GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET FORECAST 2020-2028

According to Inkwood Research, the global healthcare fraud analytics and detection market will project an anticipated CAGR of 21.09%, during the forecast period, and is expected to generate a revenue of $4.30 billion by 2028. The base year considered for the market study is 2019. The forecasted period is between 2020 and 2028.

The global healthcare fraud analytics and detection market growth is driven by:

  • Rising healthcare expenditure
  • Surging number of patients opting for health insurance
  • Rise in fabricated activities in healthcare

Global Healthcare Fraud Analytics and Detection Market

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The increasing demand for health insurance among consumers is one of the driving factors proliferating market growth. The population in developed and developing nations benefit from the protection provided by the insurance, against the economic risk posed by a serious illness. With rising insurance and claims, frauds associated with the same are also increasing, which is resulting in an increased demand for the tools to reduce such frauds. Hence, it can be concluded that a number of health insurance and their claims are having an impact on the overall market. Furthermore, the surging accessibility of software due to escalating healthcare spending, is stirring the companies to come up with a service to meet the market demand. Such factors influence market growth.

The descriptive analysis category of the type segment dominated the global market with a market share of 56.93% in 2019. The descriptive-analytical technique refers to the unsupervised learning techniques, which aim at the exploration and discovery of information in the dataset, thereby identifying the anomalies. Several European countries, the United States, and part of Asian emerging markets, have evolved in using descriptive data mining across various health institutes. However, the adoption and its distribution across different cities are slow and require decent investments. In accordance with such factors, it holds a significant share of the market studied, and is expected to observe steady growth over the forecast period.

On the other hand, the predictive analysis category is anticipated to grow at the CAGR of around 24.65% during the forecast period. Predictive analysis helps in detecting fraudulent activities by identifying patterns that are potentially fraudulent and then developing sets of rules to certain claims. Using predictive data science methodologies enable companies to ascertain potential fraudulent activity before it occurs. In addition to this, it helps in analyzing injury data to further forecast the possibility of public sector analysis, insurance policy fraud, and other fraudulent activities.

Some companies are unwilling to adopt new analytics technologies used in the detection market, which are projected to hamper market growth. This problem mainly arises in developing or underdeveloped nations, as people are not efficient with the technology, which restricts them from adopting the novel technologies that are being launched into the market.

The report scope of the global healthcare fraud analytics and detection market growth covers the segmentation analysis of type, application, and end-user.

Market by Type:

  • Descriptive Analysis
  • Predictive Analysis
  • Prescriptive Analysis

Market by Application:

  • Payment Integrity
  • Review of Insurance Claims

Market by End-user:

  • Government Agencies
  • Private Insurance Payers
  • Other End-users

On the basis of geography, the global healthcare fraud analytics and detection market has been segmented into four major regions:

  • North America: the United States and Canada
  • Europe: the United Kingdom, France, Germany, Italy, Russia, Belgium, Poland, and Rest of Europe
  • Asia Pacific: China, Japan, India, South Korea, Thailand, Indonesia, Vietnam, Australia & New Zealand, and Rest of Asia Pacific
  • Rest of World: Latin America, the Middle East & Africa

Regionally, the North American market for healthcare fraud analytics and detection held the largest market share of 58.75% in terms of revenue in 2019. The major factors driving the growth of the market are the increasing fraudulent activities in the healthcare industry, coupled with growing pressure that the US government has about improving operational efficiency and reducing the healthcare spending and prepayment review model.

On the other hand, the region of Asia Pacific is evaluated to be the fastest-growing region with a CAGR of 21.56% by 2028. The major factors contributing to the adoption of fraud detection and prevention solutions in the Asia Pacific region are the rising usage of mobile data for various applications, such as social media and mobile banking. Additionally, the growing penetration of the internet in countries, such as India and China, has fueled the adoption of fraud detection solutions in the region.

The key players involved in the global healthcare fraud analytics and detection market:

  • CGI Inc
  • DXC Technology
  • McKesson
  • OSP Labs
  • Others

In March 2019, the long-term outsourcing agreement between CGI and League Data was extended to 2023. The value of this extension is USD 18 million. As part of the new agreement, CGI continues to manage League Data's banking technology infrastructure, client service desk, and software applications, which it has done since 2002.

