Table of Content

"1    INTRODUCTION    22
1.1    OBJECTIVES OF THE STUDY    22
1.2    MARKET DEFINITION & SCOPE    22
1.2.1    INCLUSIONS & EXCLUSIONS OF THE STUDY    23
1.2.2    MARKET SEGMENTATION    24
FIGURE 1    HEALTHCARE FRAUD ANALYTICS MARKET SEGMENTATION    24
1.2.3    YEARS CONSIDERED FOR THE STUDY    24
1.3    CURRENCY    25
TABLE 1    EXCHANGE RATES UTILIZED FOR CONVERSION TO USD    25
1.4    LIMITATIONS    25
1.5    STAKEHOLDERS    25
2    RESEARCH METHODOLOGY    26
2.1    RESEARCH APPROACH    26
FIGURE 2    RESEARCH DESIGN    26
2.1.1    SECONDARY SOURCES    27
2.1.1.1    Key data from secondary sources    28
2.1.2    PRIMARY SOURCES    28
TABLE 2    LIST OF STAKEHOLDERS INTERVIEWED FOR THE STUDY    28
2.1.2.1    Key data from primary sources    29
FIGURE 3    BREAKDOWN OF PRIMARY INTERVIEWS: BY COMPANY TYPE, DESIGNATION, AND REGION    29
2.2    MARKET SIZE ESTIMATION    30
2.3    MARKET BREAKDOWN AND DATA TRIANGULATION    32
FIGURE 4    DATA TRIANGULATION METHODOLOGY    32
2.4    ASSUMPTIONS FOR THE STUDY    33
3    EXECUTIVE SUMMARY    34
FIGURE 5    HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2021 VS. 2026 (USD MILLION)    34
FIGURE 6    HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL,
2021 VS. 2026 (USD MILLION)    35
FIGURE 7    HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2021 VS. 2026 (USD MILLION)    35
FIGURE 8    HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2021 VS. 2026 (USD MILLION)    36
FIGURE 9    GEOGRAPHICAL SNAPSHOT OF THE HEALTHCARE FRAUD ANALYTICS MARKET    37

4    PREMIUM INSIGHTS    38
4.1    HEALTHCARE FRAUD ANALYTICS MARKET OVERVIEW    38
FIGURE 10    LARGE NUMBER OF FRAUDULENT ACTIVITIES IN HEALTHCARE TO DRIVE MARKET GROWTH    38
4.2    ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE AND COUNTRY    39
FIGURE 11    DESCRIPTIVE ANALYTICS SEGMENT ACCOUNTED FOR THE LARGEST SHARE OF THE ASIAN HEALTHCARE FRAUD ANALYTICS MARKET IN 2020    39
4.3    HEALTHCARE FRAUD ANALYTICS MARKET: GEOGRAPHIC GROWTH OPPORTUNITIES    40
FIGURE 12    US TO REGISTER THE HIGHEST REVENUE GROWTH DURING FORECAST PERIOD    40
4.4    HEALTHCARE FRAUD ANALYTICS MARKET: REGIONAL MIX    40
FIGURE 13    NORTH AMERICA WILL CONTINUE TO DOMINATE THE MARKET IN 2026    40
4.5    HEALTHCARE FRAUD ANALYTICS MARKET: DEVELOPING VS. DEVELOPED REGIONS    41
FIGURE 14    DEVELOPED MARKETS TO REGISTER HIGHER GROWTH DURING FORECAST PERIOD    41
5    MARKET OVERVIEW    42
5.1    INTRODUCTION    42
5.2    MARKET DYNAMICS    42
FIGURE 15    HEALTHCARE FRAUD ANALYTICS MARKET: DRIVERS, RESTRAINTS, OPPORTUNITIES, AND CHALLENGES    42
5.2.1    DRIVERS    43
5.2.1.1    Large number of fraudulent activities in healthcare    43
FIGURE 16    US NATIONAL HEALTHCARE FRAUD AND OPIOID TAKEDOWN TRENDS    43
FIGURE 17    INCIDENCE OF FRAUDULENT CLAIMS—GLOBAL SCENARIO (2019)    44
5.2.1.2    Increased number of patients seeking health insurance    44
5.2.1.3    Prepayment review model    45
5.2.1.4    High returns on investment    45
5.2.1.5    Rise in pharmacy claims-related fraud    45
5.2.2    RESTRAINTS    45
5.2.2.1    Limitations in the data capturing process in Medicaid services    45
5.2.3    OPPORTUNITIES    46
5.2.3.1    Adoption of healthcare fraud analytics in developing countries    46
5.2.3.2    Emergence of social media and its impact on the healthcare industry    46
5.2.3.3    Role of AI in healthcare fraud detection    46
5.2.4    CHALLENGES    47
5.2.4.1    Dearth of skilled personnel    47
5.2.4.2    Time-consuming deployment and the need for frequent upgrades    47
6    INDUSTRY INSIGHTS    48
6.1    INDUSTRY TRENDS    48
6.1.1    SHIFTING FOCUS FROM ON-PREMISE MODELS TO CLOUD-BASED ON-DEMAND MODELS    48
6.1.2    MERGERS AND ACQUISITIONS: THE MOST ADOPTED STRATEGY    48
FIGURE 18    MAJOR MERGERS AND ACQUISITIONS IN THE HEALTHCARE FRAUD ANALYTICS MARKET    48
6.1.3    TECHNOLOGICAL ADVANCEMENTS    49
