US Healthcare Fraud Analytics Market to 2027 - Country Analysis and Forecasts by Solution (Predictive Analytics, Descriptive Analytics, Prescriptive Analytics); Mode of Delivery (On-Premise Delivery Models, Cloud-Based Delivery Models); Application (Insurance Claims Review, Pharmacy Billing Misuse, Payment Integrity, Medical Identity Theft, Other Applications); End User (Government Agencies, Private Insurance Payers, Third-party Service Providers, Employers)

TIPRE00009215 | Pages: 77 | Healthcare IT | Feb 2020 | Type: Regional | Status: Published

The US Healthcare Fraud Analytics market is expected to reach US$ 3,483.12 Mn in 2027 from US$ 517.28 Mn in 2019. The market is estimated to grow with a CAGR of 27.4% from 2020-2027.

 

The key factor that are responsible for the growth of market include increasing number of healthcare fraudulent cases in the us and growing health insurance industry in the us; however, concerns regarding healthcare fraud analytics may hinder the growth of the healthcare fraud analytics market during the forecast period.

 

The healthcare industry is susceptible to a wide range of frauds that will lead to financial losses. Healthcare fraud is a large contributor to unnecessary costs and the rise in spending in the US healthcare industry. The financial loss can be declined by deploying artificial intelligence (AI) tools to prevent and detect fraud. AI is capable of analyzing the huge amount of data generated in the healthcare organization and flags the fraud before it starts. The technology is adaptive enough to help tackle fraud at any of its stages. Thus the adoption of AI in healthcare fraud detection is likely to experience the positive outcomes in the coming future.

 

US Healthcare Fraud Analytics Market Revenue and Forecasts to 2027 (US$ Mn)

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Market Insights

Increasing Number of Healthcare Fraudulent Cases in the US

Most of the healthcare frauds are committed by the small number of fraudulent healthcare providers, and in some cases, by people who are pretending to be legitimate healthcare providers. Unfortunately, the actions of these few deceitful individuals ultimately harms the reputation of the most trusted and respected healthcare professionals. The number of healthcare frauds is increasing in the US. The Department of Justice (DoJ) in January 2019, announced that around US$2.5 billion of the total US$2.8 billion were recovered under the False Claims Act in the US. The most significant monetary recoveries in the year 2018 were from medical device and drug industries. Also, the National Health Care Anti-Fraud Association (NHCAA) estimated that every year, losses due to healthcare frauds are in the tens of billions of dollars. Some government and law enforcement agencies also estimated that healthcare frauds cost around 10% of the total annual health expenditure, which could be around US$ 300 billion. Thus, an increasing number of fraudulent healthcare cases is likely to demand healthcare fraud analytics solutions.

 

Solution Insights

US healthcare fraud analytics market by product is segmented into predictive analytics, descriptive analytics, and prescriptive analytics. In 2019, the predictive analytics segment held the largest market share of the healthcare fraud analytics market, by product. This segment is also anticipated to dominate the market in 2027 owing analytics detection and identification patterns which are potentially fraudulent and it then develops sets of rules to flag potentially fraudulent claims. Also, the segment is anticipated to witness growth at a significant rate during the forecast period.


US Healthcare Fraud Analytics, by Solution
, 2019 & 2027

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Mode of Delivery Insights

The US healthcare fraud analytics market by mode of delivery is segmented into on-premise delivery models, cloud-based delivery models. The US healthcare fraud analytics market is dominated by on-premise delivery models segment in 2019 with a considerable market share by mode of delivery. This segment is also predicted to dominate the market in 2027. However, cloud-based delivery models segment is anticipated to witness growth at a significant rate during the forecast period, 2019 to 2027, because it is an extremely manageable alternative which helps in the accessing real-time information.

 

Application Insights

The US healthcare fraud analytics market by application is segmented into insurance claims review, pharmacy billing misuse, payment integrity, medical identity theft, and other applications. In 2019, the insurance claims review held a largest market share of the healthcare fraud analytics market, by the application. This segment is also predicted to dominate the market in 2027 because it is very common and costly to the healthcare insurance system when fraud is detected and the number of health insurance frauds are increasing every year.

 

End User Insights

The US healthcare fraud analytics market by end user is segmented into government agencies, private insurance payers, third-party service providers, and employers. In 2019, the government agencies held a largest market share of the healthcare fraud analytics market, by the end user. This segment is also predicted to dominate the market in 2027 because data analytics solutions helped the government to detect and identify the Medicare claims for expensive cancer genetic tests, leading to the charges against 35 people.

