Market Overview:
The global medical payment integrity and fraud detection market is expected to grow at a CAGR of 10.8% from 2018 to 2030. The growth of the market can be attributed to the increasing incidence of healthcare fraud, rising adoption of cloud-based solutions, and growing need for compliance with government regulations. The global medical payment integrity and fraud detection market is segmented on the basis of type, application, and region. On the basis of type, the market is segmented into external hosting and internal deployment. The external hosting segment is further sub-segmented into cloud-based deployment and on-premises deployment. The internal deployment segment is further sub-segmented into software as a service (SaaS), platform as a service (PaaS), and infrastructure as a service (IaaS). On the basis of application, the market is divided into hospital, clinic, nursing center, pharmacy benefit manager (PBM), laboratory benefits manager (LBM), health insurance company/payer/provider network administrator/managerial staffs within payers or providers organization etc., others which include dental clinics & hospitals etc.).
Product Definition:
Medical payment integrity and fraud detection is the process of ensuring that health care providers are paid accurately for the services they provide and that no fraudulent activities occur. The importance of medical payment integrity and fraud detection is that it helps to ensure that taxpayers' money is not wasted on fraudulent activities, and it also helps to protect patients from being overcharged or receiving substandard care.
External Hosting:
External hosting is a technique where the data and applications are hosted on an external server. It helps in increasing the scalability of business organizations by decreasing the maintenance and development time, as well as providing high availability of services. External hosting also helps in reducing security risks to critical data owing to its remote location from the company’s mainframe or servers.
Internal Deployment:
Internal deployment is a technique where the software solution or application is installed and operated within an organization's network. The installation of the software can be done by a professional service provider or in-house IT personnel with proper training. Internal deployment offers several advantages such as easy implementation, cost efficiency, and low maintenance which increases its adoption rate leading to market growth.
Application Insights:
Based on application, the global market is segmented into hospital, clinic and/or medical center, and other applications. The hospital segment dominated the overall market in terms of revenue in 2017. This can be attributed to factors such as increasing prevalence of chronic diseases that require long term care and higher expenditure on healthcare globally. In addition, an increase in number of hospitals has led to increased competition among them resulting in high quality services with reduced costs which has further driven growth over the recent years.
The Clinic & Medical Center segment is expected to grow at a lucrative rate during the forecast period owing to factors such as growing emphasis towards cost containment within clinics coupled with rising need for fraud detection solutions by medical centers across various geographies due to increasing incidence of healthcare frauds globally over past few years which have resulted in increased demand for these systems within clinics or medical centers thereby driving growth for this segment during forecast period (2018-2030).
Regional Analysis:
The market in North America is expected to grow at a significant rate over the forecast period. The growth can be attributed to various factors such as increasing government initiatives, rising healthcare expenditure, and technological advancements. For instance, in 2014, the U.S launched an initiative named “Healthcare Fraud Prevention Initiative†which focused on preventing frauds from occurring within its healthcare system by sharing information with other countries through a secure network called “Extensible Data Exchange†(EDI). This initiative has helped reduce medical billing errors and fraudulent claims within the U.
In Asia Pacific region market growth is anticipated to be rapid owing to growing demand for advanced technologies that aid in reducing costs while simultaneously improving patient care standards along with increasing government spending on healthcare infrastructure development projects such as hospitals & clinics.
Growth Factors:
- Increasing incidence of medical payment fraud and abuse: The global market for medical payment integrity and fraud detection is expected to grow at a CAGR of over 9% from 2016 to 2024. This growth can be attributed to the increasing incidence of medical payment fraud and abuse across the globe. According to a study by KPMG, healthcare providers lost an estimated .5 billion in revenue due to fraudulent activities in 2015, up from .8 billion in 2014.
- Proliferation of connected devices: The proliferation of connected devices is another key growth driver for the market as it enables healthcare providers to detect fraudulent activities through real-time data analysis and reporting mechanisms. For instance, hospitals are increasingly using RFID tags on patients’ belongings such as clothes, wheelchairs, etc., which helps identify any discrepancies between what has been billed and what has actually been used/consumed during treatment/stay at the hospital premises (e-pedigree).
Scope Of The Report
Report Attributes
Report Details
Report Title
Medical Payment Integrity and Fraud Detection Market Research Report
By Type
External Hosting, Internal Deployment
By Application
Hospital, Clinic, Nursing Center
By Companies
SAS Institute Inc, Context 4 Healthcare Inc, SCIOInspire, Corp, COTIVITI, INC, MultiPlan, Change Healthcare, PLEXIS Healthcare Systems, TransUnion LLC
Regions Covered
North America, Europe, APAC, Latin America, MEA
Base Year
2021
Historical Year
2019 to 2020 (Data from 2010 can be provided as per availability)
Forecast Year
2030
Number of Pages
198
Number of Tables & Figures
139
Customization Available
Yes, the report can be customized as per your need.
