Healthcare Fraud Detection Market Research Report - Forecast till 2030

Healthcare Fraud Detection Market: Information By Type (Descriptive Analytics, Predictive Analytics and Prescriptive Analytics), By Component (Services and Software), By Delivery Model (On-Premise and Cloud-Based), By Application (Insurance Claims Review and Payment Integrity), By End User (Private Insurance Payers, Public/Government Agencies and Third Party Service Providers) - Forecast till 2030

ID: MRFR/HCIT/4215-CR | September 2019 | Region: Global | 160 Pages         

1 EXECUTIVE SUMMARY

1.1 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY TYPE 19

1.2 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT 20

1.3 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL 21

1.4 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION 22

1.5 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY END USER 23

2 MARKET INTRODUCTION

2.1 DEFINITION 24

2.2 SCOPE OF THE STUDY 24

2.3 RESEARCH OBJECTIVE 24

2.4 MARKET STRUCTURE 25

3 RESEARCH METHODOLOGY

3.1 RESEARCH PROCESS 26

3.2 PRIMARY RESEARCH 27

3.3 SECONDARY RESEARCH 28

3.4 MARKET SIZE ESTIMATION 29

3.5 FORECAST MODEL 30

4 MARKET DYNAMICS

4.1 INTRODUCTION 31

4.2 DRIVERS 32

4.2.1 INCREASE IN THE NUMBER OF FRAUDULENT ACTIVITIES IN HEALTHCARE 32

4.2.2 THE RISING NUMBER OF PATIENTS OPTING FOR HEALTH INSURANCE 32

4.2.3 THE ESCALATION IN HEALTHCARE EXPENDITURE 32

4.3 RESTRAINTS 33

4.3.1 UNWILLINGNESS TO ADOPT HEALTHCARE FRAUD ANALYTICS IN DEVELOPING REGIONS 33

4.4 OPPORTUNITIES 33

4.4.1 AI IN HEALTHCARE FRAUD DETECTION 33

5 MARKET FACTOR ANALYSIS

5.1 VALUE CHAIN ANALYSIS 34

5.1.1 INPUTS 34

5.1.2 SOFTWARE DEVELOPMENT PROCESSES 35

5.1.3 OUTPUT 35

5.1.4 MARKETING AND DISTRIBUTION 35

5.2 PORTER’S FIVE FORCES MODEL 35

5.2.1 BARGAINING POWER OF SUPPLIERS 36

5.2.2 BARGAINING POWER OF BUYERS 36

5.2.3 THE THREAT OF NEW ENTRANTS 36

5.2.4 THREAT OF SUBSTITUTES 37

5.2.5 INTENSITY OF RIVALRY 37

6 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY TYPE

6.1 OVERVIEW 38

6.2 DESCRIPTIVE ANALYTICS 40

6.3 PREDICTIVE ANALYTICS 40

6.4 PRESCRIPTIVE ANALYTICS 41

7 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT

7.1 OVERVIEW 42

7.2 SERVICES 44

7.3 SOFTWARE 44

8 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL

8.1 OVERVIEW 45

8.2 ON-PREMISE 47

8.3 CLOUD BASED 47

9 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION

9.1 OVERVIEW 48

9.2 INSURANCE CLAIMS REVIEW 50

9.3 PAYMENT INTEGRITY 51

10 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY END USER

10.1 OVERVIEW 52

10.2 PRIVATE INSURANCE PAYERS 54

10.3 PUBLIC/GOVERNMENT AGENCIES 54

10.4 THIRD PARTY SERVICE PROVIDERS 55

11 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY REGION

11.1 OVERVIEW 56

11.2 AMERICAS 58

11.2.1 NORTH AMERICA 61

11.2.1.1 US 64

11.2.1.2 CANADA 66

11.2.2 SOUTH AMERICA 69

11.3 EUROPE 72