 

Strategic Insights

The companies operating in the   market have been implementing various strategies to grow in their corresponding markets; this has, in turn, enabled them to bring various changes in the market. The companies have utilized strategies such as product launches, of their product portfolio and acquisitions for the growth of their organizations.


US Healthcare Fraud Analytics – Market Segmentation

US Healthcare Fraud Analytics Market – By Solution

  • Predictive Analytics
  • Descriptive Analytics
  • Prescriptive Analytics

US Healthcare Fraud Analytics Market – By Mode of Delivery

  • On-Premise Delivery Models
  • Cloud Based Delivery Models

US Healthcare Fraud Analytics Market – By Application

  • Insurance Claims Review
  • Pharmacy Billing Misuse
  • Payment Integrity
  • Identity Theft
  • Other Applications

Companies Mentioned

  • Conduent Inc.
  • DXC Technology
  • Scioinspire, Corp.
  • FICO
  • Optum, Inc.
  • SAS Institute
  • Pondera Solutions
  • Lexisnexis Risk Solutions
  • Whitehatai
  • Cotiviti, Inc

1.             Introduction

1.1       Scope of the Study

1.2       The Insight Partners Research Report Guidance

1.3       Market Segmentation

1.3.1        US Healthcare Fraud Analytics Market – By Solution

1.3.2        US Healthcare Fraud Analytics Market – By Mode of Delivery

1.3.3        US Healthcare Fraud Analytics Market – By Application

1.3.4        US Healthcare Fraud Analytics Market – By End User

2.             Healthcare Fraud Analytics Market – Key Takeaways

3.             Research Methodology

3.1       Coverage

3.2       Secondary Research

3.3       Primary Research

4.             Healthcare Fraud Analytics– Market Landscape

4.1       Overview

4.2       Pest Analysis

4.2.1        Healthcare Fraud Analytics Market in US: PEST Analysis

4.3       Expert Opinion

5.             Healthcare Fraud Analytics Market – Key Dynamics

5.1       Drivers

5.1.1        Increasing Number of Healthcare Fraudulent Cases in the US

5.1.2        Growing Health Insurance Industry in the US

5.2       Restraints

5.2.1        Concerns Regarding Healthcare Fraud Analytics

5.3       Opportunities

5.3.1        Growing Hospital Industry

5.4       Future Trends

5.4.1        AI in Healthcare Fraud Detection

5.5       Impact Analysis

6.             Healthcare Fraud Analytics Market – US Analysis

6.1       US Healthcare Fraud Analytics Market Revenue Forecast And Analysis

6.2       Positioning of Key Players

6.2.1        Fair, Isaac and Company (FICO)

6.2.2        Conduent Inc.

7.             Healthcare Fraud Analytics Market Analysis and Forecast to 2027 – Solution

7.1       Overview

7.2       Healthcare Fraud Analytics Market, By Solution, 2019 & 2027 (%)

7.3       US Healthcare Fraud Analytics Market, Revenue and Forecast to 2027, By Solution (US$ Mn)

7.4       Predictive Analytics

7.4.1        Overview

7.4.2        Predictive Analytics Market Revenue and Forecast to 2027 (US$ Mn)

7.5       Descriptive Analytics

7.5.1        Overview

7.5.2        Descriptive Analytics Market Revenue and Forecast to 2027 (US$ Mn)

7.6       Prescriptive Analytics

7.6.1        Overview

7.6.2        Prescriptive Analytics Market Revenue and Forecast to 2027 (US$ Mn)

8.             Healthcare Fraud Analytics Market Analysis and Forecast to 2027 – Mode of Delivery

8.1       Overview

8.2       Healthcare Fraud Analytics Market, By Mode of Delivery, 2019 & 2027 (%)

8.3       US Healthcare Fraud Analytics Market, Revenue and Forecast to 2027, By Mode Of Delivery (US$ Mn)

8.4       On-Premise Delivery Models

8.4.1        Overview

8.4.2        On-Premise Delivery Models Market Revenue and Forecast to 2027 (US$ Mn)

8.5       Cloud-Based Delivery Mode

8.5.1        Overview

8.5.2        Cloud-Based Delivery Mode Market Revenue and Forecast to 2027 (US$ Mn)

9.             Healthcare Fraud Analytics Market Analysis and Forecast to 2027 –Application

9.1       Overview

9.2       Healthcare Fraud Analytics Market, By Application, 2019 & 2027 (%)

9.3       US Healthcare Fraud Analytics Market, Revenue and Forecast to 2027, By Application (US$ Mn)

9.4       Insurance Claims Review