Global Medical Payment Integrity and Fraud Detection Market Report Segments:
The global Medical Payment Integrity and Fraud Detection market is segmented on the basis of:
Types
External Hosting, Internal Deployment
The product segment provides information about the market share of each product and the respective CAGR during the forecast period. It lays out information about the product pricing parameters, trends, and profits that provides in-depth insights of the market. Furthermore, it discusses latest product developments & innovation in the market.
Applications
Hospital, Clinic, Nursing Center
The application segment fragments various applications of the product and provides information on the market share and growth rate of each application segment. It discusses the potential future applications of the products and driving and restraining factors of each application segment.
Some of the companies that are profiled in this report are:
- SAS Institute Inc
- Context 4 Healthcare Inc
- SCIOInspire, Corp
- COTIVITI, INC
- MultiPlan
- Change Healthcare
- PLEXIS Healthcare Systems
- TransUnion LLC
Highlights of The Medical Payment Integrity and Fraud Detection Market Report:
- The market structure and projections for the coming years.
- Drivers, restraints, opportunities, and current trends of market.
- Historical data and forecast.
- Estimations for the forecast period 2030.
- Developments and trends in the market.
- By Type:
- External Hosting
- Internal Deployment
- By Application:
- Hospital
- Clinic
- Nursing Center
- Market scenario by region, sub-region, and country.
- Market share of the market players, company profiles, product specifications, SWOT analysis, and competitive landscape.
- Analysis regarding upstream raw materials, downstream demand, and current market dynamics.
- Government Policies, Macro & Micro economic factors are also included in the report.
We have studied the Medical Payment Integrity and Fraud Detection Market in 360 degrees via. both primary & secondary research methodologies. This helped us in building an understanding of the current market dynamics, supply-demand gap, pricing trends, product preferences, consumer patterns & so on. The findings were further validated through primary research with industry experts & opinion leaders across countries. The data is further compiled & validated through various market estimation & data validation methodologies. Further, we also have our in-house data forecasting model to predict market growth up to 2030.
Regional Analysis
- North America
- Europe
- Asia Pacific
- Middle East & Africa
- Latin America
Note: A country of choice can be added in the report at no extra cost. If more than one country needs to be added, the research quote will vary accordingly.
The geographical analysis part of the report provides information about the product sales in terms of volume and revenue in regions. It lays out potential opportunities for the new entrants, emerging players, and major players in the region. The regional analysis is done after considering the socio-economic factors and government regulations of the countries in the regions.
How you may use our products:
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8 Reasons to Buy This Report
- Includes a Chapter on the Impact of COVID-19 Pandemic On the Market
- Report Prepared After Conducting Interviews with Industry Experts & Top Designates of the Companies in the Market
- Implemented Robust Methodology to Prepare the Report
- Includes Graphs, Statistics, Flowcharts, and Infographics to Save Time
- Industry Growth Insights Provides 24/5 Assistance Regarding the Doubts in the Report
- Provides Information About the Top-winning Strategies Implemented by Industry Players.
- In-depth Insights On the Market Drivers, Restraints, Opportunities, and Threats
- Customization of the Report Available
Frequently Asked Questions?
Medical Payment Integrity (MPI) is a term used to describe the prevention of health care fraud and abuse. Fraud detection is an important part of MPI, as it helps identify and prevent fraudulent activities before they occur.
Some of the major companies in the medical payment integrity and fraud detection market are SAS Institute Inc, Context 4 Healthcare Inc, SCIOInspire, Corp, COTIVITI, INC, MultiPlan, Change Healthcare, PLEXIS Healthcare Systems, TransUnion LLC.
The medical payment integrity and fraud detection market is expected to register a CAGR of 10.8%.