Key trends of the global healthcare fraud analytics and detection market:

  • The region of North America dominated the global healthcare fraud analytics and detection market by capturing the largest market share in 2019.
  • The region of Asia Pacific is anticipated to project the highest CAGR during the forecast period of 2020-2028.
  • Partnerships among key players are driving the overall market growth.

TABLE OF CONTENTS
  1. RESEARCH SCOPE & METHODOLOGY
    1. STUDY OBJECTIVES
    2. SCOPE OF STUDY
    3. METHODOLOGY
    4. ASSUMPTIONS & LIMITATIONS
  2. EXECUTIVE SUMMARY
    1. MARKET SIZE & ESTIMATES
    2. MARKET OVERVIEW
  3. MARKET DYNAMICS
    1. MARKET DEFINITION
    2.    KEY DRIVERS
      1. RISE IN HEALTHCARE EXPENDITURE
      2. SURGE IN THE NUMBER OF PATIENTS OPTING FOR HEALTH INSURANCE
      3. RISE IN FABRICATED ACTIVITIES IN HEALTHCARE
    3.    KEY RESTRAINTS
      1. RELUCTANCE TO ADOPT HEALTHCARE FRAUD ANALYTICS
  4. KEY ANALYTICS
    1. KEY INVESTMENT INSIGHTS
    2.    PORTER’S FIVE FORCE ANALYSIS
      1. BUYER POWER
      2. SUPPLIER POWER
      3. SUBSTITUTION
      4. NEW ENTRANTS
      5. INDUSTRY RIVALRY
    3. OPPORTUNITY MATRIX
    4. VENDOR LANDSCAPE
  5. MARKET BY TYPE
    1. DESCRIPTIVE ANALYSIS
    2. PREDICTIVE ANALYSIS
    3. PRESCRIPTIVE ANALYSIS
  6. MARKET BY APPLICATION
    1. REVIEW OF INSURANCE CLAIMS
    2. PAYMENT INTEGRITY
  7. MARKET BY END-USER
    1. PRIVATE INSURANCE PAYERS
    2. GOVERNMENT AGENCIES
    3. OTHER END-USERS
  8. GEOGRAPHICAL ANALYSIS
    1.    NORTH AMERICA
      1. UNITED STATES
      2. CANADA
    2.    EUROPE
      1. UNITED KINGDOM
      2. GERMANY
      3. FRANCE
      4. ITALY
      5. RUSSIA
      6. BELGIUM
      7. POLAND
      8. REST OF EUROPE
    3.    ASIA PACIFIC
      1. CHINA
      2. JAPAN
      3. INDIA
      4. SOUTH KOREA
      5. INDONESIA
      6. THAILAND
      7. VIETNAM
      8. AUSTRALIA & NEW ZEALAND
      9. REST OF ASIA PACIFIC
    4.    REST OF WORLD
      1. LATIN AMERICA
      2. MIDDLE EAST & AFRICA
  9. COMPANY PROFILES
    1. CGI INC
    2. DXC TECHNOLOGY
    3. EXL
    4. IBM
    5. MCKESSON
    6. NORTHROP GRUMMAN
    7. OSP LABS
    8. SAS INSTITUTE
    9. RELX GROUP PLC
    10. UNITED HEALTH GROUP INCORPORATED (OPTUM INC)
    11. COTIVITI HOLDINGS INC
    12. CHANGE HEALTHCARE
    13. FAIR ISSAC CORPORATION
    14. PONDERA SOLUTIONS
LIST OF TABLES

TABLE 1: MARKET SNAPSHOT – HEALTHCARE FRAUD ANALYTICS AND DETECTION

TABLE 2: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY TYPE, HISTORICAL YEARS, 2016-2019 (IN $ MILLION)

TABLE 3: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY TYPE, FORECAST YEARS, 2020-2028 (IN $ MILLION)

TABLE 4: GLOBAL DESCRIPTIVE ANALYSIS MARKET, BY REGION, HISTORICAL YEARS, 2016-2019 (IN $ MILLION)

