TECHNOLOGY (ICT) 

9.2 ADVANCED TECHNOLOGIES OFFER GREAT POTENTIAL TO SECURE AGAINST FRAUD 

9.3 AI IN HEALTHCARE FRAUD DETECTION 

10 MARKET GROWTH ENABLERS 

10.1 INCREASING HEALTHCARE FRAUDULENT ACTIVITIES 

10.2 INCREASING NUMBER OF PATIENTS BENEFITING FROM HEALTHCARE INSURANCE 

10.3 RISING NUMBER OF PHARMACY CLAIM-RELATED FRAUDS 

11 MARKET RESTRAINTS 

11.1 CHANGE IN FRAUD PATTERNS 

11.2 SECURITY & PRIVACY RISKS WITH FRAUD ANALYTICS SOLUTIONS 

11.3 TIME-CONSUMING DEPLOYMENT AND NEED FOR FREQUENT UPGRADES 

12 MARKET LANDSCAPE 

12.1 MARKET OVERVIEW 

12.2 MARKET SIZE & FORECAST 

12.2.1 GEOGRAPHY INSIGHTS 

12.2.2 SOLUTION TYPE INSIGHTS 

12.2.3 DELIVERY MODE INSIGHTS 

12.2.4 APPLICATION INSIGHTS 

12.2.5 END-USER INSIGHTS 

12.3 FIVE FORCES ANALYSIS 

12.3.1 THREAT OF NEW ENTRANTS 

12.3.2 BARGAINING POWER OF SUPPLIERS 

12.3.3 BARGAINING POWER OF BUYERS 

12.3.4 THREAT OF SUBSTITUTES 

12.3.5 COMPETITIVE RIVALRY 

13 SOLUTION TYPE 

13.1 MARKET SNAPSHOT & GROWTH ENGINE 

13.2 MARKET OVERVIEW 

13.3 DESCRIPTIVE ANALYTICS 

13.3.1 MARKET OVERVIEW 

13.3.2 MARKET SIZE & FORECAST 

13.3.3 MARKET BY GEOGRAPHY 

13.4 PREDICTIVE ANALYTICS 

13.4.1 MARKET OVERVIEW 

13.4.2 MARKET SIZE & FORECAST 

13.4.3 MARKET BY GEOGRAPHY 

13.5 PRESCRIPTIVE ANALYTICS 

13.5.1 MARKET OVERVIEW 

13.5.2 MARKET SIZE & FORECAST 

13.5.3 MARKET BY GEOGRAPHY 

14 DELIVERY MODE 

14.1 MARKET SNAPSHOT & GROWTH ENGINE 

14.2 MARKET OVERVIEW 

14.3 ON-PREMISES 

14.3.1 MARKET OVERVIEW 

14.3.2 MARKET SIZE & FORECAST 

14.3.3 MARKET BY GEOGRAPHY 

14.4 CLOUD-BASED 

14.4.1 MARKET OVERVIEW 

14.4.2 MARKET SIZE & FORECAST 

14.4.3 MARKET BY GEOGRAPHY 

15 APPLICATION 

15.1 MARKET SNAPSHOT & GROWTH ENGINE 

15.2 MARKET OVERVIEW 

15.3 MEDICAL PROVIDER FRAUD 

15.3.1 MARKET OVERVIEW 

15.3.2 MARKET SIZE & FORECAST 

15.3.3 MARKET BY GEOGRAPHY 

15.4 PATIENT FRAUD 

15.4.1 MARKET OVERVIEW 

15.4.2 MARKET SIZE & FORECAST 

15.4.3 MARKET BY GEOGRAPHY 

15.5 PRESCRIPTION FRAUD 

15.5.1 MARKET OVERVIEW 

15.5.2 MARKET SIZE & FORECAST 

15.5.3 MARKET BY GEOGRAPHY 

15.6 GENERAL HEALTHCARE FRAUD 

15.6.1 MARKET OVERVIEW 

15.6.2 MARKET SIZE & FORECAST 

15.6.3 MARKET BY GEOGRAPHY 

16 END-USER 

16.1 MARKET SNAPSHOT & GROWTH ENGINE 

