Market Overview:
The global healthcare fraud detection market is expected to grow at a CAGR of 10.8% from 2018 to 2030. The market growth is attributed to the increasing incidence of healthcare fraud, rising awareness about the benefits of healthcare fraud detection solutions, and growing demand for cloud-based solutions. However, the high cost of deployment and maintenance is expected to restrain the growth of this market during the forecast period. On the basis of type, the global healthcare fraud detection market can be segmented into service and software. The service segment dominates this market owing to its ability to provide end-to-end solutions for detecting various types of healthcare frauds. On the basis of application, this market can be divided into insurance claim processing, prepaid medical services, and post payment medical services.
Product Definition:
Healthcare fraud detection is the identification of fraudulent healthcare practices, typically by insurers or government healthcare programs such as Medicare and Medicaid. The goal of healthcare fraud detection is to reduce the cost of fraudulent activities, which can be considerable. For example, a study by the Government Accountability Office estimated that in 2012 federal and state governments lost billion to healthcare fraud.
Service:
Service is a process that involves the delivery of goods or products by one party to another. In the healthcare industry, service refers to professional services offered by doctors, nurses, pharmacists and other healthcare professionals. Service fraud in the healthcare sector has been growing at a rapid pace over the past few years and it's being used as an instrument for personal gain by individuals who are not entitled to receive medical services or benefits from any insurance company or government program.
Software:
Software is a set of procedures, programs, codes or algorithms that are designed to achieve a common goal. In the healthcare industry software is used for detecting fraud and other crimes. The healthcare industry has witnessed several instances of financial and billing errors which have led to revenue loss due to improper care provided by doctors or nurses.
Application Insights:
The insurance claim application segment dominated the global healthcare fraud detection market in 2017. This can be attributed to a large number of incidents that have taken place over the years, where individuals or companies impersonate authorities and trick patients or their families into paying for unnecessary services. For instance, in one such case, an individual posing as a lawyer contacted an elderly patient and her family members and convinced them to pay him via Western Union money transfer for settling her dues with Medicare.
In another instance, a man pretending to be from Microsoft Corporation called up billing numbers registered with Windows Update Service (WUS) on computers at hospitals across China¢â‚¬â„¢s Zhejiang province between July 2016 and March 2017. He then tricked hospital staff into installing malware on computers which led to massive data theft from hospitals during WUS update cycles which were later made public by Chinese media outlets in April 2017.
Regional Analysis:
North America accounted for the largest share of over 40% in 2017. The healthcare industry is one of the most fraud-prone industries owing to which it has been targeted by hackers more than once. As a result, there is an increased focus on healthcare data security across this region, which has led to a rise in demand for fraud detection solutions within this sector.
Asia Pacific is expected to be the fastest-growing market due to factors such as increasing government spending and rising penetration of digital services in emerging economies such as India and China. Moreover, these countries are also home to some of the biggest hospitals & clinics that need constant monitoring & verification while taking payments or making claims so that they don’t run into any fraudulent activities or lose money through billing errors (over billing). This scenario will further strengthen regional growth prospects over next few years.
Growth Factors:
- Increasing incidence of healthcare frauds: The global healthcare fraud detection market is expected to grow at a CAGR of 16.5% during the forecast period due to the increasing incidence of healthcare frauds. Healthcare organizations are increasingly becoming aware of the need for robust and efficient fraud detection systems in order to protect their interests and prevent financial losses.
- Proliferation of big data and analytics: The growth of big data and analytics is providing a major impetus to the growth of the healthcare fraud detection market. Big data refers to extremely large datasets that cannot be processed using traditional computing methods, necessitating the use of advanced analytical tools such as big data analytics platforms. This has led to an increase in demand for solutions that can help organizations make sense out if this unstructured data and detect fraudulent activities quickly and efficiently.