11.3.1 WESTERN EUROPE 75

11.3.1.1 GERMANY 78

11.3.1.2 UK 80

11.3.1.3 FRANCE 83

11.3.1.4 ITALY 85

11.3.1.5 SPAIN 87

11.3.1.6 REST OF WESTERN EUROPE 90

11.3.2 EASTERN EUROPE 92

11.4 ASIA-PACIFIC 95

11.4.1 JAPAN 98

11.4.2 CHINA 101

11.4.3 INDIA 103

11.4.4 AUSTRALIA 106

11.4.5 SOUTH KOREA 108

11.4.6 REST OF ASIA PACIFIC 111

11.5 MIDDLE EAST & AFRICA 114

11.5.1 MIDDLE EAST 117

11.5.2 AFRICA 120

12 COMPETITIVE LANDSCAPE

12.1 INTRODUCTION 123

12.2 COMPETITIVE OVERVIEW 123

13 COMPANY PROFILES

13.1 INTERNATIONAL BUSINESS MACHINES CORPORATION 125

13.1.1 COMPANY OVERVIEW 125

13.1.2 FINANCIAL OVERVIEW 126

13.1.3 PRODUCTS/SERVICES OFFERED 127

13.1.4 KEY DEVELOPMENTS 127

13.1.5 SWOT ANALYSIS 128

13.1.6 KEY STRATEGIES 128

13.2 UNITEDHEALTH GROUP 129

13.2.1 COMPANY OVERVIEW 129

13.2.2 FINANCIAL OVERVIEW 129

13.2.3 PRODUCTS/SERVICES OFFERED 130

13.2.4 KEY DEVELOPMENTS 130

13.2.5 SWOT ANALYSIS 131

13.2.6 KEY STRATEGIES 131

13.3 SAS INSTITUTE INC. 132

13.3.1 COMPANY OVERVIEW 132

13.3.2 FINANCIAL OVERVIEW 132

13.3.3 PRODUCTS/SERVICES OFFERED 133

13.3.4 KEY DEVELOPMENTS 133

13.3.5 SWOT ANALYSIS 134

13.3.6 KEY STRATEGIES 134

13.4 FAIR ISAAC CORPORATION 135

13.4.1 COMPANY OVERVIEW 135

13.4.2 FINANCIAL OVERVIEW 135

13.4.3 PRODUCTS/SERVICES OFFERED 136

13.4.4 KEY DEVELOPMENTS 136

13.4.5 SWOT ANALYSIS 137

13.4.6 KEY STRATEGIES 137

13.5 MCKESSON CORPORATION 138

13.5.1 COMPANY OVERVIEW 138

13.5.2 FINANCIAL OVERVIEW 138

13.5.3 PRODUCTS/SERVICES OFFERED 139

13.5.4 KEY DEVELOPMENTS 139

13.5.5 SWOT ANALYSIS 140

13.5.6 KEY STRATEGIES 140

13.6 EXLSERVICE HOLDINGS, INC. 141

13.6.1 COMPANY OVERVIEW 141

13.6.2 FINANCIAL OVERVIEW 141

13.6.3 PRODUCTS/SERVICES OFFERED 142

13.6.4 KEY DEVELOPMENTS 142

13.6.5 SWOT ANALYSIS 143

13.6.6 KEY STRATEGIES 143

13.7 DXC TECHNOLOGY COMPANY 144

13.7.1 COMPANY OVERVIEW 144

13.7.2 FINANCIAL OVERVIEW 144

13.7.3 PRODUCTS/SERVICES OFFERED 145

13.7.4 KEY DEVELOPMENTS 145

13.7.5 SWOT ANALYSIS 146

13.7.6 KEY STRATEGIES 146

13.8 LEXISNEXIS 147

13.8.1 COMPANY OVERVIEW 147

13.8.2 FINANCIAL OVERVIEW 147

13.8.3 PRODUCTS/SERVICES OFFERED 148

13.8.4 KEY DEVELOPMENTS 148

13.8.5 SWOT ANALYSIS 149

13.8.6 KEY STRATEGIES 149

13.9 COTIVITI, INC. 150

13.9.1 COMPANY OVERVIEW 150

13.9.2 FINANCIAL OVERVIEW 150

13.9.3 PRODUCTS/SERVICES OFFERED 150

13.9.4 KEY DEVELOPMENTS 150

13.9.5 SWOT ANALYSIS 151

13.9.6 KEY STRATEGIES 151

13.10 WIPRO LIMITED 152

13.10.1 COMPANY OVERVIEW 152

13.10.2 FINANCIAL OVERVIEW 153

13.10.3 PRODUCTS/SERVICES OFFERED 153

13.10.4 KEY DEVELOPMENTS 154

13.10.5 SWOT ANALYSIS 154

13.10.6 KEY STRATEGIES 155

13.11 CGI INC. 156

13.11.1 COMPANY OVERVIEW 156

13.11.2 FINANCIAL OVERVIEW 156

13.11.3 PRODUCTS/SERVICES OFFERED 157

13.11.4 KEY DEVELOPMENTS 157

13.11.5 SWOT ANALYSIS 158

13.11.6 KEY STRATEGIES 158

14 APPENDIX

14.1 REFERENCES 159

14.2 RELATED REPORTS 159

 