TABLE 5: GLOBAL DESCRIPTIVE ANALYSIS MARKET, BY REGION, FORECAST YEARS, 2020-2028 (IN $ MILLION)

TABLE 6: GLOBAL PREDICTIVE ANALYSIS MARKET, BY REGION, HISTORICAL YEARS, 2016-2019 (IN $ MILLION)

TABLE 7: GLOBAL PREDICTIVE ANALYSIS MARKET, BY REGION, FORECAST YEARS, 2020-2028 (IN $ MILLION)

TABLE 8: GLOBAL PRESCRIPTIVE ANALYSIS MARKET, BY REGION, HISTORICAL YEARS, 2016-2019 (IN $ MILLION)

TABLE 9: GLOBAL PRESCRIPTIVE ANALYSIS MARKET, BY REGION, FORECAST YEARS, 2020-2028 (IN $ MILLION)

TABLE 10: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY APPLICATION, HISTORICAL YEARS, 2016-2019 (IN $

TABLE 11: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY APPLICATION, FORECAST YEARS, 2020-2028 (IN $ MILLION)

TABLE 12: GLOBAL REVIEW OF INSURANCE CLAIMS MARKET, BY REGION, HISTORICAL YEARS, 2016-2019 (IN $ MILLION)

TABLE 13: GLOBAL REVIEW OF INSURANCE CLAIMS MARKET, BY REGION, FORECAST YEARS, 2020-2028 (IN $ MILLION)

TABLE 14: GLOBAL PAYMENT INTEGRITY MARKET, BY REGION, HISTORICAL YEARS, 2016-2019 (IN $ MILLION)

TABLE 15: GLOBAL PAYMENT INTEGRITY MARKET, BY REGION, FORECAST YEARS, 2020-2028 (IN $ MILLION)

TABLE 16: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY END-USER, HISTORICAL YEARS, 2016-2019 (IN $ MILLION)

TABLE 17: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY END-USER, FORECAST YEARS, 2020-2028 (IN $ MILLION)

TABLE 18: GLOBAL PRIVATE INSURANCE PAYERS MARKET, BY REGION, HISTORICAL YEARS, 2016-2019 (IN $ MILLION)

TABLE 19: GLOBAL PRIVATE INSURANCE PAYERS MARKET, BY REGION, FORECAST YEARS, 2020-2028 (IN $ MILLION)

TABLE 20: GLOBAL GOVERNMENT AGENCIES MARKET, BY REGION, HISTORICAL YEARS, 2016-2019 (IN $ MILLION)

TABLE 21: GLOBAL GOVERNMENT AGENCIES MARKET, BY REGION, FORECAST YEARS, 2020-2028 (IN $ MILLION)

TABLE 22: GLOBAL OTHER END-USERS MARKET, BY REGION, HISTORICAL YEARS, 2016-2019 (IN $ MILLION)

TABLE 23: GLOBAL OTHER END-USERS MARKET, BY REGION, FORECAST YEARS, 2020-2028 (IN $ MILLION)

TABLE 24: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY GEOGRAPHY, HISTORICAL YEARS, 2016-2019 (IN $

TABLE 25: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY GEOGRAPHY, FORECAST YEARS, 2020-2028 (IN $ MILLION)

TABLE 26: NORTH AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY COUNTRY, HISTORICAL YEARS, 2016-2019 (IN $ MILLION)

TABLE 27: NORTH AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY COUNTRY, FORECAST YEARS, 2020-2028 (IN $ MILLION)

TABLE 28: EUROPE HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY COUNTRY, HISTORICAL YEARS, 2016-2019 (IN $ MILLION)

TABLE 29: EUROPE HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY COUNTRY, FORECAST YEARS, 2020-2028 (IN $ MILLION)

TABLE 30: ASIA PACIFIC HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY COUNTRY, HISTORICAL YEARS, 2016-2019 (IN $ MILLION)

TABLE 31: ASIA PACIFIC HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY COUNTRY, FORECAST YEARS, 2020-2028 (IN $ MILLION)