Scope Of The Report
Report Attributes
Report Details
Report Title
Healthcare Fraud Detection Market Research Report
By Type
Service, Software
By Application
Insurance Claim, Prepay, Post Payment
By Companies
IBM (US), Optum (US), SAS (US), McKesson (US), SCIO (US), Verscend (US), Wipro (India), Conduent (US), HCL (India), CGI (Canada), DXC (US), Northrop Grumman (US), LexisNexis (US), Pondera (US)
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
233
Number of Tables & Figures
164
Customization Available
Yes, the report can be customized as per your need.
Global Healthcare Fraud Detection Market Report Segments:
The global Healthcare Fraud Detection market is segmented on the basis of:
Types
Service, Software
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
Insurance Claim, Prepay, Post Payment
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:
- IBM (US)
- Optum (US)
- SAS (US)
- McKesson (US)
- SCIO (US)
- Verscend (US)
- Wipro (India)
- Conduent (US)
- HCL (India)
- CGI (Canada)
- DXC (US)
- Northrop Grumman (US)
- LexisNexis (US)
- Pondera (US)
Highlights of The Healthcare 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:
- Service
- Software
- By Application:
- Insurance Claim
- Prepay
- Post Payment
- 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 Healthcare 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.
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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?
Healthcare fraud detection is the process of identifying and preventing healthcare fraud. Healthcare fraud can take many forms, including billing for services that were not actually provided, overcharging patients for services, and falsifying medical records. Healthcare fraud detection efforts may include monitoring patient records for signs of fraudulent activity, conducting investigations into suspected cases of healthcare fraud, and working with law enforcement to prosecute offenders.
Some of the key players operating in the healthcare fraud detection market are IBM (US), Optum (US), SAS (US), McKesson (US), SCIO (US), Verscend (US), Wipro (India), Conduent (US), HCL (India), CGI (Canada), DXC (US), Northrop Grumman (US), LexisNexis (US), Pondera (US).
The healthcare fraud detection market is expected to register a CAGR of 10.8%.
