Healthcare Fraud Detection Market - Dominated By Americas Owing To Its Wide Product Portfolio :

Industry Analysis

The global healthcare fraud detection market is likely to grow at a dual digit CAGR over the forecast period (2017 to 2023). Its companies indulge in mergers & acquisitions, strategic collaborations, and product innovations to grow their geographical reach and raise their industry value. Market expansion is credited to huge returns on investments, healthcare scams, and rising fraud incidences.

Apart from the above, people who pursue healthcare insurance and medical investment exploitations contribute to market growth. Taking an entire look into healthcare frauds, they are of different kinds. These include insurance frauds, drug frauds, etc. Health insurance scams emerge from companies swindling the insurers and regulatory proposals.

These frauds are executed in different ways and change with time. This strategy helps criminals escape the law and develop new tricks to carry on with their fraudulent operations in the future. Financial damages resulting from such activities are reimbursed via using the ‘False Claims Act.’  

Market Research Future Reports (MRFR) recently studied the trends in this industry. It came to the conclusion that the need for healthcare cost cut-backs will steer industry revenues till 2023. The development of EHR, e-Health, and other data-driven instruments has bridged the communication gap between medical experts and patients.

This factor has enabled the generation of huge data, aiding the prevention of frauds and patients to opt for personalized treatments. In general, patients are anxious before using any such devices. However, with a mix of human & artificial intelligence, medical treatments are further modified to suit the needs of various patients. Thus, the demand for medical analytics has escalated, raising the sales of medical fraud detection.

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Market - Classification/Segmentation

The global medical fraud detection industry is split by kinds, components, end-users, delivery models, and regions. Descriptive, predictive, and prescriptive are the different kinds. The components include software and services.

The end-users consist of payment integrity, third party services, private insurance payers, governmental enterprises, insurance claim reviews, and others. Delivery models encompass on-premise and on-demand. Regions under which the market is fragmented, comprise Europe, the Middle East & Africa, Asia Pacific, and Americas.

Leaders among Sub-Segments

Descriptive analytics, in terms of the kinds, dominated the industry. Prescriptive is likely to grow at the fastest pace. Its CAGR should be credited to ensuring synergistic integration of forecast and prescriptions. Services, with respect to components, generated the largest sales.

With a higher need for fraud analytics and development of innovative software, this component will grow at the maximum rate during 2017 to 2023. Private insurance payers, regarding end-users, produced the largest incomes and are forced into investing in fraud analytic services. Their incomes stemmed from complying with various terms and key cost-reduction opportunities.

As far as delivery models are concerned, on-demand is reported to grow maximally over the forecast period. Its high CAGR is attributed to the growth of self-driven analytics, lack of hardware investments, and higher adaptability. With respect to regions, Americas maintained supremacy over the market in the recent past. Europe followed suit. 

The key drivers of Americas were novel technologies, cost-reduction stress, and wide range of products & services. With the market showing decent prospects, it can be obstructed by timely innovations, shortage of experts, and time-consuming adoption.

Eminent Players and Advancements  

Well-established companies in the worldwide industry are Pondera, Wipro, IBM, and Optum. The Centers for Medicare and Medicaid Services (CMS) recently made use of predictive modeling for the detection of fraud claims before they were paid. This new service has taken CMS by storm and encouraged other participants to be creative and good at whatever they do. Research and developments and product innovations are some of the strategies employed by the players to gain an edge over one another.   

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