The Global Healthcare Fraud Detection Market is forecast to grow with the CAGR of 26.29% and reach USD 6.14 billion in the study period.
Fraud is referred to as any illegal practices leading to violation of the regulation with an intent of gaining higher profit. In healthcare, fraud is often related with the forging of medical bills, manipulation in medical records for higher medical reimbursement, improper diagnosis reporting, medical insurance, and many more. Thus, it is extremely important to detect possible risk for preventing the healthcare related frauds. The healthcare fraud detection minimizes the frauds through accurate detection along with prevention of the related risk of fraud, waste, and abuse in the medical treatment and insurance. It further minimizes the overall healthcare expenditure associated with the medical fraud. Due to this, it is widely adopted by the insurance providers, medical service provider, diagnostic laboratories, and government.
Healthcare Fraud Detection Market: Drivers & Challenges
Rising Fraud in Healthcare Sector
Healthcare has emerged as the key area of focus for the population worldwide. Booming healthcare sector, coupled with increasing demand for better access to healthcare, healthcare related fraud also rises the overall medical expenditure. Rising prevalence of the chronic and fatal diseases with increasing demand for advanced and personal healthcare services, results in higher amount of financial transactions, escalating the risk of healthcare related frauds. As per the National Healthcare Anti-Fraud Association, around USD 3.6 trillion was spent on healthcare in the US alone including several billions of healthcare claims in the year 2018, inclusive of the financial loss of several billion accounted to the healthcare fraud. Owing to increase in the healthcare services leading to rise in healthcare fraud, which drives the demand for healthcare fraud detection.
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Increasing Demand for Health Insurance
Healthcare related expenditure is upscaling at a rapid pace owing to booming healthcare sector. As per the Growing global population, increasing count of the geriatric population, along with increasing occurrence of the chronic medical conditions resulting better access to advanced and more efficient medical treatments. Additionally, higher out-of-pocket expenditure to avail better healthcare services is driving the demand for health insurance. Favorable support by the government regarding providing health insurance for the elderly people and population with selected disabilities further drives the market growth.
Higher Penetration of AI in Healthcare Fraud Detection
Artificial Intelligence is widely used across several end-use industries including manufacturing, information technology, robotics, healthcare, and many more. In healthcare sector, AI is gaining higher importance owing to its adoption in fraud detection by machine learning, an alternative to conventional healthcare fraud detection. Increasing amount of data generation in the healthcare facility through patient diagnosing to healthcare insurance claim, drives attention towards adoption of AI for eradicating risk related to human error for more accurate outcome. Also, AI helps in detection of fraud behavior through the unique data entering for securing patient information is fueling the market growth in the years to follow
Healthcare fraud detection market: Key segments
- Segmentation based on detection method: Predictive Analysis, Prescriptive Analysis and Descriptive Analysis
- Segmentation based on product type: Solution and Service
- Segmentation based on end-users: Medical Service Providers, Insurance Service Providers, Diagnostics Laboratories, Government and Others
- Segmentation based on region covers: North America, South America, Europe, Asia-Pacific, Middle East & Africa and South America, with individual country-level analysis.
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List of the leading companies operating in the Healthcare Fraud Detection Market include:
- SAS Institute Inc. (Company Description, Company Overview, Product Synopsis, Key Developments, SWOT Analysis)
- IBM Corporation
- Wipro Limited
- Optum, Inc.
- LexisNexis Group
- Other Key Companies
Healthcare Fraud Detection Market: Report Segmentation
For the scope of the report, In-depth segmentation is offered by Forencis Research
Healthcare Fraud Detection Market, by Detection Method
- Predictive Analysis
- Prescriptive Analysis
- Descriptive Analysis
Healthcare Fraud Detection Market, by Product Type
Healthcare Fraud Detection Market, by End-user
- Medical Service Providers
- Insurance Service Providers
- Diagnostics Laboratories
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Healthcare Fraud Detection Market by Region
- Asia-Pacific (China, Japan, South Korea, India, Taiwan, Rest of Asia-Pacific)
- North America (US, Canada, Mexico)
- Europe (Germany, Russia, France, Italy, UK, Spain, The Netherlands, Rest of Europe)
- Middle East and Africa (Saudi Arabia, UAE, Rest of Middle East & Africa)
- South America (Brazil, Argentina, Rest of South America)
Key Questions answered by the report
- What are the prominent developments affecting the market worldwide and its growth?
- What will be the impact of the developments in the market on the industry and on the market players in the future?
- What are the evolving variations of the market globally?
- What are the evolving functions of the market globally?
- What are the prominent aspects that will affect market growth globally during the study period?
- Who are the key players operating in the market across the globe?
- How are the key players leveraging in the present market scenario worldwide?
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