15 List Of Tables

TABLE 1 PRIMARY INTERVIEWS 27

TABLE 2 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY TYPE 2020–2027 (USD MILLION) 39

TABLE 3 DESCRIPTIVE ANALYTICS: MARKET ESTIMATES & FORECAST, BY REGION, 2020–2027 (USD MILLION) 40

TABLE 4 DISPLAY SYSTEMS: MARKET ESTIMATES & FORECAST, BY REGION, 2020–2027 (USD MILLION) 40

TABLE 5 PRESCRIPTIVE ANALYTICS: MARKET ESTIMATES & FORECAST, BY REGION, 2020-2027 (USD MILLION) 41

TABLE 6 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT 2020–2027 (USD MILLION) 43

TABLE 7 SERVICES: MARKET ESTIMATES & FORECAST, BY REGION, 2020–2027 (USD MILLION) 44

TABLE 8 SOFTWARE: MARKET ESTIMATES & FORECAST, BY REGION, 2020–2027 (USD MILLION) 44

TABLE 9 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL 2020–2027 (USD MILLION) 46

TABLE 10 ON-PREMISE: MARKET ESTIMATES & FORECAST, BY REGION, 2020–2027 (USD MILLION) 47

TABLE 11 CLOUD BASED: MARKET ESTIMATES & FORECAST, BY REGION, 2020–2027 (USD MILLION) 47

TABLE 12 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION 2020–2027 (USD MILLION) 49

TABLE 13 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE 2020–2027 (USD MILLION) 49

TABLE 14 INSURANCE CLAIMS REVIEW: MARKET ESTIMATES & FORECAST, BY REGION, 2020–2027 (USD MILLION) 50

TABLE 15 PAYMENT INTEGRITY: MARKET ESTIMATES & FORECAST, BY REGION, 2020–2027 (USD MILLION) 51

TABLE 16 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY END USER 2020–2027 (USD MILLION) 53

TABLE 17 PRIVATE INSURANCE PAYERS: MARKET ESTIMATES & FORECAST, BY REGION, 2020–2027 (USD MILLION) 54

TABLE 18 PUBLIC/GOVERNMENT AGENCIES: MARKET ESTIMATES & FORECAST, BY REGION, 2020–2027 (USD MILLION) 54

TABLE 19 THIRD PARTY SERVICE PROVIDERS: MARKET ESTIMATES & FORECAST, BY REGION, 2020-2027 (USD MILLION) 55

TABLE 20 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY REGION, 2020–2027 (USD MILLION) 57

TABLE 21 AMERICAS: HEALTHCARE FRAUD DETECTION MARKET, BY REGION, 2020–2027 (USD MILLION) 58

TABLE 22 AMERICAS: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 59

TABLE 23 AMERICAS: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 59

TABLE 24 AMERICAS: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 59

TABLE 25 AMERICAS: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 60

TABLE 26 AMERICAS: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 60

TABLE 27 AMERICAS: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 60

TABLE 28 NORTH AMERICA: HEALTHCARE FRAUD DETECTION MARKET, BY COUNTRY, 2020–2027 (USD MILLION) 61

TABLE 29 NORTH AMERICA: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 61

TABLE 30 NORTH AMERICA: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 62

TABLE 31 NORTH AMERICA: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 62

TABLE 32 NORTH AMERICA: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 62

TABLE 33 NORTH AMERICA: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 63

TABLE 34 NORTH AMERICA: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 63

TABLE 35 US: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 64

TABLE 36 US: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 64

TABLE 37 US: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 64

TABLE 38 US: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 65

TABLE 39 US: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 65

TABLE 40 US: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 66

TABLE 41 CANADA: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 66

TABLE 42 CANADA: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 67

TABLE 43 CANADA: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 67

TABLE 44 CANADA: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 67

TABLE 45 CANADA: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 68

TABLE 46 CANADA: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 68

TABLE 47 SOUTH AMERICA: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 69

TABLE 48 SOUTH AMERICA: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 69

TABLE 49 SOUTH AMERICA: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 69

TABLE 50 SOUTH AMERICA: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 70

TABLE 51 SOUTH AMERICA: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 70

TABLE 52 SOUTH AMERICA: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 71

TABLE 53 EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY REGION, 2020-2027 (USD MILLION) 72

TABLE 54 EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 73

TABLE 55 EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 73

TABLE 56 EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 73

TABLE 57 EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 74

TABLE 58 EUROPE: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 74

TABLE 59 EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 74

TABLE 60 WESTERN EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY COUNTRY, 2020–2027 (USD MILLION) 75

