Global Healthcare Fraud Analytics Market: Market growth is driven by the increasing number of patients seeking health insurance and rising pharmacy claim-related frauds

Published Date: 14/05/2021

The healthcare fraud analytics market is projected to reach USD 5.96 billion by 2027 from USD 1.2 billion in 2020, at a CAGR of 25.7 %. Market growth can be attributed to 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.

Health care fraud is defined as criminal deception intended to result in financial gain during drug manufacturing, quality of the product, medical practice, and health insurance. Health care fraud practice involves healthcare plans of the government, defrauding insurance company, company and consumer party etc. Currently, different data mining practices are adopted by leading life sciences companies to avoid these fraudulent activities.

Healthcare fraud are difficult to detect and are generally go unnoticed, therefore detection of such fraudulent claims is necessary, as they increase burden on the society. The use of fraud detection solution enables healthcare firms in accounting, and auditing by predictive data methodologies. Careful account auditing can reveal suspicious providers and policy holders and detect potential fraudulent cases before it occurs.

Large number of fraudulent activities in healthcare, rising number of patients opting health insurance, prepayment review model, increasing pressure of fraud and abuse on healthcare spending is expected to drive the growth of the market. Moreover, increasing adoption of cloud-based analytics, emergence of social media and its impact on the healthcare industry, artificial intelligence (AI) in healthcare fraud detection is expected to provide opportunity for the growth of healthcare fraud detection market during the forecast period.

The prominent players in the global healthcare fraud detection market are International Business Machines Corporation (IBM), UNITEDHEALTH group, SAS Institute Inc., FAIR ISAAC Corporation, McKesson Corporation, EXLSERVICE Holdings, Inc., DXC Technology Company, LEXISNEXIS, COTIVITI INC., WIPRO LIMITED, and CGI INC. The players operating in the global healthcare fraud detection market are focusing on product launches, along with expanding their global footprints by entering untapped markets.

Geographically, the global healthcare fraud analytics market is segmented into North America, Europe, the Asia Pacific, Latin America, and the Middle East and Africa. 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.

Europe held the second-largest market share due to the high adoption of healthcare fraud detection by the private insurance payers. The Europe region is further segmented into Western Europe and Eastern Europe. Western Europe, on the basis of countries has been, segmented into Germany, the UK, France, Italy, Spain, and the rest of Western Europe.

The Asia-Pacific region has been categorized as China, India, Japan, and the rest of Asia-Pacific. It holds the third-largest position in the healthcare fraud detection market. The Middle East & Africa is expected to witness a remarkable growth owing to the developments in the healthcare services, such as hospitals, clinics, and others.