TABLE 3    COMPANIES OFFERING INNOVATIVE FRAUD ANALYTICS SOLUTIONS    49
6.1.4    NEW USE CASE: OPIOID EPIDEMIC CRISIS    50
6.1.5    END-USER TRENDS: ADOPTION OF HEALTHCARE FRAUD ANALYTICS SOLUTIONS BY PHARMACY BENEFIT MANAGERS    50
7    HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE    51
7.1    INTRODUCTION    52
TABLE 4    HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)    52
7.2    DESCRIPTIVE ANALYTICS    52
7.2.1    DESCRIPTIVE ANALYTICS SEGMENT ACCOUNTED FOR THE LARGEST MARKET SHARE    52
TABLE 5    DESCRIPTIVE ANALYTICS SOLUTIONS FOR HEALTHCARE FRAUD DETECTION    53
TABLE 6    DESCRIPTIVE ANALYTICS MARKET, BY REGION, 2019–2026 (USD MILLION)    53
TABLE 7    DESCRIPTIVE ANALYTICS MARKET, BY COUNTRY, 2019–2026 (USD MILLION)    54
7.3    PREDICTIVE ANALYTICS    54
7.3.1    PREDICTIVE ANALYTICS HELPS IN SIMULATING FUTURE EVENTS AND TRENDS THAT CAN ENABLE PAYERS TO PREDICT PREVENTABLE EVENTS    54
TABLE 8    PREDICTIVE ANALYTICS SOLUTIONS FOR HEALTHCARE FRAUD DETECTION    55
TABLE 9    PREDICTIVE ANALYTICS MARKET, BY REGION, 2019–2026 (USD MILLION)    55
TABLE 10    PREDICTIVE ANALYTICS MARKET, BY COUNTRY, 2019–2026 (USD MILLION)    56
7.4    PRESCRIPTIVE ANALYTICS    56
7.4.1    PRESCRIPTIVE MODELS OFFER ADDITIONAL ADVANTAGES RELATING TO THE INVESTIGATION OF SUSPICIOUS BEHAVIOR TO GENERATE COMPREHENSIVE INSIGHTS    56
TABLE 11    PRESCRIPTIVE ANALYTICS SOLUTIONS FOR HEALTHCARE FRAUD DETECTION    57
TABLE 12    PRESCRIPTIVE ANALYTICS MARKET, BY REGION, 2019–2026 (USD MILLION)    57
TABLE 13    PRESCRIPTIVE ANALYTICS MARKET, BY COUNTRY, 2019–2026 (USD MILLION)    57
8    HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL    58
8.1    INTRODUCTION    59
TABLE 14    HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL,
2019–2026 (USD MILLION)    59
8.2    ON-PREMISE DELIVERY MODELS    59
8.2.1    ON-PREMISE MODELS ACCOUNT FOR THE LARGEST SHARE OF THE MARKET    59
TABLE 15    KEY VENDORS OFFERING ON-PREMISE SOLUTIONS IN THE MARKET    60
TABLE 16    HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-PREMISE DELIVERY MODEL, BY REGION, 2019–2026 (USD MILLION)    60
TABLE 17    HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-PREMISE DELIVERY MODEL, BY COUNTRY, 2019–2026 (USD MILLION)    61

8.3    ON-DEMAND DELIVERY MODELS    61
8.3.1    CLOUD-BASED DELIVERY MODELS OFFER ORGANIZATIONS INCREASED SCALABILITY AND SPEED    61
TABLE 18    KEY VENDORS PROVIDING ON-DEMAND SOLUTIONS    62
TABLE 19    HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-DEMAND DELIVERY MODEL, BY REGION, 2019–2026 (USD MILLION)    62
TABLE 20    HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-DEMAND DELIVERY MODEL, BY COUNTRY, 2019–2026 (USD MILLION)    63
9    HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION    64
9.1    INTRODUCTION    65
TABLE 21    HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)    65
9.2    INSURANCE CLAIMS REVIEW    65
TABLE 22    DEPLOYMENT OF PREPAYMENT VS. POSTPAYMENT ANALYTICS SYSTEMS    66
TABLE 23    HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)    66
TABLE 24    HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY REGION, 2019–2026 (USD MILLION)    66
TABLE 25    HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY COUNTRY, 2019–2026 (USD MILLION)    67
9.2.1    POSTPAYMENT REVIEW    67
9.2.1.1    Postpayment review dominates the healthcare fraud analytics insurance claims review market    67
TABLE 26    HEALTHCARE FRAUD ANALYTICS MARKET FOR POSTPAYMENT CLAIMS REVIEW, BY REGION, 2019–2026 (USD MILLION)    68
TABLE 27    HEALTHCARE FRAUD ANALYTICS MARKET FOR POSTPAYMENT CLAIMS REVIEW, BY COUNTRY, 2019–2026 (USD MILLION)    68
9.2.2    PREPAYMENT REVIEW    69
9.2.2.1    The majority of prepayment models use predictive analytics to detect fraud and stop fraudulent claims payments    69
