Healthcare Fraud Analytics Market by Solution Type (Descriptive, Predictive, Prescriptive), Application (Insurance Claim, Payment Integrity), Delivery (On-premise, Cloud), End User (Government, Employers, Payers), COVID-19 Impac - Global Forecast to 2026
The global healthcare fraud analytics market is projected to reach USD 5.0 billion by 2026 from USD 1.5 billion in 2021, at a CAGR of 26.7% during the forecast period. Market growth can be attributed to a large number of fraudulent activities in healthcare, increasing number of patients seeking health insurance, high returns on investment, and the rising number of pharmacy claims-related frauds. However, the dearth of skilled personnel is expected to restrain the growth of this market.
The on-demand segment is expected to grow at the highest CAGR during the forecast period
On the basis of delivery model, the healthcare fraud analytics market is segmented into on-premise and on-demand models. The on-demand models include the cloud-based and web-based models. The on-demand segment is projected to register the highest CAGR during the forecast period. Factors such as on-demand self-serving analytics, the lack of up-front capital investments for hardware, extreme capacity flexibility, and a pay-as-you-go pricing model are driving the demand for on-demand fraud detection solutions.
The prepayment review model segment is projected to witness the highest growth during the forecast period
On the basis of application, the healthcare fraud analytics market is segmented into insurance claims review, pharmacy billing misuse, payment integrity, and other applications. The insurance claims review segment is further divided into postpayment and prepayment review, with the latter expected to register the highest growth during the forecast period. This is mainly because the use of prepayment review protocols and analytics can help organizations proactively prevent fraud prior to payment, allowing rapid action to be taken. As a result, prepayment review solutions are expected to garner greater attention in the coming years.
North America accounted for the largest share of the healthcare fraud analytics market
The healthcare fraud analytics market is segmented into five major regions, namely, North America, Europe, Asia, Pacific, Latin America, and the Middle East & Africa. North America accounted for the largest share of this market in 2020 majorly due to the high penetration of health insurance in the region, high number of healthcare fraud cases, favorable government initiatives to combat healthcare fraud, and wider product and service availability in this region. Moreover, a majority of leading players in the healthcare fraud analytics market have their headquarters in North America
Break of primary participants was as mentioned below:
Major players in this market include IBM Corporation (US), Optum, Inc. (US), Cotiviti, Inc. (US), Change Healthcare (US), Fair Isaac Corporation (US), SAS Institute Inc. (US), EXLService Holdings, Inc. (US), Wipro Limited (India), Conduent, Incorporated (US), CGI Inc. (Canada), HCL Technologies Limited (India), Qlarant, Inc. (US), DXC Technology (US), Northrop Grumman Corporation (US), LexisNexis (US), Healthcare Fraud Shield (US), Sharecare, Inc. (US), FraudLens, Inc. (US), HMS Holding Corp. (US), Codoxo (US), H20.ai (US), Pondera Solutions, Inc. (US), FRISS (The Netherlands), Multiplan (US), FraudScope (US), and OSP Labs (US).
Research Coverage:
The report analyzes the healthcare fraud analytics market and aims at estimating the market size and future growth potential of this market based on various segments such as solution type, application, delivery model, end user, and region. The report also includes a product portfolio matrix of various healthcare fraud analytic solutions available in the market. The report also provides a competitive analysis of the key players in this market, along with their company profiles, product & service offerings, and key market strategies.
Reasons to Buy the Report
The report will enrich established firms as well as new entrants/smaller firms to gauge the pulse of the market, which in turn would help them, garner a more significant share of the market. Firms purchasing the report could use one or any combination of the below-mentioned strategies to strengthen their position in the market.
This report provides insights into the following pointers:
The on-demand segment is expected to grow at the highest CAGR during the forecast period
On the basis of delivery model, the healthcare fraud analytics market is segmented into on-premise and on-demand models. The on-demand models include the cloud-based and web-based models. The on-demand segment is projected to register the highest CAGR during the forecast period. Factors such as on-demand self-serving analytics, the lack of up-front capital investments for hardware, extreme capacity flexibility, and a pay-as-you-go pricing model are driving the demand for on-demand fraud detection solutions.
The prepayment review model segment is projected to witness the highest growth during the forecast period
On the basis of application, the healthcare fraud analytics market is segmented into insurance claims review, pharmacy billing misuse, payment integrity, and other applications. The insurance claims review segment is further divided into postpayment and prepayment review, with the latter expected to register the highest growth during the forecast period. This is mainly because the use of prepayment review protocols and analytics can help organizations proactively prevent fraud prior to payment, allowing rapid action to be taken. As a result, prepayment review solutions are expected to garner greater attention in the coming years.
North America accounted for the largest share of the healthcare fraud analytics market
The healthcare fraud analytics market is segmented into five major regions, namely, North America, Europe, Asia, Pacific, Latin America, and the Middle East & Africa. North America accounted for the largest share of this market in 2020 majorly due to the high penetration of health insurance in the region, high number of healthcare fraud cases, favorable government initiatives to combat healthcare fraud, and wider product and service availability in this region. Moreover, a majority of leading players in the healthcare fraud analytics market have their headquarters in North America
Break of primary participants was as mentioned below:
- By Company Type – Tier 1–45%, Tier 2–18%, and Tier 3–37%
- By Designation – C-level–35%, Director-level–50%, Others–15%
- By Region – North America–60%, Europe–22%, Asia–13%, Latin America- 3%, Middle East and Africa–2%
Major players in this market include IBM Corporation (US), Optum, Inc. (US), Cotiviti, Inc. (US), Change Healthcare (US), Fair Isaac Corporation (US), SAS Institute Inc. (US), EXLService Holdings, Inc. (US), Wipro Limited (India), Conduent, Incorporated (US), CGI Inc. (Canada), HCL Technologies Limited (India), Qlarant, Inc. (US), DXC Technology (US), Northrop Grumman Corporation (US), LexisNexis (US), Healthcare Fraud Shield (US), Sharecare, Inc. (US), FraudLens, Inc. (US), HMS Holding Corp. (US), Codoxo (US), H20.ai (US), Pondera Solutions, Inc. (US), FRISS (The Netherlands), Multiplan (US), FraudScope (US), and OSP Labs (US).
Research Coverage:
The report analyzes the healthcare fraud analytics market and aims at estimating the market size and future growth potential of this market based on various segments such as solution type, application, delivery model, end user, and region. The report also includes a product portfolio matrix of various healthcare fraud analytic solutions available in the market. The report also provides a competitive analysis of the key players in this market, along with their company profiles, product & service offerings, and key market strategies.
Reasons to Buy the Report
The report will enrich established firms as well as new entrants/smaller firms to gauge the pulse of the market, which in turn would help them, garner a more significant share of the market. Firms purchasing the report could use one or any combination of the below-mentioned strategies to strengthen their position in the market.