16.2 MARKET OVERVIEW 

16.3 PUBLIC HEALTH INSURANCE COMPANIES 

16.3.1 MARKET OVERVIEW 

16.3.2 MARKET SIZE & FORECAST 

16.3.3 MARKET BY GEOGRAPHY 

16.4 PRIVATE HEALTH INSURANCE COMPANIES 

16.4.1 MARKET OVERVIEW 

16.4.2 MARKET SIZE & FORECAST 

16.4.3 MARKET BY GEOGRAPHY 

16.5 THIRD-PARTY SERVICE PROVIDERS 

16.5.1 MARKET OVERVIEW 

16.5.2 MARKET SIZE & FORECAST 

16.5.3 MARKET BY GEOGRAPHY 

16.6 OTHERS 

16.6.1 MARKET OVERVIEW 

16.6.2 MARKET SIZE & FORECAST 

16.6.3 MARKET BY GEOGRAPHY 

17 GEOGRAPHY 

17.1 MARKET SNAPSHOT & GROWTH ENGINE 

17.2 GEOGRAPHIC OVERVIEW 

18 NORTH AMERICA 

18.1 MARKET OVERVIEW 

18.2 MARKET SIZE & FORECAST 

18.2.1 MARKET BY SOLUTION TYPE 

18.2.2 MARKET BY DELIVERY MODE 

18.2.3 MARKET BY APPLICATION 

18.2.4 MARKET BY END-USER 

18.3 KEY COUNTRIES 

18.3.1 US: MARKET SIZE & FORECAST 

18.3.2 CANADA: MARKET SIZE & FORECAST 

19 EUROPE 

19.1 MARKET OVERVIEW 

19.2 MARKET SIZE & FORECAST 

19.2.1 MARKET BY SOLUTION TYPE 

19.2.2 MARKET BY DELIVERY MODE 

19.2.3 MARKET BY APPLICATION 

19.2.4 MARKET BY END-USER 

19.3 KEY COUNTRIES 

19.3.1 GERMANY: MARKET SIZE & FORECAST 

19.3.2 UK: MARKET SIZE & FORECAST 

19.3.3 FRANCE: MARKET SIZE & FORECAST 

19.3.4 ITALY: MARKET SIZE & FORECAST 

19.3.5 SPAIN: MARKET SIZE & FORECAST 

20 APAC 

20.1 MARKET OVERVIEW 

20.2 MARKET SIZE & FORECAST 

20.2.1 MARKET BY SOLUTION TYPE 

20.2.2 MARKET BY DELIVERY MODE 

20.2.3 MARKET BY APPLICATION 

20.2.4 MARKET BY END-USER 

20.3 KEY COUNTRIES 

20.3.1 CHINA: MARKET SIZE & FORECAST 

20.3.2 JAPAN: MARKET SIZE & FORECAST 

20.3.3 SOUTH KOREA: MARKET SIZE & FORECAST 

20.3.4 INDIA: MARKET SIZE & FORECAST 

20.3.5 AUSTRALIA: MARKET SIZE & FORECAST 

21 LATIN AMERICA 

21.1 MARKET OVERVIEW 

21.2 MARKET SIZE & FORECAST 

21.2.1 MARKET BY SOLUTION TYPE 

21.2.2 MARKET BY DELIVERY MODE 

21.2.3 MARKET BY APPLICATION 

21.2.4 MARKET BY END-USER 

21.3 KEY COUNTRIES 

21.3.1 BRAZIL: MARKET SIZE & FORECAST 

21.3.2 MEXICO: MARKET SIZE & FORECAST 

21.3.3 ARGENTINA: MARKET SIZE & FORECAST 

22 MIDDLE EAST & AFRICA 

22.1 MARKET OVERVIEW 

22.2 MARKET SIZE & FORECAST 

22.2.1 MARKET BY SOLUTION TYPE 

22.2.2 MARKET BY DELIVERY MODE 

22.2.3 MARKET BY APPLICATION 

22.2.4 MARKET BY END-USER 

22.3 KEY COUNTRIES 