TABLE 32: REST OF WORLD HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY REGION, HISTORICAL YEARS, 2016-2019 (IN $ MILLION)

TABLE 33: REST OF WORLD HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY REGION, FORECAST YEARS, 2020-2028 (IN $ MILLION)

LIST OF FIGURES

FIGURE 1: KEY INVESTMENT INSIGHTS

FIGURE 2: PORTER’S FIVE FORCE ANALYSIS

FIGURE 3: OPPORTUNITY MATRIX

FIGURE 4: VENDOR LANDSCAPE

FIGURE 5: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, GROWTH POTENTIAL, BY TYPE, IN 2019

FIGURE 6: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY DESCRIPTIVE ANALYSIS, 2020-2028 (IN $ MILLION)

FIGURE 7: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY PREDICTIVE ANALYSIS, 2020-2028 (IN $ MILLION)

FIGURE 8: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY PRESCRIPTIVE ANALYSIS, 2020-2028 (IN $ MILLION)

FIGURE 9: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, GROWTH POTENTIAL, BY APPLICATION, IN 2019

FIGURE 10: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY REVIEW OF INSURANCE CLAIMS, 2020-2028 (IN $ MILLION)

FIGURE 11: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY PAYMENT INTEGRITY, 2020-2028 (IN $ MILLION)

FIGURE 12: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, GROWTH POTENTIAL, BY END-USER, IN 2019

FIGURE 13: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY PRIVATE INSURANCE PAYERS, 2020-2028 (IN $ MILLION)

FIGURE 14: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY GOVERNMENT AGENCIES, 2020-2028 (IN $ MILLION)

FIGURE 15: GLOBAL HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, BY OTHER END-USERS, 2020-2028 (IN $ MILLION)

FIGURE 16: NORTH AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, REGIONAL OUTLOOK, 2019 & 2028 (IN %)

FIGURE 17: UNITED STATES HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2020-2028 (IN $ MILLION)

FIGURE 18: CANADA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2020-2028 (IN $ MILLION)

FIGURE 19: EUROPE HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, REGIONAL OUTLOOK, 2019 & 2028 (IN %)

FIGURE 20: UNITED KINGDOM HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2020-2028 (IN $ MILLION)

FIGURE 21: GERMANY HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2020-2028 (IN $ MILLION)

FIGURE 22: FRANCE HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2020-2028 (IN $ MILLION)

FIGURE 23: ITALY HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2020-2028 (IN $ MILLION)

FIGURE 24: RUSSIA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2020-2028 (IN $ MILLION)

FIGURE 25: BELGIUM HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2020-2028 (IN $ MILLION)

FIGURE 26: POLAND HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2020-2028 (IN $ MILLION)

FIGURE 27: REST OF EUROPE HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2020-2028 (IN $ MILLION)

FIGURE 28: ASIA PACIFIC HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, REGIONAL OUTLOOK, 2019 & 2028 (IN %)

FIGURE 29: CHINA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2020-2028 (IN $ MILLION)

FIGURE 30: JAPAN HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2020-2028 (IN $ MILLION)

FIGURE 31: INDIA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2020-2028 (IN $ MILLION)

FIGURE 32: SOUTH KOREA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2020-2028 (IN $ MILLION)

FIGURE 33: INDONESIA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2020-2028 (IN $ MILLION)

FIGURE 34: THAILAND HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2020-2028 (IN $ MILLION)

FIGURE 35: VIETNAM HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2020-2028 (IN $ MILLION)

FIGURE 36: AUSTRALIA & NEW ZEALAND HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2020-2028 (IN $ MILLION)

FIGURE 37: REST OF ASIA PACIFIC HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2020-2028 (IN $ MILLION)

FIGURE 38: REST OF WORLD HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, REGIONAL OUTLOOK, 2019 & 2028 (IN %)

FIGURE 39: LATIN AMERICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2020-2028 (IN $ MILLION)

FIGURE 40: MIDDLE EAST & AFRICA HEALTHCARE FRAUD ANALYTICS AND DETECTION MARKET, 2020-2028 (IN $ MILLION)

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