This report provides insights into the following pointers:
- Market Penetration: Comprehensive information on product portfolios offered by the top players in the global healthcare fraud analytics market. The report analyzes this market by solution type, application, delivery model, and end user
- Solution Enhancement/Innovation: Detailed insights on upcoming trends and solution launches in the global healthcare fraud analytics market
- Market Development: Comprehensive information on the lucrative emerging markets by products and services, and end user
- Market Diversification: Exhaustive information about new solutions or service enhancements, growing geographies, recent developments, and investments in the global healthcare fraud analytics market
- Competitive Assessment: In-depth assessment of market shares, growth strategies, solution offerings, competitive leadership mapping, and capabilities of leading players in the global healthcare fraud analytics market.
1 INTRODUCTION
1.1 OBJECTIVES OF THE STUDY
1.2 MARKET DEFINITION & SCOPE
1.2.1 INCLUSIONS & EXCLUSIONS OF THE STUDY
1.2.2 MARKET SEGMENTATION
FIGURE 1 HEALTHCARE FRAUD ANALYTICS MARKET SEGMENTATION
1.2.3 YEARS CONSIDERED FOR THE STUDY
1.3 CURRENCY
TABLE 1 EXCHANGE RATES UTILIZED FOR CONVERSION TO USD
1.4 LIMITATIONS
1.5 STAKEHOLDERS
2 RESEARCH METHODOLOGY
2.1 RESEARCH APPROACH
FIGURE 2 RESEARCH DESIGN
2.1.1 SECONDARY SOURCES
2.1.1.1 Key data from secondary sources
2.1.2 PRIMARY SOURCES
TABLE 2 LIST OF STAKEHOLDERS INTERVIEWED FOR THE STUDY
2.1.2.1 Key data from primary sources
FIGURE 3 BREAKDOWN OF PRIMARY INTERVIEWS: BY COMPANY TYPE, DESIGNATION, AND REGION
2.2 MARKET SIZE ESTIMATION
2.3 MARKET BREAKDOWN AND DATA TRIANGULATION
FIGURE 4 DATA TRIANGULATION METHODOLOGY
2.4 ASSUMPTIONS FOR THE STUDY
3 EXECUTIVE SUMMARY
FIGURE 5 HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2021 VS. 2026 (USD MILLION)
FIGURE 6 HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2021 VS. 2026 (USD MILLION)
FIGURE 7 HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2021 VS. 2026 (USD MILLION)
FIGURE 8 HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2021 VS. 2026 (USD MILLION)
FIGURE 9 GEOGRAPHICAL SNAPSHOT OF THE HEALTHCARE FRAUD ANALYTICS MARKET
4 PREMIUM INSIGHTS
4.1 HEALTHCARE FRAUD ANALYTICS MARKET OVERVIEW
FIGURE 10 LARGE NUMBER OF FRAUDULENT ACTIVITIES IN HEALTHCARE TO DRIVE MARKET GROWTH
4.2 ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE AND COUNTRY
FIGURE 11 DESCRIPTIVE ANALYTICS SEGMENT ACCOUNTED FOR THE LARGEST SHARE OF THE ASIAN HEALTHCARE FRAUD ANALYTICS MARKET IN 2020
4.3 HEALTHCARE FRAUD ANALYTICS MARKET: GEOGRAPHIC GROWTH OPPORTUNITIES
FIGURE 12 US TO REGISTER THE HIGHEST REVENUE GROWTH DURING FORECAST PERIOD
4.4 HEALTHCARE FRAUD ANALYTICS MARKET: REGIONAL MIX
FIGURE 13 NORTH AMERICA WILL CONTINUE TO DOMINATE THE MARKET IN 2026
4.5 HEALTHCARE FRAUD ANALYTICS MARKET: DEVELOPING VS. DEVELOPED REGIONS
FIGURE 14 DEVELOPED MARKETS TO REGISTER HIGHER GROWTH DURING FORECAST PERIOD
5 MARKET OVERVIEW
5.1 INTRODUCTION
5.2 MARKET DYNAMICS
FIGURE 15 HEALTHCARE FRAUD ANALYTICS MARKET: DRIVERS, RESTRAINTS, OPPORTUNITIES, AND CHALLENGES
5.2.1 DRIVERS
5.2.1.1 Large number of fraudulent activities in healthcare
FIGURE 16 US NATIONAL HEALTHCARE FRAUD AND OPIOID TAKEDOWN TRENDS
FIGURE 17 INCIDENCE OF FRAUDULENT CLAIMS—GLOBAL SCENARIO (2019)
5.2.1.2 Increased number of patients seeking health insurance
5.2.1.3 Prepayment review model
5.2.1.4 High returns on investment
5.2.1.5 Rise in pharmacy claims-related fraud
5.2.2 RESTRAINTS
5.2.2.1 Limitations in the data capturing process in Medicaid services
5.2.3 OPPORTUNITIES
5.2.3.1 Adoption of healthcare fraud analytics in developing countries
5.2.3.2 Emergence of social media and its impact on the healthcare industry
5.2.3.3 Role of AI in healthcare fraud detection
5.2.4 CHALLENGES
5.2.4.1 Dearth of skilled personnel
5.2.4.2 Time-consuming deployment and the need for frequent upgrades
6 INDUSTRY INSIGHTS
6.1 INDUSTRY TRENDS
6.1.1 SHIFTING FOCUS FROM ON-PREMISE MODELS TO CLOUD-BASED ON-DEMAND MODELS
6.1.2 MERGERS AND ACQUISITIONS: THE MOST ADOPTED STRATEGY
FIGURE 18 MAJOR MERGERS AND ACQUISITIONS IN THE HEALTHCARE FRAUD ANALYTICS MARKET
6.1.3 TECHNOLOGICAL ADVANCEMENTS
TABLE 3 COMPANIES OFFERING INNOVATIVE FRAUD ANALYTICS SOLUTIONS
6.1.4 NEW USE CASE: OPIOID EPIDEMIC CRISIS
6.1.5 END-USER TRENDS: ADOPTION OF HEALTHCARE FRAUD ANALYTICS SOLUTIONS BY PHARMACY BENEFIT MANAGERS
7 HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE
7.1 INTRODUCTION
TABLE 4 HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
7.2 DESCRIPTIVE ANALYTICS
7.2.1 DESCRIPTIVE ANALYTICS SEGMENT ACCOUNTED FOR THE LARGEST MARKET SHARE
TABLE 5 DESCRIPTIVE ANALYTICS SOLUTIONS FOR HEALTHCARE FRAUD DETECTION
TABLE 6 DESCRIPTIVE ANALYTICS MARKET, BY REGION, 2019–2026 (USD MILLION)
TABLE 7 DESCRIPTIVE ANALYTICS MARKET, BY COUNTRY, 2019–2026 (USD MILLION)
7.3 PREDICTIVE ANALYTICS
7.3.1 PREDICTIVE ANALYTICS HELPS IN SIMULATING FUTURE EVENTS AND TRENDS THAT CAN ENABLE PAYERS TO PREDICT PREVENTABLE EVENTS
TABLE 8 PREDICTIVE ANALYTICS SOLUTIONS FOR HEALTHCARE FRAUD DETECTION
TABLE 9 PREDICTIVE ANALYTICS MARKET, BY REGION, 2019–2026 (USD MILLION)
TABLE 10 PREDICTIVE ANALYTICS MARKET, BY COUNTRY, 2019–2026 (USD MILLION)
7.4 PRESCRIPTIVE ANALYTICS
7.4.1 PRESCRIPTIVE MODELS OFFER ADDITIONAL ADVANTAGES RELATING TO THE INVESTIGATION OF SUSPICIOUS BEHAVIOR TO GENERATE COMPREHENSIVE INSIGHTS
TABLE 11 PRESCRIPTIVE ANALYTICS SOLUTIONS FOR HEALTHCARE FRAUD DETECTION
TABLE 12 PRESCRIPTIVE ANALYTICS MARKET, BY REGION, 2019–2026 (USD MILLION)
TABLE 13 PRESCRIPTIVE ANALYTICS MARKET, BY COUNTRY, 2019–2026 (USD MILLION)
8 HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL
8.1 INTRODUCTION
TABLE 14 HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
8.2 ON-PREMISE DELIVERY MODELS
8.2.1 ON-PREMISE MODELS ACCOUNT FOR THE LARGEST SHARE OF THE MARKET
TABLE 15 KEY VENDORS OFFERING ON-PREMISE SOLUTIONS IN THE MARKET
TABLE 16 HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-PREMISE DELIVERY MODEL, BY REGION, 2019–2026 (USD MILLION)
TABLE 17 HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-PREMISE DELIVERY MODEL, BY COUNTRY, 2019–2026 (USD MILLION)