TABLE 28    HEALTHCARE FRAUD ANALYTICS MARKET FOR PREPAYMENT CLAIMS REVIEW, BY REGION, 2019–2026 (USD MILLION)    69
TABLE 29    HEALTHCARE FRAUD ANALYTICS MARKET FOR PREPAYMENT CLAIMS REVIEW, BY COUNTRY, 2019–2026 (USD MILLION)    70
9.3    PHARMACY BILLING MISUSE    70
9.3.1    FRAUD, WASTE, AND ABUSE CASES IN PHARMACY AND PRESCRIPTION DRUG AREAS TO DRIVE THE DEMAND FOR ANALYTICS    70
TABLE 30    HEALTHCARE FRAUD ANALYTICS MARKET FOR PHARMACY BILLING MISUSE APPLICATION, BY REGION, 2019–2026 (USD MILLION)    71
TABLE 31    HEALTHCARE FRAUD ANALYTICS MARKET FOR PHARMACY BILLING MISUSE APPLICATION, BY COUNTRY, 2019–2026 (USD MILLION)    71
9.4    PAYMENT INTEGRITY    72
9.4.1    CHANGES IN REGULATORY GUIDELINES HAVE AIDED THE ADOPTION OF PAYMENT INTEGRITY SOFTWARE    72
TABLE 32    HEALTHCARE FRAUD ANALYTICS MARKET FOR PAYMENT INTEGRITY APPLICATION, BY REGION, 2019–2026 (USD MILLION)    72
TABLE 33    HEALTHCARE FRAUD ANALYTICS MARKET FOR PAYMENT INTEGRITY APPLICATION, BY COUNTRY, 2019–2026 (USD MILLION)    73
9.5    OTHER APPLICATIONS    73
TABLE 34    HEALTHCARE FRAUD ANALYTICS MARKET FOR OTHER APPLICATION,
BY REGION, 2019–2026 (USD MILLION)    74
TABLE 35    HEALTHCARE FRAUD ANALYTICS MARKET FOR OTHER APPLICATIONS,
BY COUNTRY, 2019–2026 (USD MILLION)    74
10    HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER    75
10.1    INTRODUCTION    76
TABLE 36    HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)    76
10.2    PUBLIC & GOVERNMENT AGENCIES    76
10.2.1    PUBLIC & GOVERNMENT AGENCIES DOMINATE THE HEALTHCARE FRAUD ANALYTICS MARKET    76
TABLE 37    HEALTHCARE FRAUD ANALYTICS MARKET FOR PUBLIC & GOVERNMENT AGENCIES, BY REGION, 2019–2026 (USD MILLION)    77
TABLE 38    HEALTHCARE FRAUD ANALYTICS MARKET FOR PUBLIC & GOVERNMENT AGENCIES, BY COUNTRY, 2019–2026 (USD MILLION)    77
10.3    PRIVATE INSURANCE PAYERS    78
10.3.1    PRIVATE INSURANCE PAYERS ARE FOCUSED ON DEPLOYING ANALYTICS TO COMBAT INCREASING MONETARY LOSSES    78
TABLE 39    HEALTHCARE FRAUD ANALYTICS MARKET FOR PRIVATE INSURANCE PAYERS, BY REGION, 2019–2026 (USD MILLION)    78
TABLE 40    HEALTHCARE FRAUD ANALYTICS MARKET FOR PRIVATE INSURANCE PAYERS, BY COUNTRY, 2019–2026 (USD MILLION)    79
10.4    THIRD-PARTY SERVICE PROVIDERS    79
10.4.1    ADOPTION OF FRAUD ANALYTICS SOLUTIONS BY PUBLIC INSURERS PUTS PRIVATE BODIES AT RISK, DRIVING ATTENTION TOWARD OUTSOURCING    79
TABLE 41    HEALTHCARE FRAUD ANALYTICS MARKET FOR THIRD-PARTY SERVICE PROVIDERS, BY REGION, 2019–2026 (USD MILLION)    80
TABLE 42    HEALTHCARE FRAUD ANALYTICS MARKET FOR THIRD-PARTY SERVICE PROVIDERS, BY COUNTRY, 2019–2026 (USD MILLION)    80
10.5    EMPLOYERS    81
10.5.1    EMPLOYERS ARE CONSIDERING FRAUD ANALYTICS SOLUTIONS AS A STEP TOWARD BETTER COST MANAGEMENT    81
TABLE 43    HEALTHCARE FRAUD ANALYTICS MARKET FOR EMPLOYERS, BY REGION, 2019–2026 (USD MILLION)    81
TABLE 44    HEALTHCARE FRAUD ANALYTICS MARKET FOR EMPLOYERS, BY COUNTRY, 2019–2026 (USD MILLION)    82
11    HEALTHCARE FRAUD ANALYTICS MARKET, BY REGION    83
11.1    INTRODUCTION    84
TABLE 45    HEALTHCARE FRAUD ANALYTICS MARKET, BY REGION,
2019–2026 (USD MILLION)    84
11.2    NORTH AMERICA    84
FIGURE 19    NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET SNAPSHOT    85
TABLE 46    NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY COUNTRY, 2019–2026 (USD MILLION)    85
TABLE 47    NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)    86
TABLE 48    NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)    86
TABLE 49    NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET,
BY APPLICATION, 2019–2026 (USD MILLION)    86
TABLE 50    NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)    87
TABLE 51    NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)    87
11.2.1    US    87
11.2.1.1    US dominates the global healthcare fraud analytics market    87
TABLE 52    US: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL,