1. Executive Summary
2. Assumptions and Acronyms Used
3. Research Methodology
4. Healthcare Fraud Detection Market Overview
4.1. Introduction
4.1.1. Market Taxonomy
4.1.2. Market Definition
4.2. Macro-Economic Factors
4.2.1. Industry Outlook
4.3. Healthcare Fraud Detection Market Dynamics
4.3.1. Market Drivers
4.3.2. Market Restraints
4.3.3. Opportunity
4.3.4. Market Trends
4.4. Healthcare Fraud Detection Market - Supply Chain
4.5. Global Healthcare Fraud Detection Market Forecast
4.5.1. Healthcare Fraud Detection Market Size (US$ Mn) and Y-o-Y Growth
4.5.2. Healthcare Fraud Detection Market Size (000 Units) and Y-o-Y Growth
4.5.3. Healthcare Fraud Detection Market Absolute $ Opportunity
5. Global Healthcare Fraud Detection Market Analysis and Forecast by Type
5.1. Market Trends
5.2. Introduction
5.2.1. Basis Point Share (BPS) Analysis by Type
5.2.2. Y-o-Y Growth Projections by Type
5.3. Healthcare Fraud Detection Market Size and Volume Forecast by Type
5.3.1. Service
5.3.2. Software
5.4. Absolute $ Opportunity Assessment by Type
5.5. Market Attractiveness/Growth Potential Analysis by Type
6. Global Healthcare Fraud Detection Market Analysis and Forecast by Application
6.1. Market Trends
6.2. Introduction
6.2.1. Basis Point Share (BPS) Analysis by Application
6.2.2. Y-o-Y Growth Projections by Application
6.3. Healthcare Fraud Detection Market Size and Volume Forecast by Application
6.3.1. Insurance Claim
6.3.2. Prepay
6.3.3. Post Payment
6.4. Absolute $ Opportunity Assessment by Application
6.5. Market Attractiveness/Growth Potential Analysis by Application
7. Global Healthcare Fraud Detection Market Analysis and Forecast by Sales Channel
7.1. Market Trends
7.2. Introduction
7.2.1. Basis Point Share (BPS) Analysis by Sales Channel
7.2.2. Y-o-Y Growth Projections by Sales Channel
7.3. Healthcare Fraud Detection Market Size and Volume Forecast by Sales Channel
7.3.1. Manufacturer/Distributor/Service Provider
7.3.2. Aftermarket
7.4. Absolute $ Opportunity Assessment by Sales Channel
7.5. Market Attractiveness/Growth Potential Analysis by Sales Channel
8. Global Healthcare Fraud Detection Market Analysis and Forecast by Region
8.1. Market Trends
8.2. Introduction
8.2.1. Basis Point Share (BPS) Analysis by Region
8.2.2. Y-o-Y Growth Projections by Region
8.3. Healthcare Fraud Detection Market Size and Volume Forecast by Region
8.3.1. North America
8.3.2. Latin America
8.3.3. Europe
8.3.4. Asia Pacific
8.3.5. Middle East and Africa (MEA)
8.4. Absolute $ Opportunity Assessment by Region
8.5. Market Attractiveness/Growth Potential Analysis by Region
8.6. Global Healthcare Fraud Detection Demand Share Forecast, 2019-2026
9. North America Healthcare Fraud Detection Market Analysis and Forecast
9.1. Introduction
9.1.1. Basis Point Share (BPS) Analysis by Country
9.1.2. Y-o-Y Growth Projections by Country
9.2. North America Healthcare Fraud Detection Market Size and Volume Forecast by Country
9.2.1. U.S.
9.2.2. Canada
9.3. Absolute $ Opportunity Assessment by Country
9.4. North America Healthcare Fraud Detection Market Size and Volume Forecast by Application
9.4.1. Insurance Claim
9.4.2. Prepay
9.4.3. Post Payment
9.5. Basis Point Share (BPS) Analysis by Application
9.6. Y-o-Y Growth Projections by Application
9.7. North America Healthcare Fraud Detection Market Size and Volume Forecast by Type
9.7.1. Service
9.7.2. Software
9.8. Basis Point Share (BPS) Analysis by Type
9.9. Y-o-Y Growth Projections by Type
9.10. Market Attractiveness/Growth Potential Analysis
9.10.1. By Country
9.10.2. By Product Type
9.10.3. By Application
9.10.4. By Sales Channel