9.4.1        Overview

9.4.2        Insurance Claims Review Market Revenue and Forecast to 2027 (US$ Mn)

9.5       Pharmacy Billing Misuse

9.5.1        Overview

9.5.2        Pharmacy Billing Misuse Market Revenue and Forecast to 2027 (US$ Mn)

9.6       Payment Integrity

9.6.1        Overview

9.6.2        Payment Integrity Market Revenue and Forecast to 2027 (US$ Mn)

9.7       Medical Identity Theft

9.7.1        Overview

9.7.2        Medical Identity Theft Market Revenue and Forecast to 2027 (US$ Mn)

9.8       Other Applications

9.8.1        Overview

9.8.2        Other Applications Market Revenue and Forecast to 2027 (US$ Mn)

10.          Healthcare Fraud Analytics Market Analysis and Forecast to 2027 – End User

10.1    Overview

10.2    Healthcare Fraud Analytics Market, By End User, 2019 & 2027 (%)

10.3    US Healthcare Fraud Analytics Market, Revenue and Forecast to 2027, End User (US$ Mn)

10.4    Government Agencies

10.4.1     Overview

10.4.2     Government Agencies Review Market Revenue and Forecast to 2027 (US$ Mn)

10.5    Private Insurance Payers

10.5.1     Overview

10.5.2     Private Insurance Payers Market Revenue and Forecast to 2027 (US$ Mn)

10.6    Third-party Service Providers

10.6.1     Overview

10.6.2     Third-party Service Providers Market Revenue and Forecast to 2027 (US$ Mn)

10.7    Employers

10.7.1     Overview

10.7.2     Employers Market Revenue and Forecast to 2027 (US$ Mn)

11.          Healthcare Fraud Analytics Market to 2027 – Industry Landscape

11.1    Overview

11.2    Growth Strategies Done By The Companies In The Market, (%)

11.3    Organic Developments Done By The Companies In The Market

11.4    Inorganic Developments Done By The Companies In The Market

12.          Healthcare Fraud Analytics Market – Key Company Profiles

12.1    Conduent, Inc.

12.1.1     Key Facts

12.1.2     Business Description

12.1.3     Products and Services

12.1.4     Financial Overview

12.1.5     SWOT Analysis

12.1.6     Key Developments

12.2    DXC Technology Company

12.2.1     Key Facts

12.2.2     Business Description

12.2.3     Products and Services

12.2.4     Financial Overview

12.2.5     SWOT Analysis

12.2.6     Key Developments

12.3    SCIOInspire, Corp. (EXL Service Holdings, Inc.)

12.3.1     Key Facts

12.3.2     Business Description

12.3.3     Products and Services

12.3.4     Financial Overview

12.3.5     SWOT Analysis

12.3.6     Key Developments

12.4    OPTUM, INC (UnitedHealth Group)

12.4.1     Key Facts

12.4.2     Business Description

12.4.3     Products and Services

12.4.4     Financial Overview

12.4.5     SWOT Analysis

12.4.6     Key Developments

12.5    SAS Institute

12.5.1     Key Facts

12.5.2     Business Description

12.5.3     Products and Services

12.5.4     Financial Overview

12.5.5     SWOT Analysis

12.5.6     Key Developments

12.6    Pondera Solutions

12.6.1     Key Facts

12.6.2     Business Description

12.6.3     Products and Services

12.6.4     Financial Overview

12.6.5     SWOT Analysis

12.6.6     Key Developments

12.7    LexisNexis Risk Solutions (RELX plc)

12.7.1     Key Facts

12.7.2     Business Description

12.7.3     Products and Services

12.7.4     Financial Overview

12.7.5     SWOT Analysis

12.7.6     Key Developments

12.8    Fair, Isaac and Company (FICO)

12.8.1     Key Facts

12.8.2     Business Description

12.8.3     Financial Overview

12.8.4     Product Portfolio

12.8.5     SWOT Analysis

12.8.6     Key Developments

12.9    Cotiviti, Inc. (Verscend Technologies, Inc.)

12.9.1     Key Facts

12.9.2     Business Description

12.9.3     Financial Overview

12.9.4     Product Portfolio

12.9.5     SWOT Analysis

12.9.6     Key Developments

12.10 WhiteHatAI

12.10.1   Key Facts

12.10.2   Business Description

12.10.3   Financial Overview

12.10.4   Product Portfolio

12.10.5   SWOT Analysis

12.10.6   Key Developments

13.          Appendix

13.1    About The Insight Partners

13.2    Glossary Of Terms

LIST OF TABLES

Table 1.            Number of Hospitals in the US

Table 2.            US Healthcare Fraud Analytics Market, Revenue and Forecast to 2027, By Solution (US$ Mn)