2019–2026 (USD MILLION)    88
TABLE 53    US: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)    88
TABLE 54    US: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)    89
TABLE 55    US: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)    89
TABLE 56    US: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)    89
11.2.2    CANADA    90
11.2.2.1    Growing adoption of data-crunching technologies like predictive analytics to drive market growth    90
TABLE 57    CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)    90
TABLE 58    CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)    90
TABLE 59    CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)    91
TABLE 60    CANADA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)    91
TABLE 61    CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)    91
11.3    EUROPE    92
TABLE 62    LIST OF SOME OF THE EHFCN MEMBER ORGANIZATIONS ACROSS EUROPE    92
TABLE 63    EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY COUNTRY,
2019–2026 (USD MILLION)    93
TABLE 64    EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)    93
TABLE 65    EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)    93
TABLE 66    EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)    94
TABLE 67    EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)    94
TABLE 68    EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)    94
11.3.1    GERMANY    95
11.3.1.1    Germany is the fastest-growing market for healthcare fraud analytics solutions in Europe    95
TABLE 69    GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)    95
TABLE 70    GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)    96
TABLE 71    GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)    96
TABLE 72    GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)    96
TABLE 73    GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)    97
11.3.2    UK    97
11.3.2.1    Launch of initiatives such as NHSCFA will support the market for fraud analytics solutions in the UK    97
TABLE 74    UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL,
2019–2026 (USD MILLION)    98
TABLE 75    UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)    98
TABLE 76    UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)    98
TABLE 77    UK: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)    99
TABLE 78    UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)    99
11.3.3    FRANCE    99
11.3.3.1    Increasing adoption of information technology for the detection of healthcare fraud—a key factor driving market growth    99
TABLE 79    FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)    100
TABLE 80    FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)    100
TABLE 81    FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)    100
TABLE 82    FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)    101
TABLE 83    FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)    101
11.3.4    ITALY    101
11.3.4.1    Increasing government support for the adoption of fraud analytics solutions    101
TABLE 84    ITALY: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)    102
TABLE 85    ITALY: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)    102
TABLE 86    ITALY: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)    102
TABLE 87    ITALY: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)    103
TABLE 88    ITALY: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)    103
11.3.5    SPAIN    103
11.3.5.1    Advanced healthcare infrastructure to propel the adoption of innovative technologies like fraud analytics    103
TABLE 89    SPAIN: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)    104
TABLE 90    SPAIN: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)    104
TABLE 91    SPAIN: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)    104