TABLE 61 WESTERN EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 75

TABLE 62 WESTERN EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 76

TABLE 63 WESTERN EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 76

TABLE 64 WESTERN EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 76

TABLE 65 WESTERN EUROPE: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 77

TABLE 66 WESTERN EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 77

TABLE 67 GERMANY: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 78

TABLE 68 GERMANY: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 78

TABLE 69 GERMANY: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 78

TABLE 70 GERMANY: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 79

TABLE 71 GERMANY: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 79

TABLE 72 GERMANY: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 80

TABLE 73 UK: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 80

TABLE 74 UK: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 81

TABLE 75 UK: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 81

TABLE 76 UK: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 81

TABLE 77 UK: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 82

TABLE 78 UK: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 82

TABLE 79 FRANCE: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 83

TABLE 80 FRANCE: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 83

TABLE 81 FRANCE: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 83

TABLE 82 FRANCE: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 84

TABLE 83 FRANCE: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 84

TABLE 84 FRANCE: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 84

TABLE 85 ITALY: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 85

TABLE 86 ITALY: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 85

TABLE 87 ITALY: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 86

TABLE 88 ITALY: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 86

TABLE 89 ITALY: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 86

TABLE 90 ITALY: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 87

TABLE 91 SPAIN: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 87

TABLE 92 SPAIN: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 88

TABLE 93 SPAIN: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 88

TABLE 94 SPAIN: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 88

TABLE 95 SPAIN: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 89

TABLE 96 SPAIN: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 89

TABLE 97 REST OF WESTERN EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 90

TABLE 98 REST OF WESTERN EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 90

TABLE 99 REST OF WESTERN EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 90

TABLE 100 REST OF WESTERN EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 91

TABLE 101 REST OF WESTERN EUROPE: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 91

TABLE 102 REST OF WESTERN EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 92

TABLE 103 EASTERN EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 92

TABLE 104 EASTERN EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 93

TABLE 105 EASTERN EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 93

TABLE 106 EASTERN EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 93

TABLE 107 EASTERN EUROPE: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 94

TABLE 108 EASTERN EUROPE: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 94

TABLE 109 ASIA-PACIFIC: HEALTHCARE FRAUD DETECTION MARKET, BY COUNTRY, 2020–2027 (USD MILLION) 95

TABLE 110 ASIA-PACIFIC: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 96

TABLE 111 ASIA-PACIFIC: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 96

TABLE 112 ASIA-PACIFIC: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 96

TABLE 113 ASIA-PACIFIC: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 97

TABLE 114 ASIA-PACIFIC: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 97

TABLE 115 ASIA-PACIFIC: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 98

TABLE 116 JAPAN: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 98

TABLE 117 JAPAN: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 99

TABLE 118 JAPAN: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 99

TABLE 119 JAPAN: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 99

TABLE 120 JAPAN: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 100

TABLE 121 JAPAN: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 100

TABLE 122 CHINA: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 101

TABLE 123 CHINA: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 101

TABLE 124 CHINA: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 101

TABLE 125 CHINA: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 102

TABLE 126 CHINA: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 102

TABLE 127 CHINA: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 103

TABLE 128 INDIA: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 103

TABLE 129 INDIA: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 104

TABLE 130 INDIA: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 104

TABLE 131 INDIA: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 104

TABLE 132 INDIA: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 105

TABLE 133 INDIA: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 105

TABLE 134 AUSTRALIA: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 106

TABLE 135 AUSTRALIA: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 106

TABLE 136 AUSTRALIA: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 106

TABLE 137 AUSTRALIA: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 107

TABLE 138 AUSTRALIA: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 107

TABLE 139 AUSTRALIA: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 108

TABLE 140 SOUTH KOREA: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 108

TABLE 141 SOUTH KOREA: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 109

TABLE 142 SOUTH KOREA: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 109

TABLE 143 SOUTH KOREA: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 109

TABLE 144 SOUTH KOREA: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 110

TABLE 145 SOUTH KOREA: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 110

TABLE 146 REST OF ASIA PACIFIC: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 111

TABLE 147 REST OF ASIA PACIFIC: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 111

TABLE 148 REST OF ASIA PACIFIC: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 111

TABLE 149 REST OF ASIA PACIFIC: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 112

TABLE 150 REST OF ASIA PACIFIC: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 112

TABLE 151 REST OF ASIA PACIFIC: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 113