Table 3.            US Healthcare Fraud Analytics Market, Revenue and Forecast to 2027, By Mode Of Delivery (US$ Mn)

Table 4.            US Healthcare Fraud Analytics Market, Revenue and Forecast to 2027, By Application (US$ Mn)

Table 5.            US Healthcare Fraud Analytics Market, Revenue and Forecast to 2027, By End User (US$ Mn)

Table 6.            Organic Developments Done by the Companies

Table 7.            Inorganic Developments Done by the Companies

Table 8.            Glossary of Terms, Healthcare Fraud Analytics Market

LIST OF FIGURES

Figure 1.          Healthcare Fraud Analytics Market Segmentation

Figure 2.          US Healthcare Fraud Analytics Market Overview

Figure 3.          Predictive Analytics Segment Held Largest Share Of Solution Segment In Healthcare Fraud Analytics Market

Figure 4.          US Healthcare Fraud Analytics Market, Industry Landscape

Figure 5.          Healthcare Fraud Analytics Market in US: PEST Analysis

Figure 6.          Healthcare Fraud Analytics Market Impact Analysis of Drivers and Restraints

Figure 7.          US Healthcare Fraud Analytics Market – Revenue Forecast And Analysis – 2019- 2027

Figure 8.          Market Positioning Of Key Player In Healthcare Fraud Analytics Market

Figure 9.          Healthcare Fraud Analytics Market, by Solution, 2019 & 2027 (%)

Figure 10.       Predictive Analytics Market Revenue and Forecast to 2027 (US$ Mn)

Figure 11.       Descriptive Analytics Market Revenue and Forecast to 2027 (US$ Mn)

Figure 12.       Surgical Lamp Market Revenue and Forecast to 2027 (US$ Mn)

Figure 13.       Healthcare Fraud Analytics Market, by Mode of Delivery, 2019 & 2027 (%)

Figure 14.       On-Premise Delivery Models Market Revenue and Forecasts to 2027 (US$ Mn)

Figure 15.       Cloud-Based Delivery Mode Market Revenue and Forecast to 2027 (US$ Mn)

Figure 16.       Healthcare Fraud Analytics Market, by Application, 2019 & 2027 (%)

Figure 17.       Insurance Claims Review Market Revenue and Forecasts to 2027 (US$ Mn)

Figure 18.       Pharmacy Billing Misuse Market Revenue and Forecasts to 2027 (US$ Mn)

Figure 19.       Payment Integrity Market Revenue and Forecasts to 2027 (US$ Mn)

Figure 20.       Medical Identity Theft Market Revenue and Forecasts to 2027 (US$ Mn)

Figure 21.       Other Applications Market Revenue and Forecasts to 2027 (US$ Mn)

Figure 22.       Healthcare Fraud Analytics Market, by End User, 2019 & 2027 (%)

Figure 23.       Government Agencies Review Market Revenue and Forecasts to 2027 (US$ Mn)

Figure 24.       Private Insurance Payers Market Revenue and Forecasts to 2027 (US$ Mn)

Figure 25.       Third-party Service Providers Market Revenue and Forecasts to 2027 (US$ Mn)

Figure 26.       Medical Identity Theft Market Revenue and Forecasts to 2027 (US$ Mn)

Figure 27.       Growth Strategies Done By the Companies in the Market, (%)

 

The List of Companies - US Healthcare Fraud Analytics Market

  1. Conduent Inc.
  2. DXC Technology
  3. Scioinspire, Corp.
  4. FICO
  5. Optum, Inc.
  6. SAS Institute
  7. Pondera Solutions
  8. Lexisnexis Risk Solutions
  9. Whitehatai
  10. Cotiviti, Inc

 

  • Save and reduce time carrying out entry-level research by identifying the growth, size, leading players and segments in the Healthcare fraud analytics market.

 

  • Highlights key business priorities in order to assist companies to realign their business strategies.

 

  • The key findings and recommendations highlight crucial progressive industry trends in the US Healthcare fraud analytics market, thereby allowing players across the value chain to develop effective long-term strategies.

 

  • Develop/modify business expansion plans by using substantial growth offering developed and emerging markets.

 

  • Scrutinize in-depth US market trends and outlook coupled with the factors driving the market, as well as those hindering it.

 

  • Enhance the decision-making process by understanding the strategies that underpin security interest with respect to client products, segmentation, pricing and distribution.

 

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