8.3 ON-DEMAND DELIVERY MODELS
8.3.1 CLOUD-BASED DELIVERY MODELS OFFER ORGANIZATIONS INCREASED SCALABILITY AND SPEED
TABLE 18 KEY VENDORS PROVIDING ON-DEMAND SOLUTIONS
TABLE 19 HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-DEMAND DELIVERY MODEL, BY REGION, 2019–2026 (USD MILLION)
TABLE 20 HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-DEMAND DELIVERY MODEL, BY COUNTRY, 2019–2026 (USD MILLION)
9 HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION
9.1 INTRODUCTION
TABLE 21 HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
9.2 INSURANCE CLAIMS REVIEW
TABLE 22 DEPLOYMENT OF PREPAYMENT VS. POSTPAYMENT ANALYTICS SYSTEMS
TABLE 23 HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 24 HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY REGION, 2019–2026 (USD MILLION)
TABLE 25 HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY COUNTRY, 2019–2026 (USD MILLION)
9.2.1 POSTPAYMENT REVIEW
9.2.1.1 Postpayment review dominates the healthcare fraud analytics insurance claims review market
TABLE 26 HEALTHCARE FRAUD ANALYTICS MARKET FOR POSTPAYMENT CLAIMS REVIEW, BY REGION, 2019–2026 (USD MILLION)
TABLE 27 HEALTHCARE FRAUD ANALYTICS MARKET FOR POSTPAYMENT CLAIMS REVIEW, BY COUNTRY, 2019–2026 (USD MILLION)
9.2.2 PREPAYMENT REVIEW
9.2.2.1 The majority of prepayment models use predictive analytics to detect fraud and stop fraudulent claims payments
TABLE 28 HEALTHCARE FRAUD ANALYTICS MARKET FOR PREPAYMENT CLAIMS REVIEW, BY REGION, 2019–2026 (USD MILLION)
TABLE 29 HEALTHCARE FRAUD ANALYTICS MARKET FOR PREPAYMENT CLAIMS REVIEW, BY COUNTRY, 2019–2026 (USD MILLION)
9.3 PHARMACY BILLING MISUSE
9.3.1 FRAUD, WASTE, AND ABUSE CASES IN PHARMACY AND PRESCRIPTION DRUG AREAS TO DRIVE THE DEMAND FOR ANALYTICS
TABLE 30 HEALTHCARE FRAUD ANALYTICS MARKET FOR PHARMACY BILLING MISUSE APPLICATION, BY REGION, 2019–2026 (USD MILLION)
TABLE 31 HEALTHCARE FRAUD ANALYTICS MARKET FOR PHARMACY BILLING MISUSE APPLICATION, BY COUNTRY, 2019–2026 (USD MILLION)
9.4 PAYMENT INTEGRITY
9.4.1 CHANGES IN REGULATORY GUIDELINES HAVE AIDED THE ADOPTION OF PAYMENT INTEGRITY SOFTWARE
TABLE 32 HEALTHCARE FRAUD ANALYTICS MARKET FOR PAYMENT INTEGRITY APPLICATION, BY REGION, 2019–2026 (USD MILLION)
TABLE 33 HEALTHCARE FRAUD ANALYTICS MARKET FOR PAYMENT INTEGRITY APPLICATION, BY COUNTRY, 2019–2026 (USD MILLION)
9.5 OTHER APPLICATIONS
TABLE 34 HEALTHCARE FRAUD ANALYTICS MARKET FOR OTHER APPLICATION, BY REGION, 2019–2026 (USD MILLION)
TABLE 35 HEALTHCARE FRAUD ANALYTICS MARKET FOR OTHER APPLICATIONS, BY COUNTRY, 2019–2026 (USD MILLION)
10 HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER
10.1 INTRODUCTION
TABLE 36 HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
10.2 PUBLIC & GOVERNMENT AGENCIES
10.2.1 PUBLIC & GOVERNMENT AGENCIES DOMINATE THE HEALTHCARE FRAUD ANALYTICS MARKET
TABLE 37 HEALTHCARE FRAUD ANALYTICS MARKET FOR PUBLIC & GOVERNMENT AGENCIES, BY REGION, 2019–2026 (USD MILLION)
TABLE 38 HEALTHCARE FRAUD ANALYTICS MARKET FOR PUBLIC & GOVERNMENT AGENCIES, BY COUNTRY, 2019–2026 (USD MILLION)
10.3 PRIVATE INSURANCE PAYERS
10.3.1 PRIVATE INSURANCE PAYERS ARE FOCUSED ON DEPLOYING ANALYTICS TO COMBAT INCREASING MONETARY LOSSES
TABLE 39 HEALTHCARE FRAUD ANALYTICS MARKET FOR PRIVATE INSURANCE PAYERS, BY REGION, 2019–2026 (USD MILLION)
TABLE 40 HEALTHCARE FRAUD ANALYTICS MARKET FOR PRIVATE INSURANCE PAYERS, BY COUNTRY, 2019–2026 (USD MILLION)
10.4 THIRD-PARTY SERVICE PROVIDERS
10.4.1 ADOPTION OF FRAUD ANALYTICS SOLUTIONS BY PUBLIC INSURERS PUTS PRIVATE BODIES AT RISK, DRIVING ATTENTION TOWARD OUTSOURCING
TABLE 41 HEALTHCARE FRAUD ANALYTICS MARKET FOR THIRD-PARTY SERVICE PROVIDERS, BY REGION, 2019–2026 (USD MILLION)
TABLE 42 HEALTHCARE FRAUD ANALYTICS MARKET FOR THIRD-PARTY SERVICE PROVIDERS, BY COUNTRY, 2019–2026 (USD MILLION)
10.5 EMPLOYERS
10.5.1 EMPLOYERS ARE CONSIDERING FRAUD ANALYTICS SOLUTIONS AS A STEP TOWARD BETTER COST MANAGEMENT
TABLE 43 HEALTHCARE FRAUD ANALYTICS MARKET FOR EMPLOYERS, BY REGION, 2019–2026 (USD MILLION)
TABLE 44 HEALTHCARE FRAUD ANALYTICS MARKET FOR EMPLOYERS, BY COUNTRY, 2019–2026 (USD MILLION)
11 HEALTHCARE FRAUD ANALYTICS MARKET, BY REGION
11.1 INTRODUCTION
TABLE 45 HEALTHCARE FRAUD ANALYTICS MARKET, BY REGION, 2019–2026 (USD MILLION)
11.2 NORTH AMERICA
FIGURE 19 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET SNAPSHOT
TABLE 46 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY COUNTRY, 2019–2026 (USD MILLION)
TABLE 47 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 48 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 49 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 50 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 51 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.2.1 US
11.2.1.1 US dominates the global healthcare fraud analytics market
TABLE 52 US: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 53 US: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 54 US: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 55 US: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 56 US: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.2.2 CANADA
11.2.2.1 Growing adoption of data-crunching technologies like predictive analytics to drive market growth
TABLE 57 CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 58 CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 59 CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 60 CANADA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 61 CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.3 EUROPE
TABLE 62 LIST OF SOME OF THE EHFCN MEMBER ORGANIZATIONS ACROSS EUROPE
TABLE 63 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY COUNTRY, 2019–2026 (USD MILLION)
TABLE 64 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 65 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 66 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 67 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 68 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.3.1 GERMANY
11.3.1.1 Germany is the fastest-growing market for healthcare fraud analytics solutions in Europe