TABLE 152 MIDDLE EAST & AFRICA: HEALTHCARE FRAUD DETECTION MARKET, BY REGION, 2020–2027 (USD MILLION) 114

TABLE 153 MIDDLE EAST & AFRICA: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 115

TABLE 154 MIDDLE EAST & AFRICA: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 115

TABLE 155 MIDDLE EAST & AFRICA: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 115

TABLE 156 MIDDLE EAST & AFRICA: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 116

TABLE 157 MIDDLE EAST & AFRICA: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 116

TABLE 158 MIDDLE EAST & AFRICA: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 117

TABLE 159 MIDDLE EAST: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 117

TABLE 160 MIDDLE EAST: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 118

TABLE 161 MIDDLE EAST: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 118

TABLE 162 MIDDLE EAST: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 118

TABLE 163 MIDDLE EAST: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 119

TABLE 164 MIDDLE EAST: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 119

TABLE 165 AFRICA: HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020–2027 (USD MILLION) 120

TABLE 166 AFRICA: HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020–2027 (USD MILLION) 120

TABLE 167 AFRICA: HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020–2027 (USD MILLION) 120

TABLE 168 AFRICA: HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020–2027 (USD MILLION) 121

TABLE 169 AFRICA: HEALTHCARE FRAUD DETECTION MARKET, FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2020–2027 (USD MILLION) 121

TABLE 170 AFRICA: HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020–2027 (USD MILLION) 122

TABLE 171 MAJOR MANUFACTURERS IN THE GLOBAL HEALTHCARE FRAUD DETECTION MARKET 123

TABLE 172 IBM PRODUCTS/SERVICES OFFERED 127

TABLE 173 IBM: KEY DEVELOPMENTS 127

TABLE 174 UHG: PRODUCTS OFFERED 130

TABLE 175 OPTUM: KEY DEVELOPMENTS 130

TABLE 176 SAS: PRODUCTS/SERVICES OFFERED 133

TABLE 177 SAS: KEY DEVELOPMENTS 133

TABLE 178 FICO: PRODUCTS/SERVICES OFFERED 136

TABLE 179 FICO: KEY DEVELOPMENTS 136

TABLE 180 MCKESSON: PRODUCTS/SERVICES OFFERED 139

TABLE 181 MCKESSON: KEY DEVELOPMENTS 139

TABLE 182 EXL: PRODUCTS/SERVICES OFFERED 142

TABLE 183 EXL: KEY DEVELOPMENTS 142

TABLE 184 DXC COMPANY: PRODUCTS/SERVICES OFFERED 145

TABLE 185 DXC :KEY DEVELOPMENTS 145

TABLE 186 LEXISNEXIS: PRODUCTS/SERVICES OFFERED 148

TABLE 187 LEXISNEXIS: KEY DEVELOPMENTS 148

TABLE 188 COTIVITI, INC.: PRODUCTS/SERVICES OFFERED 150

TABLE 189 COTIVITI, INC.: KEY DEVELOPMENTS 150

TABLE 190 WIPRO LIMITED: PRODUCTS/SERVICES OFFERED 153

TABLE 191 WIPRO LIMITED: KEY DEVELOPMENTS 154

TABLE 192 CGI INC.: PRODUCTS/SERVICES OFFERED 157

TABLE 193 CGI INC.: KEY DEVELOPMENTS 157

 

16 List Of Figures

FIGURE 1 MARKET SYNOPSIS 18

FIGURE 2 GLOBAL HEALTHCARE FRAUD DETECTION MARKET ANALYSIS, BY TYPE 19

FIGURE 3 GLOBAL HEALTHCARE FRAUD DETECTION MARKET ANALYSIS, BY COMPONENT 20

FIGURE 4 GLOBAL HEALTHCARE FRAUD DETECTION MARKET ANALYSIS, BY DELIVERY MODEL 21

FIGURE 5 GLOBAL HEALTHCARE FRAUD DETECTION MARKET ANALYSIS, BY APPLICATION 22

FIGURE 6 GLOBAL HEALTHCARE FRAUD DETECTION MARKET ANALYSIS, BY END USER 23

FIGURE 7 GLOBAL HEALTHCARE FRAUD DETECTION MARKET: STRUCTURE 25

FIGURE 8 RESEARCH PROCESS 26

FIGURE 9 TOP-DOWN & BOTTOM-UP APPROACHES 29

FIGURE 10 MARKET DYNAMICS: ANALYSIS OF THE GLOBAL HEALTHCARE FRAUD DETECTION MARKET 31

FIGURE 11 VALUE CHAIN: GLOBAL HEALTHCARE FRAUD DETECTION MARKET 34

FIGURE 12 PORTER’S FIVE FORCES ANALYSIS: GLOBAL HEALTHCARE FRAUD DETECTION MARKET 36

FIGURE 13 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020 (% SHARE) 38

FIGURE 14 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY TYPE, 2020 AND 2027 (USD MILLION) 39

