Healthcare Fraud Analytics Market: Rising Pharmacy Claim-related Frauds

PUNE, India, 2021-May-03 — /EPR Network/ —

The large number of fraudulent activities in healthcare; the increasing number of patients seeking health insurance; high returns on investment; and rising pharmacy claim-related frauds. However, the dearth of skilled personnel is likely to restrain the growth of this market.

How much is the Healthcare Fraud Analytics Market worth?

The Healthcare Fraud Detection market is projected to reach USD 7.9 billion by 2024 from USD 5.7 billion in 2019, at a CAGR of 6.6% during the forecast period. Factors such as the high number of cases of healthcare fraud, including pharmacy-related fraud, favorable government initiatives, technological advancements, and the availability of solutions in this region are some factors contributing large share in the global healthcare fraud analytics space.

North America is expected to register the highest growth rate during the forecast period mainly due to a rise in the number of fraudulent activities in healthcare, combined with the increasing number of patients seeking medical insurance and rising pharmacy claim-related frauds. Emerging markets like APAC and Latin America provide significant growth opportunities in this market.

The descriptive analytics segment dominated the healthcare fraud analytics market in 2019

The market is segmented based on solution type, delivery model, application, and end user. Based on the solution type, the descriptive analytics segment accounted for the largest share of the market in 2019.

Descriptive analytics forms the base for the effective application of predictive or prescriptive analytics. Hence, these analytics use the basics of descriptive analytics and integrate them with additional sources of data in order to produce meaningful insights.

By application, the insurance claims review segment accounted for the largest share of the market in 2019

On the basis of application, the market is segmented into insurance claims review, pharmacy billing misuse, payment integrity, and other applications. In 2019, the insurance claims review segment dominated the healthcare fraud analytics market.

The increasing number of patients seeking health insurance, the rising number of fraudulent claims, and the growing adoption of the prepayment review model are expected to drive the growth of this segment in the coming years.

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The prescriptive analytics segment registered the highest growth during the forecast period.

Fraud analytics solutions vary from vendor to vendor. Some vendors offer rule-based models while others offer AI-based technologies, but broadly, these solutions are classified based on the type of analytics used—descriptive analytics, predictive analytics, and prescriptive analytics.

The prescriptive analytics segment registered the highest growth in the healthcare fraud analytics market during the forecast period. The high adoption of this technology is attributed to its advantages, such as rapid detection and investigation of suspects, claimants, and claim-level behavior from unstructured and/or semi-structured data.

In 2019, public & government agencies accounted for the largest share of the healthcare fraud analytics market, by end user.

Based on end user, the healthcare fraud detection market is segmented into public & government agencies, private insurance payers, employers, and third-party service providers. The public & government agencies segment accounted for the largest share of the healthcare fraud analytics market in 2019.

The increasing cost burden due to healthcare fraud is proving to be a financial threat to public and government agencies globally. These factors are compelling payer organizations associated with these agencies to adopt analytics solutions to avoid losses incurred due to FWA and improper payments, which is driving the market growth.

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North America is expected to grow at the highest rate in the Healthcare Fraud Detection market in 2019

Geographically, the Healthcare Fraud Detection market is segmented into North America, Europe, Asia-Pacific, and the Rest of the World. North America accounted for the largest share of the market in 2019.

The high share of the North American market is attributed to the large number of people having health insurance, growing healthcare fraud, favorable government anti-fraud initiatives, the pressure to reduce healthcare costs, technological advancements, and greater product and service availability in this region. Moreover, a majority of leading players in the healthcare fraud detection market have their headquarters in North America.

Leading Companies

IBM Corporation (US), Optum (US), SAS Institute (US), Change Healthcare (US), EXL Service Holdings (US), Cotiviti (US), Wipro Limited (India), Conduent (US), HCL (India), Canadian Global Information Technology Group (Canada), DXC Technology Company (US), Northrop Grumman Corporation (US), LexisNexis Group (US), and Pondera Solutions (US).

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