TABLE 69 GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 70 GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 71 GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 72 GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 73 GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.3.2 UK
11.3.2.1 Launch of initiatives such as NHSCFA will support the market for fraud analytics solutions in the UK
TABLE 74 UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 75 UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 76 UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 77 UK: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 78 UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.3.3 FRANCE
11.3.3.1 Increasing adoption of information technology for the detection of healthcare fraud—a key factor driving market growth
TABLE 79 FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 80 FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 81 FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 82 FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 83 FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.3.4 ITALY
11.3.4.1 Increasing government support for the adoption of fraud analytics solutions
TABLE 84 ITALY: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 85 ITALY: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 86 ITALY: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 87 ITALY: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 88 ITALY: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.3.5 SPAIN
11.3.5.1 Advanced healthcare infrastructure to propel the adoption of innovative technologies like fraud analytics
TABLE 89 SPAIN: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 90 SPAIN: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 91 SPAIN: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 92 SPAIN: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 93 SPAIN: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.3.6 REST OF EUROPE
TABLE 94 ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 95 ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 96 ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 97 ROE: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 98 ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.4 ASIA
FIGURE 20 ASIA PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET SNAPSHOT
TABLE 99 ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY COUNTRY, 2019–2026 (USD MILLION)
TABLE 100 ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 101 ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 102 ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 103 ASIA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 104 ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.4.1 JAPAN
11.4.1.1 Increasing fraud cases in medical billing to drive market growth
TABLE 105 JAPAN: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 106 JAPAN: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 107 JAPAN: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 108 JAPAN: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 109 JAPAN: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.4.2 CHINA
11.4.2.1 Growing need for advanced healthcare systems for a better outcome to drive the demand for fraud analytics solutions
TABLE 110 CHINA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 111 CHINA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 112 CHINA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 113 CHINA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 114 CHINA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.4.3 ROA
11.4.3.1 Increasing initiatives for establishing healthcare IT solutions to support market growth
TABLE 115 ROA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 116 ROA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 117 ROA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 118 ROA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 119 ROA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.5 PACIFIC
11.5.1 GROWING NEED FOR INSURANCE COVERAGES AND MEDICAL CLAIMS TO DRIVE MARKET GROWTH
TABLE 120 PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 121 PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 122 PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 123 PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 124 PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.6 LATIN AMERICA
11.6.1 INCREASING PENETRATION OF HEALTH INSURANCE TO DRIVE VOLUME OF CLAIMS PROCESSING IN LATIN AMERICAN COUNTRIES
TABLE 125 LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 126 LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 127 LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 128 LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 129 LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.7 MIDDLE EAST & AFRICA
11.7.1 HEALTHCARE FRAUD IS ONE OF THE LEADING CRIMES IN SOUTH AFRICA
TABLE 130 MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 131 MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 132 MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 133 MEA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 134 MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
12 COMPETITIVE LANDSCAPE
12.1 INTRODUCTION
FIGURE 21 KEY DEVELOPMENTS IN THE HEALTHCARE FRAUD ANALYTICS MARKET BETWEEN JANUARY 2018 AND AUGUST 2021
12.2 COMPETITIVE SITUATION AND TRENDS
12.2.1 DEALS
TABLE 135 DEALS, 2018-2021
12.3 COMPETITIVE LEADERSHIP MAPPING
12.3.1 STARS
12.3.2 EMERGING LEADERS
12.3.3 PERVASIVE PLAYERS
12.3.4 PARTICIPANTS
FIGURE 22 HEALTHCARE FRAUD ANALYTICS MARKET: COMPETITIVE LEADERSHIP MAPPING, 2020
13 COMPANY PROFILES
(Business Overview, Products Offered, Recent Developments, SWOT Analysis, MnM View)*
13.1 KEY PLAYERS
13.1.1 IBM CORPORATION
TABLE 136 IBM CORPORATION: BUSINESS OVERVIEW
FIGURE 23 IBM CORPORATION: COMPANY SNAPSHOT (2020)
13.1.2 OPTUM, INC. (A PART OF UNITEDHEALTH GROUP)
TABLE 137 OPTUM, INC.: BUSINESS OVERVIEW
13.1.3 COTIVITI, INC.
TABLE 138 COTIVITI, INC.: BUSINESS OVERVIEW
13.1.4 FAIR ISAAC CORPORATION
TABLE 139 FAIR ISAAC CORPORATION: BUSINESS OVERVIEW
FIGURE 24 FAIR ISAAC CORPORATION: COMPANY SNAPSHOT (2020)