FIGURE 15 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020 (% SHARE) 42

FIGURE 16 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY COMPONENT, 2020 AND 2027 (USD MILLION) 43

FIGURE 17 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020 (% SHARE) 45

FIGURE 18 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY DELIVERY MODEL, 2020 AND 2027 (USD MILLION) 46

FIGURE 19 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020 (% SHARE) 48

FIGURE 20 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY APPLICATION, 2020 AND 2027 (USD MILLION) 50

FIGURE 21 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020 (% SHARE) 52

FIGURE 22 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY END USER, 2020 AND 2027 (USD MILLION) 53

FIGURE 23 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY REGION, 2020 AND 2027 (USD MILLION) 56

FIGURE 24 GLOBAL HEALTHCARE FRAUD DETECTION MARKET, BY REGION, 2020 (% SHARE) 57

FIGURE 25 AMERICAS: HEALTHCARE FRAUD DETECTION MARKET SHARE, BY REGION, 2020 (% SHARE) 58

FIGURE 26 EUROPE: HEALTHCARE FRAUD DETECTION MARKET SHARE, BY REGION, 2020 (% SHARE) 72

FIGURE 27 ASIA-PACIFIC: HEALTHCARE FRAUD DETECTION MARKET SHARE, BY COUNTRY, 2020 (% SHARE) 95

FIGURE 28 MIDDLE EAST & AFRICA: HEALTHCARE FRAUD DETECTION MARKET SHARE, BY REGION, 2020 (% SHARE) 114

FIGURE 29 IBM FINANCIAL OVERVIEW SNAPSHOT 126

FIGURE 30 IBM: SWOT ANALYSIS 128

FIGURE 31 UHG: FINANCIAL OVERVIEW SNAPSHOT 129

FIGURE 32 UHG: SWOT ANALYSIS 131

FIGURE 33 SAS: FINANCIAL OVERVIEW SNAPSHOT 132

FIGURE 34 SAS: SWOT ANALYSIS 134

FIGURE 35 FICO: FINANCIAL OVERVIEW SNAPSHOT 135

FIGURE 36 FICO: SWOT ANALYSIS 137

FIGURE 37 MCKESSON: FINANCIAL OVERVIEW SNAPSHOT 138

FIGURE 38 MCKESSON: SWOT ANALYSIS 140

FIGURE 39 EXL: FINANCIAL OVERVIEW SNAPSHOT 141

FIGURE 40 EXL: SWOT ANALYSIS 143

FIGURE 41 DXC: FINANCIAL OVERVIEW SNAPSHOT 144

FIGURE 42 DXC: SWOT ANALYSIS 146

FIGURE 43 RELX: FINANCIAL OVERVIEW SNAPSHOT 147

FIGURE 44 LEXISNEXIS COMPANY: SWOT ANALYSIS 149

FIGURE 45 COTIVITI, INC.: SWOT ANALYSIS 151

FIGURE 46 WIPRO LIMITED: FINANCIAL OVERVIEW SNAPSHOT 153

FIGURE 47 WIPRO LIMITED: SWOT ANALYSIS 154

FIGURE 48 CGI INC.: FINANCIAL OVERVIEW SNAPSHOT 156

FIGURE 49 CGI INC.: SWOT ANALYSIS 158

Healthcare Fraud Detection Market

Global Healthcare Fraud Detection Market can attain a strong valuation of USD 18,300.31 Million by 2030 at 29.50%.

Segmentation

By Type Descriptive Analytics Predictive Analytics Prescriptive Analytics
By Component Services Software
By Delivery Model On Premise Cloud Based
By Application Insurance Claims Review Payment Integrity
By End User Private Insurance Payers Public/Government Agencies Third Party Service Providers

Key Players

  • DXC Technology Company
  • UNITEDHEALTH group
  • SAS Institute Inc.
  • WIPRO LIMITED
  • EXLSERVICE Holdings Inc.
  • International Business Machines Corporation (IBM)
  • COTIVITI INC.
  • McKesson Corporation
  • CGI INC
  • FAIR ISAAC Corporation
  • LEXISNEXIS

Drivers

  • Healthcare Insurance
  • Rise in fraudulent events in healthcare industry
  • Rising adoption of cloud-based analytical solutions
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Healthcare Fraud Detection Market Overview

Market Research Future (MRFR) evaluates that the Global Healthcare Fraud Detection Market can attain a strong valuation of USD 18,300.31 Million by 2030.


