Healthcare Analytics To Limit Healthcare Fraud

The healthcare industry is susceptible to a wide range of frauds that will lead to financial losses. Healthcare fraud is a large contributor to unnecessary costs and the rise in spending in the US healthcare industry. The financial loss can be declined by deploying artificial intelligence (AI) tools to prevent and detect fraud. AI is capable of analyzing the huge amount of data generated in the healthcare organization and flags the fraud before it starts. The technology is adaptive enough to help tackle fraud at any of its stages. Thus the adoption of AI in healthcare fraud detection is likely to experience the positive outcomes in the coming future.

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Us Healthcare Fraud Analytics Industry Insight:

Most of the healthcare frauds are committed by the small number of fraudulent healthcare providers, and in some cases, by people who are pretending to be legitimate healthcare providers. Unfortunately, the actions of these few deceitful individuals ultimately harms the reputation of the most trusted and respected healthcare professionals. The number of healthcare frauds is increasing in the US. The Department of Justice (DoJ) in January 2019, announced that around US$2.5 billion of the total US$2.8 billion were recovered under the False Claims Act in the US. The most significant monetary recoveries in the year 2018 were from medical device and drug industries. Also, the National Health Care Anti-Fraud Association (NHCAA) estimated that every year, losses due to healthcare frauds are in the tens of billions of dollars. Some government and law enforcement agencies also estimated that healthcare frauds cost around 10% of the total annual health expenditure, which could be around US$ 300 billion. Thus, an increasing number of fraudulent healthcare cases is likely to demand healthcare fraud analytics solutions.

Solution Insights

US healthcare fraud analytics market by product is segmented into predictive analytics, descriptive analytics, and prescriptive analytics. In 2019, the predictive analytics segment held the largest market share of the healthcare fraud analytics market, by product. This segment is also anticipated to dominate the market in 2027 owing analytics detection and identification patterns which are potentially fraudulent and it then develops sets of rules to flag potentially fraudulent claims. Also, the segment is anticipated to witness growth at a significant rate during the forecast period.

Top Companies Insight

Conduent Inc., DXC Technology, Scioinspire, Corp., FICO, Optum, Inc., SAS Institute, Pondera Solutions, Lexisnexis Risk Solutions, Whitehatai, Cotiviti And Others

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References:

  • businessmarketinsights.com