22.3.1 TURKEY: MARKET SIZE & FORECAST 

22.3.2 SAUDI ARABIA: MARKET SIZE & FORECAST 

22.3.3 SOUTH AFRICA: MARKET SIZE & FORECAST 

23 COMPETITIVE LANDSCAPE 

23.1 COMPETITION OVERVIEW 

23.2 MARKET SHARE ANALYSIS 

23.2.1 IBM 

23.2.2 LEXISNEXIS RISK SOLUTIONS 

23.2.3 OPTUM 

23.2.4 SAS INSTITUTE 

23.2.5 VERISK ANALYTICS 

23.2.6 WIPRO 

24 KEY COMPANY PROFILES 

24.1 IBM 

24.1.1 BUSINESS OVERVIEW 

24.1.2 PRODUCT OFFERINGS 

24.1.3 KEY STRATEGIES 

24.1.4 KEY STRENGTHS 

24.1.5 KEY OPPORTUNITIES 

24.2 LEXISNEXIS RISK SOLUTIONS 

24.3 OPTUM 

24.4 SAS INSTITUTE 

24.5 VERISK ANALYTICS 

24.6 WIPRO 

25 OTHER PROMINENT VENDORS 

25.1 ALIVIA ANALYTICS 

25.1.1 BUSINESS OVERVIEW 

25.1.2 PRODUCT OFFERINGS 

25.2 CGI 

25.3 CODOXO 

25.4 CONDUENT 

25.5 COTIVITI 

25.6 FRAUDLENS 

25.7 FRISS 

25.8 HEALTHCARE FRAUD SHIELD 

25.9 NORTHROP GRUMMAN CORPORATION 

25.10 OSP 

25.11 QLARANT 

25.12 QUALETICS DATA MACHINES 

25.13 SHARECARE 

26 REPORT SUMMARY 

26.1 KEY TAKEAWAYS 

26.2 STRATEGIC RECOMMENDATIONS 

27 QUANTITATIVE SUMMARY 

27.1 MARKET BY SOLUTION TYPE 

27.1.1 NORTH AMERICA: MARKET BY SOLUTION TYPE 

27.1.2 EUROPE: MARKET BY SOLUTION TYPE 

27.1.3 APAC: MARKET BY SOLUTION TYPE 

27.1.4 LATIN AMERICA: MARKET BY SOLUTION TYPE 

27.1.5 MIDDLE EAST & AFRICA: MARKET BY SOLUTION TYPE 

27.2 MARKET BY DELIVERY MODE 

27.2.1 NORTH AMERICA: MARKET BY DELIVERY MODE 

27.2.2 EUROPE: MARKET BY DELIVERY MODE 

27.2.3 APAC: MARKET BY DELIVERY MODE 

27.2.4 LATIN AMERICA: MARKET BY DELIVERY MODE 

27.2.5 MIDDLE EAST & AFRICA: MARKET BY DELIVERY MODE 

27.3 MARKET BY APPLICATION 

27.3.1 NORTH AMERICA: MARKET BY APPLICATION 

27.3.2 EUROPE: MARKET BY APPLICATION 

27.3.3 APAC: MARKET BY APPLICATION 

27.3.4 LATIN AMERICA: MARKET BY APPLICATION 

27.3.5 MIDDLE EAST & AFRICA: MARKET BY APPLICATION 

27.4 MARKET BY END-USER 

27.4.1 NORTH AMERICA: MARKET BY END-USER 

27.4.2 EUROPE: MARKET BY END-USER 

27.4.3 APAC: MARKET BY END-USER 

27.4.4 LATIN AMERICA: MARKET BY END-USER 

27.4.5 MIDDLE EAST & AFRICA: MARKET BY END-USER 

28 APPENDIX 

28.1 ABBREVIATIONS 

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SOURCE Arizton Advisory & Intelligence

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