COVID-19 Analysis


Following the COVID-19 outbreak, healthcare IT has been at the epicentre of a host of challenges posed by the pandemic worldwide. Virtual care and data technologies along with healthcare IT systems such as digitalization, analytical technologies and more have backed the healthcare IT market during the novel coronavirus outbreak. Healthcare fraud detection solutions have been observing a higher demand since the lockdown, given the rising need for solutions that have biometric sensors to identify frauds. The alarming surge in unauthorized payments and other threats following the SARS-CoV-2 pandemic has also bolstered the demand for healthcare fraud detection services and solutions.


Market Dynamics


Drivers


Expanding Patient Pool Opting for Healthcare Insurance to Benefit the Market


Burgeoning patient pool opting for health care insurance, alarming rise in fraudulent events in the healthcare industry, and the rising pressure to track abuse and fraud in healthcare are some of the top growth boosters in the global market.


A few other encouraging factors include the growing number of healthcare BPO, introduction of cutting edge fraud identity management software, rising adoption of cloud-based analytical solutions and social media’s significant influence on the healthcare industry. The surging integration of artificial intelligence (AI) in healthcare solutions and services could also work in the favor of the global healthcare fraud detection market.


Opportunities


Developing Countries to Provide Attractive Opportunities


Supportive initiatives taken up by governments to bolster the healthcare IT industry could be an attractive opportunity for healthcare fraud detection firms in the coming years. The surge in funding for the implementation of several IT platforms in the healthcare industry will create a host of growth avenues for the leading vendors during the evaluation period.


Restraints


Low Awareness Level in Emerging Countries to be a Restraint


Lower awareness level regarding healthcare fraud analytics solutions in emerging countries is expected to restrain the market growth in the near future.


Challenges


Reluctance among Companies to Challenge Market Growth


Dearth of skilled professionals to deal with the healthcare fraud detection technology, and the companies unwilling to adopt new technologies could be key challenges surrounding the global industry.


Cumulative Growth Analysis


Market Share Set to Thrive at a Strong Rate


MRFR believes that the Healthcare Fraud Detection Market can soar at a significant rate of 28.83% during the forecast period from 2019 to 2024, in view of the surge in fraudulent events within the healthcare industry and the expanding pool of patients taking up healthcare insurance.


Segment Overview


Descriptive Analytics Type Captures the Highest Share


Various types of healthcare fraud detection solutions in the market are predictive analytics, prescriptive analytics and descriptive analytics. Between these, the descriptive analytics segment owns the biggest share in the global market as these types facilitate efficient application of prescriptive or predictive analytics.


Software Segment to be in the Lead


Key components covered in the report are software and services. The healthcare fraud detection software market is growing at a stable rate thanks to the emergence of technically advanced software and the resultant surge in their demand.


Insurance Claims Review Segment Seizes the Biggest Share


The main applications of healthcare fraud detection solutions are insurance claims review as well as payment integrity. In the lead is the insurance claims review segment, with the biggest share in the healthcare fraud analytics market due to the soaring number of people opting for health insurance, surge in fraudulent claims, and the escalating uptake of prepayment review model among patients.


Public/Government Agencies Segment to Secure the Lead


Public/government agencies, third-party service providers and private insurance payers are the key end-users listed in the report. Public/government agencies are expected to be the top market end-users in the coming years.


Regional Analysis


America to Emerge as the Most Lucrative Market


The Americas, 2018, took the lead with the biggest share of 49.97% in the global industry. Americas has emerged as a lucrative market, in view of the rising use of technically innovative products, supportive reimbursement policies, and the rising spending on healthcare analytical services. An expansive pool of world-renowned players that offer an extensive range of healthcare fraud detection solutions also bolsters the market share in the region.


Europe Secures the Second Position


Europe has landed the second spot in the medical fraud detection management system market, thanks to the surging adoption of cloud-based analytic solutions, social media’s rising influence on the healthcare sector, and the growing integration of artificial intelligence in various healthcare solutions and services.