13.1.5 SAS INSTITUTE INC.
TABLE 140 SAS INSTITUTE INC.: BUSINESS OVERVIEW
13.1.6 CHANGE HEALTHCARE
TABLE 141 CHANGE HEALTHCARE: BUSINESS OVERVIEW
13.1.7 PONDERA SOLUTIONS, INC. (A SUBSIDIARY OF THOMSON REUTERS CORPORATION)
TABLE 142 PONDERA SOLUTIONS, INC.: BUSINESS OVERVIEW
13.1.8 EXLSERVICE HOLDINGS, INC.
TABLE 143 EXLSERVICE HOLDINGS, INC.: BUSINESS OVERVIEW
FIGURE 25 EXLSERVICE HOLDINGS, INC.: COMPANY SNAPSHOT (2020)
13.1.9 WIPRO LIMITED
TABLE 144 WIPRO LIMITED: BUSINESS OVERVIEW
FIGURE 26 WIPRO LIMITED: COMPANY SNAPSHOT (2021)
13.1.10 CONDUENT INCORPORATED
TABLE 145 CONDUENT INCORPORATED: BUSINESS OVERVIEW
FIGURE 27 CONDUENT INCORPORATED: COMPANY SNAPSHOT (2020)
13.1.11 HCL TECHNOLOGIES LIMITED
TABLE 146 HCL TECHNOLOGIES LIMITED.: BUSINESS OVERVIEW
FIGURE 28 HCL TECHNOLOGIES LIMITED.: COMPANY SNAPSHOT (2021)
13.1.12 CGI INC.
TABLE 147 CGI INC.: BUSINESS OVERVIEW
FIGURE 29 CGI INC.: COMPANY SNAPSHOT (2020)
13.1.13 DXC TECHNOLOGY
TABLE 148 DXC TECHNOLOGY COMPANY: BUSINESS OVERVIEW
FIGURE 30 DXC TECHNOLOGY COMPANY: COMPANY SNAPSHOT (2021)
13.1.14 NORTHROP GRUMMAN CORPORATION
TABLE 149 NORTHROP GRUMMAN CORPORATION: BUSINESS OVERVIEW
FIGURE 31 NORTHROP GRUMMAN CORPORATION: COMPANY SNAPSHOT (2020)
13.1.15 LEXISNEXIS (A PART OF RELX GROUP)
TABLE 150 LEXISNEXIS: BUSINESS OVERVIEW
FIGURE 32 RELX GROUP: COMPANY SNAPSHOT (2020)
13.1.16 QLARANT, INC.
TABLE 151 QLARANT, INC.: BUSINESS OVERVIEW
13.1.17 H2O.AI
TABLE 152 H2O.AI: BUSINESS OVERVIEW
13.1.18 MULTIPLAN
TABLE 153 MULTIPLAN: BUSINESS OVERVIEW
13.1.19 FRISS
TABLE 154 FRISS: BUSINESS OVERVIEW
13.1.20 OSP LABS
TABLE 155 OSP LABS: BUSINESS OVERVIEW
13.2 OTHER PLAYERS
13.2.1 SHARECARE, INC. (A SUBSIDIARY OF FALCON CAPITAL ACQUISITION CORP.)
13.2.2 HEALTHCARE FRAUD SHIELD
13.2.3 FRAUDLENS, INC.
13.2.4 HMS HOLDINGS CORP.
13.2.5 CODOXO
*Details on Business Overview, Products Offered, Recent Developments, SWOT Analysis, MnM View might not be captured in case of unlisted companies.
14 APPENDIX
14.1 DISCUSSION GUIDE
14.2 KNOWLEDGE STORE: MARKETSANDMARKETS’ SUBSCRIPTION PORTAL
14.3 AVAILABLE CUSTOMIZATIONS
14.4 RELATED REPORTS
14.5 AUTHOR DETAILS
1.1 OBJECTIVES OF THE STUDY
1.2 MARKET DEFINITION & SCOPE
1.2.1 INCLUSIONS & EXCLUSIONS OF THE STUDY
1.2.2 MARKET SEGMENTATION
FIGURE 1 HEALTHCARE FRAUD ANALYTICS MARKET SEGMENTATION
1.2.3 YEARS CONSIDERED FOR THE STUDY
1.3 CURRENCY
TABLE 1 EXCHANGE RATES UTILIZED FOR CONVERSION TO USD
1.4 LIMITATIONS
1.5 STAKEHOLDERS
2 RESEARCH METHODOLOGY
2.1 RESEARCH APPROACH
FIGURE 2 RESEARCH DESIGN
2.1.1 SECONDARY SOURCES
2.1.1.1 Key data from secondary sources
2.1.2 PRIMARY SOURCES
TABLE 2 LIST OF STAKEHOLDERS INTERVIEWED FOR THE STUDY
2.1.2.1 Key data from primary sources
FIGURE 3 BREAKDOWN OF PRIMARY INTERVIEWS: BY COMPANY TYPE, DESIGNATION, AND REGION
2.2 MARKET SIZE ESTIMATION
2.3 MARKET BREAKDOWN AND DATA TRIANGULATION
FIGURE 4 DATA TRIANGULATION METHODOLOGY
2.4 ASSUMPTIONS FOR THE STUDY
3 EXECUTIVE SUMMARY
FIGURE 5 HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2021 VS. 2026 (USD MILLION)
FIGURE 6 HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2021 VS. 2026 (USD MILLION)
FIGURE 7 HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2021 VS. 2026 (USD MILLION)
FIGURE 8 HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2021 VS. 2026 (USD MILLION)
FIGURE 9 GEOGRAPHICAL SNAPSHOT OF THE HEALTHCARE FRAUD ANALYTICS MARKET
4 PREMIUM INSIGHTS
4.1 HEALTHCARE FRAUD ANALYTICS MARKET OVERVIEW
FIGURE 10 LARGE NUMBER OF FRAUDULENT ACTIVITIES IN HEALTHCARE TO DRIVE MARKET GROWTH
4.2 ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE AND COUNTRY
FIGURE 11 DESCRIPTIVE ANALYTICS SEGMENT ACCOUNTED FOR THE LARGEST SHARE OF THE ASIAN HEALTHCARE FRAUD ANALYTICS MARKET IN 2020
4.3 HEALTHCARE FRAUD ANALYTICS MARKET: GEOGRAPHIC GROWTH OPPORTUNITIES
FIGURE 12 US TO REGISTER THE HIGHEST REVENUE GROWTH DURING FORECAST PERIOD
4.4 HEALTHCARE FRAUD ANALYTICS MARKET: REGIONAL MIX
FIGURE 13 NORTH AMERICA WILL CONTINUE TO DOMINATE THE MARKET IN 2026
4.5 HEALTHCARE FRAUD ANALYTICS MARKET: DEVELOPING VS. DEVELOPED REGIONS
FIGURE 14 DEVELOPED MARKETS TO REGISTER HIGHER GROWTH DURING FORECAST PERIOD
5 MARKET OVERVIEW
5.1 INTRODUCTION
5.2 MARKET DYNAMICS
FIGURE 15 HEALTHCARE FRAUD ANALYTICS MARKET: DRIVERS, RESTRAINTS, OPPORTUNITIES, AND CHALLENGES
5.2.1 DRIVERS
5.2.1.1 Large number of fraudulent activities in healthcare
FIGURE 16 US NATIONAL HEALTHCARE FRAUD AND OPIOID TAKEDOWN TRENDS
FIGURE 17 INCIDENCE OF FRAUDULENT CLAIMS—GLOBAL SCENARIO (2019)
5.2.1.2 Increased number of patients seeking health insurance
5.2.1.3 Prepayment review model
5.2.1.4 High returns on investment
5.2.1.5 Rise in pharmacy claims-related fraud
5.2.2 RESTRAINTS
5.2.2.1 Limitations in the data capturing process in Medicaid services
5.2.3 OPPORTUNITIES
5.2.3.1 Adoption of healthcare fraud analytics in developing countries
5.2.3.2 Emergence of social media and its impact on the healthcare industry
5.2.3.3 Role of AI in healthcare fraud detection
5.2.4 CHALLENGES
5.2.4.1 Dearth of skilled personnel
5.2.4.2 Time-consuming deployment and the need for frequent upgrades
6 INDUSTRY INSIGHTS
6.1 INDUSTRY TRENDS
6.1.1 SHIFTING FOCUS FROM ON-PREMISE MODELS TO CLOUD-BASED ON-DEMAND MODELS
6.1.2 MERGERS AND ACQUISITIONS: THE MOST ADOPTED STRATEGY
FIGURE 18 MAJOR MERGERS AND ACQUISITIONS IN THE HEALTHCARE FRAUD ANALYTICS MARKET
6.1.3 TECHNOLOGICAL ADVANCEMENTS
TABLE 3 COMPANIES OFFERING INNOVATIVE FRAUD ANALYTICS SOLUTIONS
6.1.4 NEW USE CASE: OPIOID EPIDEMIC CRISIS