TABLE 92    SPAIN: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)    105
TABLE 93    SPAIN: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)    105
11.3.6    REST OF EUROPE    105
TABLE 94    ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL,
2019–2026 (USD MILLION)    106
TABLE 95    ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)    106
TABLE 96    ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)    106
TABLE 97    ROE: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)    107
TABLE 98    ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)    107
11.4    ASIA    107
FIGURE 20    ASIA PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET SNAPSHOT    108
TABLE 99    ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY COUNTRY,
2019–2026 (USD MILLION)    108
TABLE 100    ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL,
2019–2026 (USD MILLION)    109
TABLE 101    ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)    109
TABLE 102    ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)    109
TABLE 103    ASIA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)    110
TABLE 104    ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)    110
11.4.1    JAPAN    110
11.4.1.1    Increasing fraud cases in medical billing to drive market growth    110
TABLE 105    JAPAN: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)    111
TABLE 106    JAPAN: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)    111
TABLE 107    JAPAN: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)    111
TABLE 108    JAPAN: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)    112
TABLE 109    JAPAN: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)    112
11.4.2    CHINA    112
11.4.2.1    Growing need for advanced healthcare systems for a better outcome to drive the demand for fraud analytics solutions    112
TABLE 110    CHINA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)    113
TABLE 111    CHINA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)    113
TABLE 112    CHINA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)    113
TABLE 113    CHINA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)    114
TABLE 114    CHINA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)    114
11.4.3    ROA    114
11.4.3.1    Increasing initiatives for establishing healthcare IT solutions to support market growth    114
TABLE 115    ROA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL,
2019–2026 (USD MILLION)    115
TABLE 116    ROA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)    115
TABLE 117    ROA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)    115
TABLE 118    ROA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)    116
TABLE 119    ROA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)    116
11.5    PACIFIC    116
11.5.1    GROWING NEED FOR INSURANCE COVERAGES AND MEDICAL CLAIMS TO DRIVE MARKET GROWTH    116
TABLE 120    PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)    117
TABLE 121    PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)    117
TABLE 122    PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)    117
TABLE 123    PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)    118
TABLE 124    PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)    118

11.6    LATIN AMERICA    118
11.6.1    INCREASING PENETRATION OF HEALTH INSURANCE TO DRIVE VOLUME OF CLAIMS PROCESSING IN LATIN AMERICAN COUNTRIES    118
TABLE 125    LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)    118
TABLE 126    LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)    119
TABLE 127    LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)    119
TABLE 128    LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)    119
TABLE 129    LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)    120
11.7    MIDDLE EAST & AFRICA    120