APAC to Procure a Significant Growth Rate


The Asia Pacific healthcare fraud detection market size is expanding on the back of the soaring number of government anti-fraud initiatives, growing need to cut down healthcare costs, technological advances, and increasing service and product availability. Rising threats in the region, especially in India and China, has boosted the focus of major companies on developing advanced healthcare fraud prevention services, which helps foster market growth. Moreover, growing popularity of medical tourism and rising demand in the pharmaceutical industry can emerge as key healthcare fraud detection market trends in the region.


Competitive Landscape


Competition Rises as Major Companies Focus on Technical Advances


Technological innovations and launch of new solutions and services are some of the major parameters leading to intense competition in the fraud in healthcare industry. Many of the companies are focused on bolstering their portfolio of medical fraud prevention solutions, while also adopting strategies like partnerships, acquisitions, and mergers to stay competitive.


Optum is a well-renowned brand in the healthcare fraud detection software market, with its Optum Program Integrity Solutions delivering insightful intelligence. The system helps generate information that assists end-users in preventing inappropriate payments, identify suspicious activity, and boost recoveries. The company has made a huge name in the healthcare fraud analytics market, offering advanced solutions that are designed primarily for Medicaid in the US.


List of Key Companies Covered in this Report



  • DXC Technology Company

  • UNITEDHEALTH group

  • SAS Institute Inc.

  • WIPRO LIMITED

  • EXLSERVICE Holdings Inc.

  • International Business Machines Corporation (IBM)

  • COTIVITI INC.

  • McKesson Corporation

  • CGI INC

  • FAIR ISAAC Corporation and LEXISNEXIS


Recent Developments



  • October 2020 – Fiserv has launched an intelligent fraud detection system, Advance Defense that caters to card issuers for reducing losses while bolstering cardholder spend for a complete set of card types.



  • November 2020 – LexisNexis Risk Solutions released LexisNexis Emailage, an innovative fraud risk scoring service backed by email intelligence, which enables companies deliver a smooth user experience with extensive fraud detection as well as prevention capacity. The solution helps address these issues by letting organizations effectively analyze risks, facilitate faster transactions and efficiently tackle quickly evolving fraud tactics during digital transactions.


Report Overview


Scope of the Report


Healthcare fraud detection software market, healthcare fraud detection market trends, healthcare fraud detection market size, healthcare and fraud solutions, healthcare fraud detection solutions, medical fraud detection management system market are some of the top parameters considered in the scope of the report. MRFR report extensively covers the global healthcare fraud detection market, with respect to type, component, delivery model, application and regions.               


Segmentation Table


By Type



  • Descriptive Analytics

  • Predictive Analytics

  • Prescriptive Analytics


Global Healthcare Fraud Detection Market, By Component         



  • Services

  • Software


Global Healthcare Fraud Detection Market, By Delivery Model



  • On-Premise

  • Cloud-Based


Global Healthcare Fraud Detection Market, By Application



  • Insurance Claims Review

  • Payment Integrity


Global Healthcare Fraud Detection Market, By End User



  • Private Insurance Payers

  • Public/Government Agencies

  • Third-Party Service Providers



Report Scope:

Report Attribute/Metric Details
  Market Size   USD 18,300.31 Million
  CAGR   29.50%
  Base Year   2016
  Forecast Period   2030
  Historical Data   2015
  Forecast Units   Value (USD Million)
  Report Coverage   Revenue Forecast, Competitive Landscape, Growth Factors, and Trends
  Segments Covered   Type, Component, Delivery Model, Application, End User
  Geographies Covered   North America, Europe, Asia-Pacific, and Rest of the World (RoW)
  Key Vendors   DXC Technology Company, UNITEDHEALTH group, SAS Institute Inc., WIPRO LIMITED, EXLSERVICE Holdings Inc., International Business Machines Corporation (IBM), COTIVITI INC., McKesson Corporation, CGI INC, FAIR ISAAC Corporation and LEXISNEXIS
  Key Market Opportunities

  • Supportive initiatives taken up by governments
  • Surge in funding for the implementation of several IT platforms
  •   Key Market Drivers

  • Healthcare Insurance
  • Rise in fraudulent events in healthcare industry
  • Rising adoption of cloud-based analytical solutions


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    Frequently Asked Questions (FAQ) :

    Healthcare Fraud Detection Market is predicted to touch USD 18,300.31 million by 2030.

    Healthcare Fraud Detection Market is projected to grow at a 29.50% CAGR between 2020-2030.

    Americas is projected to dominate in the Healthcare Fraud Detection Market.

    It finds extensive applications in Payment Integrity and Insurance Claims Review.

    Unwillingness of various end users to use Healthcare Fraud analytics systems may deter market growth.