6.1.5 END-USER TRENDS: ADOPTION OF HEALTHCARE FRAUD ANALYTICS SOLUTIONS BY PHARMACY BENEFIT MANAGERS
7 HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE
7.1 INTRODUCTION
TABLE 4 HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
7.2 DESCRIPTIVE ANALYTICS
7.2.1 DESCRIPTIVE ANALYTICS SEGMENT ACCOUNTED FOR THE LARGEST MARKET SHARE
TABLE 5 DESCRIPTIVE ANALYTICS SOLUTIONS FOR HEALTHCARE FRAUD DETECTION
TABLE 6 DESCRIPTIVE ANALYTICS MARKET, BY REGION, 2019–2026 (USD MILLION)
TABLE 7 DESCRIPTIVE ANALYTICS MARKET, BY COUNTRY, 2019–2026 (USD MILLION)
7.3 PREDICTIVE ANALYTICS
7.3.1 PREDICTIVE ANALYTICS HELPS IN SIMULATING FUTURE EVENTS AND TRENDS THAT CAN ENABLE PAYERS TO PREDICT PREVENTABLE EVENTS
TABLE 8 PREDICTIVE ANALYTICS SOLUTIONS FOR HEALTHCARE FRAUD DETECTION
TABLE 9 PREDICTIVE ANALYTICS MARKET, BY REGION, 2019–2026 (USD MILLION)
TABLE 10 PREDICTIVE ANALYTICS MARKET, BY COUNTRY, 2019–2026 (USD MILLION)
7.4 PRESCRIPTIVE ANALYTICS
7.4.1 PRESCRIPTIVE MODELS OFFER ADDITIONAL ADVANTAGES RELATING TO THE INVESTIGATION OF SUSPICIOUS BEHAVIOR TO GENERATE COMPREHENSIVE INSIGHTS
TABLE 11 PRESCRIPTIVE ANALYTICS SOLUTIONS FOR HEALTHCARE FRAUD DETECTION
TABLE 12 PRESCRIPTIVE ANALYTICS MARKET, BY REGION, 2019–2026 (USD MILLION)
TABLE 13 PRESCRIPTIVE ANALYTICS MARKET, BY COUNTRY, 2019–2026 (USD MILLION)
8 HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL
8.1 INTRODUCTION
TABLE 14 HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
8.2 ON-PREMISE DELIVERY MODELS
8.2.1 ON-PREMISE MODELS ACCOUNT FOR THE LARGEST SHARE OF THE MARKET
TABLE 15 KEY VENDORS OFFERING ON-PREMISE SOLUTIONS IN THE MARKET
TABLE 16 HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-PREMISE DELIVERY MODEL, BY REGION, 2019–2026 (USD MILLION)
TABLE 17 HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-PREMISE DELIVERY MODEL, BY COUNTRY, 2019–2026 (USD MILLION)
8.3 ON-DEMAND DELIVERY MODELS
8.3.1 CLOUD-BASED DELIVERY MODELS OFFER ORGANIZATIONS INCREASED SCALABILITY AND SPEED
TABLE 18 KEY VENDORS PROVIDING ON-DEMAND SOLUTIONS
TABLE 19 HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-DEMAND DELIVERY MODEL, BY REGION, 2019–2026 (USD MILLION)
TABLE 20 HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-DEMAND DELIVERY MODEL, BY COUNTRY, 2019–2026 (USD MILLION)
9 HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION
9.1 INTRODUCTION
TABLE 21 HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
9.2 INSURANCE CLAIMS REVIEW
TABLE 22 DEPLOYMENT OF PREPAYMENT VS. POSTPAYMENT ANALYTICS SYSTEMS
TABLE 23 HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 24 HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY REGION, 2019–2026 (USD MILLION)
TABLE 25 HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY COUNTRY, 2019–2026 (USD MILLION)
9.2.1 POSTPAYMENT REVIEW
9.2.1.1 Postpayment review dominates the healthcare fraud analytics insurance claims review market
TABLE 26 HEALTHCARE FRAUD ANALYTICS MARKET FOR POSTPAYMENT CLAIMS REVIEW, BY REGION, 2019–2026 (USD MILLION)
TABLE 27 HEALTHCARE FRAUD ANALYTICS MARKET FOR POSTPAYMENT CLAIMS REVIEW, BY COUNTRY, 2019–2026 (USD MILLION)
9.2.2 PREPAYMENT REVIEW
9.2.2.1 The majority of prepayment models use predictive analytics to detect fraud and stop fraudulent claims payments
TABLE 28 HEALTHCARE FRAUD ANALYTICS MARKET FOR PREPAYMENT CLAIMS REVIEW, BY REGION, 2019–2026 (USD MILLION)
TABLE 29 HEALTHCARE FRAUD ANALYTICS MARKET FOR PREPAYMENT CLAIMS REVIEW, BY COUNTRY, 2019–2026 (USD MILLION)
9.3 PHARMACY BILLING MISUSE
9.3.1 FRAUD, WASTE, AND ABUSE CASES IN PHARMACY AND PRESCRIPTION DRUG AREAS TO DRIVE THE DEMAND FOR ANALYTICS
TABLE 30 HEALTHCARE FRAUD ANALYTICS MARKET FOR PHARMACY BILLING MISUSE APPLICATION, BY REGION, 2019–2026 (USD MILLION)
TABLE 31 HEALTHCARE FRAUD ANALYTICS MARKET FOR PHARMACY BILLING MISUSE APPLICATION, BY COUNTRY, 2019–2026 (USD MILLION)
9.4 PAYMENT INTEGRITY
9.4.1 CHANGES IN REGULATORY GUIDELINES HAVE AIDED THE ADOPTION OF PAYMENT INTEGRITY SOFTWARE
TABLE 32 HEALTHCARE FRAUD ANALYTICS MARKET FOR PAYMENT INTEGRITY APPLICATION, BY REGION, 2019–2026 (USD MILLION)
TABLE 33 HEALTHCARE FRAUD ANALYTICS MARKET FOR PAYMENT INTEGRITY APPLICATION, BY COUNTRY, 2019–2026 (USD MILLION)
9.5 OTHER APPLICATIONS
TABLE 34 HEALTHCARE FRAUD ANALYTICS MARKET FOR OTHER APPLICATION, BY REGION, 2019–2026 (USD MILLION)
TABLE 35 HEALTHCARE FRAUD ANALYTICS MARKET FOR OTHER APPLICATIONS, BY COUNTRY, 2019–2026 (USD MILLION)
10 HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER
10.1 INTRODUCTION
TABLE 36 HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
10.2 PUBLIC & GOVERNMENT AGENCIES
10.2.1 PUBLIC & GOVERNMENT AGENCIES DOMINATE THE HEALTHCARE FRAUD ANALYTICS MARKET
TABLE 37 HEALTHCARE FRAUD ANALYTICS MARKET FOR PUBLIC & GOVERNMENT AGENCIES, BY REGION, 2019–2026 (USD MILLION)
TABLE 38 HEALTHCARE FRAUD ANALYTICS MARKET FOR PUBLIC & GOVERNMENT AGENCIES, BY COUNTRY, 2019–2026 (USD MILLION)
10.3 PRIVATE INSURANCE PAYERS
10.3.1 PRIVATE INSURANCE PAYERS ARE FOCUSED ON DEPLOYING ANALYTICS TO COMBAT INCREASING MONETARY LOSSES
TABLE 39 HEALTHCARE FRAUD ANALYTICS MARKET FOR PRIVATE INSURANCE PAYERS, BY REGION, 2019–2026 (USD MILLION)
TABLE 40 HEALTHCARE FRAUD ANALYTICS MARKET FOR PRIVATE INSURANCE PAYERS, BY COUNTRY, 2019–2026 (USD MILLION)
10.4 THIRD-PARTY SERVICE PROVIDERS
10.4.1 ADOPTION OF FRAUD ANALYTICS SOLUTIONS BY PUBLIC INSURERS PUTS PRIVATE BODIES AT RISK, DRIVING ATTENTION TOWARD OUTSOURCING