9.11. North America Healthcare Fraud Detection Demand Share Forecast, 2019-2026
10. Latin America Healthcare Fraud Detection Market Analysis and Forecast
10.1. Introduction
10.1.1. Basis Point Share (BPS) Analysis by Country
10.1.2. Y-o-Y Growth Projections by Country
10.1.3. Latin America Average Pricing Analysis
10.2. Latin America Healthcare Fraud Detection Market Size and Volume Forecast by Country
10.2.1. Brazil
10.2.2. Mexico
10.2.3. Rest of Latin America
10.3. Absolute $ Opportunity Assessment by Country
10.4. Latin America Healthcare Fraud Detection Market Size and Volume Forecast by Application
10.4.1. Insurance Claim
10.4.2. Prepay
10.4.3. Post Payment
10.5. Basis Point Share (BPS) Analysis by Application
10.6. Y-o-Y Growth Projections by Application
10.7. Latin America Healthcare Fraud Detection Market Size and Volume Forecast by Type
10.7.1. Service
10.7.2. Software
10.8. Basis Point Share (BPS) Analysis by Type
10.9. Y-o-Y Growth Projections by Type
10.10. Market Attractiveness/Growth Potential Analysis
10.10.1. By Country
10.10.2. By Product Type
10.10.3. By Application
10.10.4. By Sales Channel
10.11. Latin America Healthcare Fraud Detection Demand Share Forecast, 2019-2026
11. Europe Healthcare Fraud Detection Market Analysis and Forecast
11.1. Introduction
11.1.1. Basis Point Share (BPS) Analysis by Country
11.1.2. Y-o-Y Growth Projections by Country
11.1.3. Europe Average Pricing Analysis
11.2. Europe Healthcare Fraud Detection Market Size and Volume Forecast by Country
11.2.1. Germany
11.2.2. France
11.2.3. Italy
11.2.4. U.K.
11.2.5. Spain
11.2.6. Russia
11.2.7. Rest of Europe
11.3. Absolute $ Opportunity Assessment by Country
11.4. Europe Healthcare Fraud Detection Market Size and Volume Forecast by Application
11.4.1. Insurance Claim
11.4.2. Prepay
11.4.3. Post Payment
11.5. Basis Point Share (BPS) Analysis by Application
11.6. Y-o-Y Growth Projections by Application
11.7. Europe Healthcare Fraud Detection Market Size and Volume Forecast by Type
11.7.1. Service
11.7.2. Software
11.8. Basis Point Share (BPS) Analysis by Type
11.9. Y-o-Y Growth Projections by Type
11.10. Market Attractiveness/Growth Potential Analysis
11.10.1. By Country
11.10.2. By Product Type
11.10.3. By Application
11.10.4. By Sales Channel
11.11. Europe Healthcare Fraud Detection Demand Share, 2019-2026
12. Asia Pacific Healthcare Fraud Detection Market Analysis and Forecast
12.1. Introduction
12.1.1. Basis Point Share (BPS) Analysis by Country
12.1.2. Y-o-Y Growth Projections by Country
12.1.3. Asia Pacific Average Pricing Analysis
12.2. Asia Pacific Healthcare Fraud Detection Market Size and Volume Forecast by Country
12.2.1. China
12.2.2. Japan
12.2.3. South Korea
12.2.4. India
12.2.5. Australia
12.2.6. Rest of Asia Pacific (APAC)
12.3. Absolute $ Opportunity Assessment by Country
12.4. Asia Pacific Healthcare Fraud Detection Market Size and Volume Forecast by Application
12.4.1. Insurance Claim
12.4.2. Prepay
12.4.3. Post Payment
12.5. Basis Point Share (BPS) Analysis by Application
12.6. Y-o-Y Growth Projections by Application
12.7. Asia Pacific Healthcare Fraud Detection Market Size and Volume Forecast by Type
12.7.1. Service
12.7.2. Software
12.8. Basis Point Share (BPS) Analysis by Type
12.9. Y-o-Y Growth Projections by Type
12.10. Market Attractiveness/Growth Potential Analysis
12.10.1. By Country
12.10.2. By Product Type
12.10.3. By Application
12.10.4. By Sales Channel
12.11. Asia Pacific Healthcare Fraud Detection Demand Share, 2019-2026
13. Middle East & Africa Healthcare Fraud Detection Market Analysis and Forecast
13.1. Introduction