Chapter 1 Executive Summary
Chapter 2 Assumptions and Acronyms Used
Chapter 3 Research Methodology
Chapter 4 Medical Payment Integrity and Fraud Detection Market Overview
4.1 Introduction
4.1.1 Market Taxonomy
4.1.2 Market Definition
4.1.3 Macro-Economic Factors Impacting the Market Growth
4.2 Medical Payment Integrity and Fraud Detection Market Dynamics
4.2.1 Market Drivers
4.2.2 Market Restraints
4.2.3 Market Opportunity
4.3 Medical Payment Integrity and Fraud Detection Market - Supply Chain Analysis
4.3.1 List of Key Suppliers
4.3.2 List of Key Distributors
4.3.3 List of Key Consumers
4.4 Key Forces Shaping the Medical Payment Integrity and Fraud Detection Market
4.4.1 Bargaining Power of Suppliers
4.4.2 Bargaining Power of Buyers
4.4.3 Threat of Substitution
4.4.4 Threat of New Entrants
4.4.5 Competitive Rivalry
4.5 Global Medical Payment Integrity and Fraud Detection Market Size & Forecast, 2018-2028
4.5.1 Medical Payment Integrity and Fraud Detection Market Size and Y-o-Y Growth
4.5.2 Medical Payment Integrity and Fraud Detection Market Absolute $ Opportunity
Chapter 5 Global Medical Payment Integrity and Fraud Detection Market Analysis and Forecast by Type
5.1 Introduction
5.1.1 Key Market Trends & Growth Opportunities by Type
5.1.2 Basis Point Share (BPS) Analysis by Type
5.1.3 Absolute $ Opportunity Assessment by Type
5.2 Medical Payment Integrity and Fraud Detection Market Size Forecast by Type
5.2.1 External Hosting
5.2.2 Internal Deployment
5.3 Market Attractiveness Analysis by Type
Chapter 6 Global Medical Payment Integrity and Fraud Detection Market Analysis and Forecast by Applications
6.1 Introduction
6.1.1 Key Market Trends & Growth Opportunities by Applications
6.1.2 Basis Point Share (BPS) Analysis by Applications
6.1.3 Absolute $ Opportunity Assessment by Applications
6.2 Medical Payment Integrity and Fraud Detection Market Size Forecast by Applications
6.2.1 Hospital
6.2.2 Clinic
6.2.3 Nursing Center
6.3 Market Attractiveness Analysis by Applications
Chapter 7 Global Medical Payment Integrity and Fraud Detection Market Analysis and Forecast by Region
7.1 Introduction
7.1.1 Key Market Trends & Growth Opportunities by Region
7.1.2 Basis Point Share (BPS) Analysis by Region
7.1.3 Absolute $ Opportunity Assessment by Region
7.2 Medical Payment Integrity and Fraud Detection Market Size Forecast by Region
7.2.1 North America
7.2.2 Europe
7.2.3 Asia Pacific
7.2.4 Latin America
7.2.5 Middle East & Africa (MEA)
7.3 Market Attractiveness Analysis by Region
Chapter 8 Coronavirus Disease (COVID-19) Impact
8.1 Introduction
8.2 Current & Future Impact Analysis
8.3 Economic Impact Analysis
8.4 Government Policies
8.5 Investment Scenario
Chapter 9 North America Medical Payment Integrity and Fraud Detection Analysis and Forecast
9.1 Introduction
9.2 North America Medical Payment Integrity and Fraud Detection Market Size Forecast by Country
9.2.1 U.S.
9.2.2 Canada
9.3 Basis Point Share (BPS) Analysis by Country
9.4 Absolute $ Opportunity Assessment by Country
9.5 Market Attractiveness Analysis by Country
9.6 North America Medical Payment Integrity and Fraud Detection Market Size Forecast by Type
9.6.1 External Hosting
9.6.2 Internal Deployment
9.7 Basis Point Share (BPS) Analysis by Type
9.8 Absolute $ Opportunity Assessment by Type
9.9 Market Attractiveness Analysis by Type
9.10 North America Medical Payment Integrity and Fraud Detection Market Size Forecast by Applications
9.10.1 Hospital
9.10.2 Clinic
9.10.3 Nursing Center
9.11 Basis Point Share (BPS) Analysis by Applications
9.12 Absolute $ Opportunity Assessment by Applications
9.13 Market Attractiveness Analysis by Applications
Chapter 10 Europe Medical Payment Integrity and Fraud Detection Analysis and Forecast