TABLE 41 HEALTHCARE FRAUD ANALYTICS MARKET FOR THIRD-PARTY SERVICE PROVIDERS, BY REGION, 2019–2026 (USD MILLION)
TABLE 42 HEALTHCARE FRAUD ANALYTICS MARKET FOR THIRD-PARTY SERVICE PROVIDERS, BY COUNTRY, 2019–2026 (USD MILLION)
10.5 EMPLOYERS
10.5.1 EMPLOYERS ARE CONSIDERING FRAUD ANALYTICS SOLUTIONS AS A STEP TOWARD BETTER COST MANAGEMENT
TABLE 43 HEALTHCARE FRAUD ANALYTICS MARKET FOR EMPLOYERS, BY REGION, 2019–2026 (USD MILLION)
TABLE 44 HEALTHCARE FRAUD ANALYTICS MARKET FOR EMPLOYERS, BY COUNTRY, 2019–2026 (USD MILLION)
11 HEALTHCARE FRAUD ANALYTICS MARKET, BY REGION
11.1 INTRODUCTION
TABLE 45 HEALTHCARE FRAUD ANALYTICS MARKET, BY REGION, 2019–2026 (USD MILLION)
11.2 NORTH AMERICA
FIGURE 19 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET SNAPSHOT
TABLE 46 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY COUNTRY, 2019–2026 (USD MILLION)
TABLE 47 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 48 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 49 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 50 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 51 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.2.1 US
11.2.1.1 US dominates the global healthcare fraud analytics market
TABLE 52 US: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 53 US: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 54 US: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 55 US: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 56 US: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.2.2 CANADA
11.2.2.1 Growing adoption of data-crunching technologies like predictive analytics to drive market growth
TABLE 57 CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 58 CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 59 CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 60 CANADA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 61 CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.3 EUROPE
TABLE 62 LIST OF SOME OF THE EHFCN MEMBER ORGANIZATIONS ACROSS EUROPE
TABLE 63 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY COUNTRY, 2019–2026 (USD MILLION)
TABLE 64 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 65 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 66 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 67 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 68 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.3.1 GERMANY
11.3.1.1 Germany is the fastest-growing market for healthcare fraud analytics solutions in Europe
TABLE 69 GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 70 GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 71 GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 72 GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 73 GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.3.2 UK
11.3.2.1 Launch of initiatives such as NHSCFA will support the market for fraud analytics solutions in the UK
TABLE 74 UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 75 UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 76 UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 77 UK: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 78 UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.3.3 FRANCE
11.3.3.1 Increasing adoption of information technology for the detection of healthcare fraud—a key factor driving market growth
TABLE 79 FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 80 FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 81 FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 82 FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 83 FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.3.4 ITALY
11.3.4.1 Increasing government support for the adoption of fraud analytics solutions
TABLE 84 ITALY: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 85 ITALY: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 86 ITALY: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 87 ITALY: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 88 ITALY: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.3.5 SPAIN
11.3.5.1 Advanced healthcare infrastructure to propel the adoption of innovative technologies like fraud analytics
TABLE 89 SPAIN: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 90 SPAIN: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 91 SPAIN: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 92 SPAIN: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 93 SPAIN: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.3.6 REST OF EUROPE
TABLE 94 ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 95 ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 96 ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 97 ROE: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 98 ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.4 ASIA
FIGURE 20 ASIA PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET SNAPSHOT
TABLE 99 ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY COUNTRY, 2019–2026 (USD MILLION)
TABLE 100 ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 101 ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 102 ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 103 ASIA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 104 ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.4.1 JAPAN
11.4.1.1 Increasing fraud cases in medical billing to drive market growth