13.1.1. Basis Point Share (BPS) Analysis by Country
13.1.2. Y-o-Y Growth Projections by Country
13.1.3. Asia Pacific Average Pricing Analysis
13.2. Middle East & Africa Healthcare Fraud Detection Market Size and Volume 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. Absolute $ Opportunity Assessment by Country
13.4. Middle East & Africa Healthcare Fraud Detection Market Size and Volume Forecast by Application
13.4.1. Insurance Claim
13.4.2. Prepay
13.4.3. Post Payment
13.5. Basis Point Share (BPS) Analysis by Application
13.6. Y-o-Y Growth Projections by Application
13.7. Middle East & Africa Healthcare Fraud Detection Market Size and Volume Forecast by Type
13.7.1. Service
13.7.2. Software
13.8. Basis Point Share (BPS) Analysis by Type
13.9. Y-o-Y Growth Projections by Type
13.10. Market Attractiveness/Growth Potential Analysis
13.10.1. By Country
13.10.2. By Product Type
13.10.3. By Application
13.10.4. By Sales Channel
13.11. Middle East & Africa Healthcare Fraud Detection Demand Share, 2019-2026
14. Competition Landscape
14.1. Global Healthcare Fraud Detection Market: Market Share Analysis
14.2. Healthcare Fraud Detection Distributors and Customers
14.3. Healthcare Fraud Detection Market: Competitive Dashboard
14.4. Company Profiles (Details Overview, Financials, Developments, Strategy)
14.4.1. IBM (US)
14.4.1.1. Overview
14.4.1.2. Financials
14.4.1.3. Developments
14.4.1.4. Strategic Outlook
14.4.2. Optum (US)
14.4.2.1. Overview
14.4.2.2. Financials
14.4.2.3. Developments
14.4.2.4. Strategic Outlook
14.4.3. SAS (US)
14.4.3.1. Overview
14.4.3.2. Financials
14.4.3.3. Developments
14.4.3.4. Strategic Outlook
14.4.4. McKesson (US)
14.4.4.1. Overview
14.4.4.2. Financials
14.4.4.3. Developments
14.4.4.4. Strategic Outlook
14.4.5. SCIO (US)
14.4.5.1. Overview
14.4.5.2. Financials
14.4.5.3. Developments
14.4.5.4. Strategic Outlook
14.4.6. Verscend (US)
14.4.6.1. Overview
14.4.6.2. Financials
14.4.6.3. Developments
14.4.6.4. Strategic Outlook
14.4.7. Wipro (India)
14.4.7.1. Overview
14.4.7.2. Financials
14.4.7.3. Developments
14.4.7.4. Strategic Outlook
14.4.8. Conduent (US)
14.4.8.1. Overview
14.4.8.2. Financials
14.4.8.3. Developments
14.4.8.4. Strategic Outlook
14.4.9. HCL (India)
14.4.9.1. Overview
14.4.9.2. Financials
14.4.9.3. Developments
14.4.9.4. Strategic Outlook
14.4.10. CGI (Canada)
14.4.10.1. Overview
14.4.10.2. Financials
14.4.10.3. Developments
14.4.10.4. Strategic Outlook
14.4.11. DXC (US)
14.4.11.1. Overview
14.4.11.2. Financials
14.4.11.3. Developments
14.4.11.4. Strategic Outlook
14.4.12. Northrop Grumman (US)
14.4.12.1. Overview
14.4.12.2. Financials
14.4.12.3. Developments
14.4.12.4. Strategic Outlook
14.4.13. LexisNexis (US)
14.4.13.1. Overview
14.4.13.2. Financials
14.4.13.3. Developments
14.4.13.4. Strategic Outlook
14.4.14. Pondera (US)
14.4.14.1. Overview
14.4.14.2. Financials
14.4.14.3. Developments
14.4.14.4. Strategic Outlook
14.4.15. COMPANY 15
14.4.15.1. Overview
14.4.15.2. Financials
14.4.15.3. Developments
14.4.15.4. Strategic Outlook
14.4.16. COMPANY 16
14.4.16.1. Overview
14.4.16.2. Financials
14.4.16.3. Developments
14.4.16.4. Strategic Outlook
14.4.17. COMPANY 17
14.4.17.1. Overview
14.4.17.2. Financials
14.4.17.3. Developments
14.4.17.4. Strategic Outlook
14.4.18. COMPANY 18
14.4.18.1. Overview
14.4.18.2. Financials
14.4.18.3. Developments
14.4.18.4. Strategic Outlook
14.4.19. COMPANY 19
14.4.19.1. Overview
14.4.19.2. Financials
14.4.19.3. Developments
14.4.19.4. Strategic Outlook
14.4.20. COMPANY 20
14.4.20.1. Overview
14.4.20.2. Financials
14.4.20.3. Developments
14.4.20.4. Strategic Outlook
