Health Fraud Detection Market Sales Gains Significant Momentum With AI Technology

Posted on 2021-06-28 by Future Market Insights, Inc in Healthcare // 0 Comments

Market overview:

A surprising number of medical fraud cases have come to the fore using false claims to Medicare and Medicaid. Many of these frauds were accompanied by false service invoices that were never submitted. This situation can certainly be denied with the advent of AI.

Advanced AI algorithms can be used for financial fraud, insurance fraud, and transaction fraud. Several trials have shown that AI-based automated fraud detection systems help offset financial losses, reduce the auditor’s workload, and generate more resources for patients.

Here, the machine learning program provides two subsets of billing data. One is a doctor-generated claim and the other is established fraudulent case data.

The machine then elicits patterns and general inference to detect fraud. Therefore, AI could establish itself as a front-line defense and revolutionize the healthcare fraud detection market.

Big data and data analysis is another way for healthcare organizations to collect data about what constitutes “normal” patient purchasing behavior. Hospitals can blacklist if patients use the service in an atypical way.

Rogue clusters of data can be identified using unsupervised machine learning. Advanced data mining techniques can be used for fraudulent tactics that prove to be fraudulent.

The analysis performed is highly influential and a powerful tool to drive the healthcare fraud detection market.

Health care is an integral part of people’s lives and must be affordable. The healthcare industry is a very complex system, with a variety of moving components expanding at a rapid pace.

Abuse of the health insurance system is of utmost concern, and fraud in the medical industry has become a serious problem in recent years.

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Health fraud detection market-market dynamics

Increasing fraud cases in the healthcare industry that create opportunities

In parallel with the increasing number of patients using medical insurance, the proliferation of fraud in the medical industry is driving the adoption of medical fraud detection software and services.

The healthcare fraud detection market can grow against the backdrop of factors such as fraud on healthcare costs, waste, increasing pressure on abuse, and high return on investment.

For example, in 2017, government agencies said the annual removal of medical fraud included 400 individuals charged with medical fraud programs, accounting for US $ 1.3 billion in fake claims against Medicaid and Medicare. It was.

Prepaid review model

The prepaid review model has changed the medical industry for the better. Even Medicare claims are investigated by prepaid reviews. With this model, the Medicare Medicaid Service Center (CMS) can save money while reducing the burden on the hospital.

This model not only causes process improvements throughout the system, but also has a significant positive impact on hospital cash flow. In this model, the government holds money until the billing confirmation is valid.

This variant of the medical fraud detection model adds some burden to the hospital as the number of claims under review increases dramatically over time, but because cash flow is suspended until the claims are confirmed. Hospitals no longer have to worry about auditing after receiving payment.

Due to the myriad advantages of the prepaid review model, hospitals are increasingly enhancing system-wide operations and deploying predictive modeling techniques for error-free documentation.

It will be offered to major regions as follows:

North America (US, Canada, Mexico)

Europe (Germany, France, United Kingdom, Netherlands, Russia, Italy, other Europe)

Asia Pacific (China, Japan, Australia, New Zealand, South Korea, India, Southeast Asia)

South America (Brazil, Argentina, Colombia, other countries, etc.)

Middle East and Africa (Saudi Arabia, United Arab Emirates, Israel, Egypt, Nigeria, South Africa)

Health Fraud Detection Market-Notable Highlights

Leading companies operating in the healthcare fraud detection market include Optum, Verscend Technologies, Inc., DXC, Northrop Grumman, Fair Isaac Corporation, HCL Technologies Limited, LexisNexis, SAS Institute Inc., Pondera, Conduent, Inc., These include SCIOInspire and Corp. .. , CGI Group Inc., Wipro Limited, IBM Corporation, McKesson Corporation, etc.

In August 2018, Veritas Capital’s portfolio company, Verscend Technologies, purchased Cotiviti Holdings Inc, a payment accuracy and analytics-driven solution provider focused primarily on the healthcare industry.

Both companies operate under the name Cotiviti and are enhanced with new capabilities across risk, payment, quality, and a combination of financial and clinical data to help create differentiated value for our clients.

In June 2018, SCIO Health Analytics, another major player in the healthcare fraud detection market, was certified by Veeva CRM MyInsights.

SCIO can use Patient Personas and advanced predictive and prescribing analysis capabilities to provide actionable insights into patient risk, impact, and profile diverse patients treated within the care site.

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