TABLE 105 JAPAN: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 106 JAPAN: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 107 JAPAN: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 108 JAPAN: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 109 JAPAN: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.4.2 CHINA
11.4.2.1 Growing need for advanced healthcare systems for a better outcome to drive the demand for fraud analytics solutions
TABLE 110 CHINA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 111 CHINA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 112 CHINA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 113 CHINA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 114 CHINA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.4.3 ROA
11.4.3.1 Increasing initiatives for establishing healthcare IT solutions to support market growth
TABLE 115 ROA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 116 ROA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 117 ROA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 118 ROA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 119 ROA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.5 PACIFIC
11.5.1 GROWING NEED FOR INSURANCE COVERAGES AND MEDICAL CLAIMS TO DRIVE MARKET GROWTH
TABLE 120 PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 121 PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 122 PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 123 PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 124 PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.6 LATIN AMERICA
11.6.1 INCREASING PENETRATION OF HEALTH INSURANCE TO DRIVE VOLUME OF CLAIMS PROCESSING IN LATIN AMERICAN COUNTRIES
TABLE 125 LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 126 LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 127 LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 128 LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 129 LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
11.7 MIDDLE EAST & AFRICA
11.7.1 HEALTHCARE FRAUD IS ONE OF THE LEADING CRIMES IN SOUTH AFRICA
TABLE 130 MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)
TABLE 131 MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)
TABLE 132 MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)
TABLE 133 MEA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)
TABLE 134 MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)
12 COMPETITIVE LANDSCAPE
12.1 INTRODUCTION
FIGURE 21 KEY DEVELOPMENTS IN THE HEALTHCARE FRAUD ANALYTICS MARKET BETWEEN JANUARY 2018 AND AUGUST 2021
12.2 COMPETITIVE SITUATION AND TRENDS
12.2.1 DEALS
TABLE 135 DEALS, 2018-2021
12.3 COMPETITIVE LEADERSHIP MAPPING
12.3.1 STARS
12.3.2 EMERGING LEADERS
12.3.3 PERVASIVE PLAYERS
12.3.4 PARTICIPANTS
FIGURE 22 HEALTHCARE FRAUD ANALYTICS MARKET: COMPETITIVE LEADERSHIP MAPPING, 2020
13 COMPANY PROFILES
(Business Overview, Products Offered, Recent Developments, SWOT Analysis, MnM View)*
13.1 KEY PLAYERS
13.1.1 IBM CORPORATION
TABLE 136 IBM CORPORATION: BUSINESS OVERVIEW
FIGURE 23 IBM CORPORATION: COMPANY SNAPSHOT (2020)
13.1.2 OPTUM, INC. (A PART OF UNITEDHEALTH GROUP)
TABLE 137 OPTUM, INC.: BUSINESS OVERVIEW
13.1.3 COTIVITI, INC.
TABLE 138 COTIVITI, INC.: BUSINESS OVERVIEW
13.1.4 FAIR ISAAC CORPORATION
TABLE 139 FAIR ISAAC CORPORATION: BUSINESS OVERVIEW
FIGURE 24 FAIR ISAAC CORPORATION: COMPANY SNAPSHOT (2020)
13.1.5 SAS INSTITUTE INC.
TABLE 140 SAS INSTITUTE INC.: BUSINESS OVERVIEW
13.1.6 CHANGE HEALTHCARE
TABLE 141 CHANGE HEALTHCARE: BUSINESS OVERVIEW
13.1.7 PONDERA SOLUTIONS, INC. (A SUBSIDIARY OF THOMSON REUTERS CORPORATION)
TABLE 142 PONDERA SOLUTIONS, INC.: BUSINESS OVERVIEW
13.1.8 EXLSERVICE HOLDINGS, INC.
TABLE 143 EXLSERVICE HOLDINGS, INC.: BUSINESS OVERVIEW
FIGURE 25 EXLSERVICE HOLDINGS, INC.: COMPANY SNAPSHOT (2020)
13.1.9 WIPRO LIMITED
TABLE 144 WIPRO LIMITED: BUSINESS OVERVIEW
FIGURE 26 WIPRO LIMITED: COMPANY SNAPSHOT (2021)
13.1.10 CONDUENT INCORPORATED
TABLE 145 CONDUENT INCORPORATED: BUSINESS OVERVIEW
FIGURE 27 CONDUENT INCORPORATED: COMPANY SNAPSHOT (2020)
13.1.11 HCL TECHNOLOGIES LIMITED
TABLE 146 HCL TECHNOLOGIES LIMITED.: BUSINESS OVERVIEW
FIGURE 28 HCL TECHNOLOGIES LIMITED.: COMPANY SNAPSHOT (2021)
13.1.12 CGI INC.
TABLE 147 CGI INC.: BUSINESS OVERVIEW
FIGURE 29 CGI INC.: COMPANY SNAPSHOT (2020)
13.1.13 DXC TECHNOLOGY
TABLE 148 DXC TECHNOLOGY COMPANY: BUSINESS OVERVIEW
FIGURE 30 DXC TECHNOLOGY COMPANY: COMPANY SNAPSHOT (2021)
13.1.14 NORTHROP GRUMMAN CORPORATION
TABLE 149 NORTHROP GRUMMAN CORPORATION: BUSINESS OVERVIEW
FIGURE 31 NORTHROP GRUMMAN CORPORATION: COMPANY SNAPSHOT (2020)
13.1.15 LEXISNEXIS (A PART OF RELX GROUP)
TABLE 150 LEXISNEXIS: BUSINESS OVERVIEW
FIGURE 32 RELX GROUP: COMPANY SNAPSHOT (2020)
13.1.16 QLARANT, INC.
TABLE 151 QLARANT, INC.: BUSINESS OVERVIEW
13.1.17 H2O.AI
TABLE 152 H2O.AI: BUSINESS OVERVIEW
13.1.18 MULTIPLAN
TABLE 153 MULTIPLAN: BUSINESS OVERVIEW
13.1.19 FRISS
TABLE 154 FRISS: BUSINESS OVERVIEW
13.1.20 OSP LABS
TABLE 155 OSP LABS: BUSINESS OVERVIEW
13.2 OTHER PLAYERS
13.2.1 SHARECARE, INC. (A SUBSIDIARY OF FALCON CAPITAL ACQUISITION CORP.)
13.2.2 HEALTHCARE FRAUD SHIELD
13.2.3 FRAUDLENS, INC.
13.2.4 HMS HOLDINGS CORP.
13.2.5 CODOXO
*Details on Business Overview, Products Offered, Recent Developments, SWOT Analysis, MnM View might not be captured in case of unlisted companies.
14 APPENDIX
14.1 DISCUSSION GUIDE
14.2 KNOWLEDGE STORE: MARKETSANDMARKETS’ SUBSCRIPTION PORTAL
14.3 AVAILABLE CUSTOMIZATIONS
14.4 RELATED REPORTS
14.5 AUTHOR DETAILS