10.1 Introduction
10.2 Europe Medical Payment Integrity and Fraud Detection Market Size Forecast by Country
10.2.1 Germany
10.2.2 France
10.2.3 Italy
10.2.4 U.K.
10.2.5 Spain
10.2.6 Russia
10.2.7 Rest of Europe
10.3 Basis Point Share (BPS) Analysis by Country
10.4 Absolute $ Opportunity Assessment by Country
10.5 Market Attractiveness Analysis by Country
10.6 Europe Medical Payment Integrity and Fraud Detection Market Size Forecast by Type
10.6.1 External Hosting
10.6.2 Internal Deployment
10.7 Basis Point Share (BPS) Analysis by Type
10.8 Absolute $ Opportunity Assessment by Type
10.9 Market Attractiveness Analysis by Type
10.10 Europe Medical Payment Integrity and Fraud Detection Market Size Forecast by Applications
10.10.1 Hospital
10.10.2 Clinic
10.10.3 Nursing Center
10.11 Basis Point Share (BPS) Analysis by Applications
10.12 Absolute $ Opportunity Assessment by Applications
10.13 Market Attractiveness Analysis by Applications
Chapter 11 Asia Pacific Medical Payment Integrity and Fraud Detection Analysis and Forecast
11.1 Introduction
11.2 Asia Pacific Medical Payment Integrity and Fraud Detection Market Size Forecast by Country
11.2.1 China
11.2.2 Japan
11.2.3 South Korea
11.2.4 India
11.2.5 Australia
11.2.6 South East Asia (SEA)
11.2.7 Rest of Asia Pacific (APAC)
11.3 Basis Point Share (BPS) Analysis by Country
11.4 Absolute $ Opportunity Assessment by Country
11.5 Market Attractiveness Analysis by Country
11.6 Asia Pacific Medical Payment Integrity and Fraud Detection Market Size Forecast by Type
11.6.1 External Hosting
11.6.2 Internal Deployment
11.7 Basis Point Share (BPS) Analysis by Type
11.8 Absolute $ Opportunity Assessment by Type
11.9 Market Attractiveness Analysis by Type
11.10 Asia Pacific Medical Payment Integrity and Fraud Detection Market Size Forecast by Applications
11.10.1 Hospital
11.10.2 Clinic
11.10.3 Nursing Center
11.11 Basis Point Share (BPS) Analysis by Applications
11.12 Absolute $ Opportunity Assessment by Applications
11.13 Market Attractiveness Analysis by Applications
Chapter 12 Latin America Medical Payment Integrity and Fraud Detection Analysis and Forecast
12.1 Introduction
12.2 Latin America Medical Payment Integrity and Fraud Detection Market Size Forecast by Country
12.2.1 Brazil
12.2.2 Mexico
12.2.3 Rest of Latin America (LATAM)
12.3 Basis Point Share (BPS) Analysis by Country
12.4 Absolute $ Opportunity Assessment by Country
12.5 Market Attractiveness Analysis by Country
12.6 Latin America Medical Payment Integrity and Fraud Detection Market Size Forecast by Type
12.6.1 External Hosting
12.6.2 Internal Deployment
12.7 Basis Point Share (BPS) Analysis by Type
12.8 Absolute $ Opportunity Assessment by Type
12.9 Market Attractiveness Analysis by Type
12.10 Latin America Medical Payment Integrity and Fraud Detection Market Size Forecast by Applications
12.10.1 Hospital
12.10.2 Clinic
12.10.3 Nursing Center
12.11 Basis Point Share (BPS) Analysis by Applications
12.12 Absolute $ Opportunity Assessment by Applications
12.13 Market Attractiveness Analysis by Applications
Chapter 13 Middle East & Africa (MEA) Medical Payment Integrity and Fraud Detection Analysis and Forecast
13.1 Introduction
13.2 Middle East & Africa (MEA) Medical Payment Integrity and Fraud Detection Market Size Forecast by Country
13.2.1 Saudi Arabia
13.2.2 South Africa
13.2.3 UAE
13.2.4 Rest of Middle East & Africa (MEA)
13.3 Basis Point Share (BPS) Analysis by Country
13.4 Absolute $ Opportunity Assessment by Country
13.5 Market Attractiveness Analysis by Country
13.6 Middle East & Africa (MEA) Medical Payment Integrity and Fraud Detection Market Size Forecast by Type
13.6.1 External Hosting
13.6.2 Internal Deployment
13.7 Basis Point Share (BPS) Analysis by Type
13.8 Absolute $ Opportunity Assessment by Type
13.9 Market Attractiveness Analysis by Type
13.10 Middle East & Africa (MEA) Medical Payment Integrity and Fraud Detection Market Size Forecast by Applications
13.10.1 Hospital
13.10.2 Clinic
13.10.3 Nursing Center
13.11 Basis Point Share (BPS) Analysis by Applications
13.12 Absolute $ Opportunity Assessment by Applications
13.13 Market Attractiveness Analysis by Applications
Chapter 14 Competition Landscape
14.1 Medical Payment Integrity and Fraud Detection Market: Competitive Dashboard
14.2 Global Medical Payment Integrity and Fraud Detection Market: Market Share Analysis, 2019
14.3 Company Profiles (Details – Overview, Financials, Developments, Strategy)
14.3.1 SAS Institute Inc
14.3.2 Context 4 Healthcare Inc
14.3.3 SCIOInspire, Corp
14.3.4 COTIVITI, INC
14.3.5 MultiPlan
14.3.6 Change Healthcare
14.3.7 PLEXIS Healthcare Systems
14.3.8 TransUnion LLC