11.7.1    HEALTHCARE FRAUD IS ONE OF THE LEADING CRIMES IN SOUTH AFRICA    120
TABLE 130    MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL,
2019–2026 (USD MILLION)    121
TABLE 131    MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)    121
TABLE 132    MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)    121
TABLE 133    MEA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)    122
TABLE 134    MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)    122
12    COMPETITIVE LANDSCAPE    123
12.1    INTRODUCTION    123
FIGURE 21    KEY DEVELOPMENTS IN THE HEALTHCARE FRAUD ANALYTICS MARKET BETWEEN JANUARY 2018 AND AUGUST 2021    124
12.2    COMPETITIVE SITUATION AND TRENDS    125
12.2.1    DEALS    125
TABLE 135    DEALS, 2018-2021    125
12.3    COMPETITIVE LEADERSHIP MAPPING    126
12.3.1    STARS    126
12.3.2    EMERGING LEADERS    126
12.3.3    PERVASIVE PLAYERS    126
12.3.4    PARTICIPANTS    126
FIGURE 22    HEALTHCARE FRAUD ANALYTICS MARKET: COMPETITIVE LEADERSHIP MAPPING, 2020    127
13    COMPANY PROFILES    128
(Business Overview, Products Offered, Recent Developments, SWOT Analysis, MnM View)*
13.1    KEY PLAYERS    128
13.1.1    IBM CORPORATION    128
TABLE 136    IBM CORPORATION: BUSINESS OVERVIEW    128
FIGURE 23    IBM CORPORATION: COMPANY SNAPSHOT (2020)    129
13.1.2    OPTUM, INC. (A PART OF UNITEDHEALTH GROUP)    131
TABLE 137    OPTUM, INC.: BUSINESS OVERVIEW    131
13.1.3    COTIVITI, INC.    133
TABLE 138    COTIVITI, INC.: BUSINESS OVERVIEW    133
13.1.4    FAIR ISAAC CORPORATION    135
TABLE 139    FAIR ISAAC CORPORATION: BUSINESS OVERVIEW    135
FIGURE 24    FAIR ISAAC CORPORATION: COMPANY SNAPSHOT (2020)    136
13.1.5    SAS INSTITUTE INC.    138
TABLE 140    SAS INSTITUTE INC.: BUSINESS OVERVIEW    138
13.1.6    CHANGE HEALTHCARE    140
TABLE 141    CHANGE HEALTHCARE: BUSINESS OVERVIEW    140
13.1.7    PONDERA SOLUTIONS, INC. (A SUBSIDIARY OF THOMSON REUTERS CORPORATION)    141
TABLE 142    PONDERA SOLUTIONS, INC.: BUSINESS OVERVIEW    141
13.1.8    EXLSERVICE HOLDINGS, INC.    143
TABLE 143    EXLSERVICE HOLDINGS, INC.: BUSINESS OVERVIEW    143
FIGURE 25    EXLSERVICE HOLDINGS, INC.: COMPANY SNAPSHOT (2020)    144
13.1.9    WIPRO LIMITED    146
TABLE 144    WIPRO LIMITED: BUSINESS OVERVIEW    146
FIGURE 26    WIPRO LIMITED: COMPANY SNAPSHOT (2021)    147
13.1.10    CONDUENT INCORPORATED    148
TABLE 145    CONDUENT INCORPORATED: BUSINESS OVERVIEW    148
FIGURE 27    CONDUENT INCORPORATED: COMPANY SNAPSHOT (2020)    149
13.1.11    HCL TECHNOLOGIES LIMITED    150
TABLE 146    HCL TECHNOLOGIES LIMITED.: BUSINESS OVERVIEW    150
FIGURE 28    HCL TECHNOLOGIES LIMITED.: COMPANY SNAPSHOT (2021)    151
13.1.12    CGI INC.    152
TABLE 147    CGI INC.: BUSINESS OVERVIEW    152
FIGURE 29    CGI INC.: COMPANY SNAPSHOT (2020)    153
13.1.13    DXC TECHNOLOGY    154
TABLE 148    DXC TECHNOLOGY COMPANY: BUSINESS OVERVIEW    154
FIGURE 30    DXC TECHNOLOGY COMPANY: COMPANY SNAPSHOT (2021)    155
13.1.14    NORTHROP GRUMMAN CORPORATION    156
TABLE 149    NORTHROP GRUMMAN CORPORATION: BUSINESS OVERVIEW    156
FIGURE 31    NORTHROP GRUMMAN CORPORATION: COMPANY SNAPSHOT (2020)    157
13.1.15    LEXISNEXIS (A PART OF RELX GROUP)    158
TABLE 150    LEXISNEXIS: BUSINESS OVERVIEW    158
FIGURE 32    RELX GROUP: COMPANY SNAPSHOT (2020)    159
13.1.16    QLARANT, INC.    161
TABLE 151    QLARANT, INC.: BUSINESS OVERVIEW    161
13.1.17    H2O.AI    162
TABLE 152    H2O.AI: BUSINESS OVERVIEW    162
13.1.18    MULTIPLAN    163
TABLE 153    MULTIPLAN: BUSINESS OVERVIEW    163
13.1.19    FRISS    164
TABLE 154    FRISS: BUSINESS OVERVIEW    164
13.1.20    OSP LABS    165
TABLE 155    OSP LABS: BUSINESS OVERVIEW    165
13.2    OTHER PLAYERS    166
13.2.1    SHARECARE, INC. (A SUBSIDIARY OF FALCON CAPITAL ACQUISITION CORP.)    166
13.2.2    HEALTHCARE FRAUD SHIELD    166
13.2.3    FRAUDLENS, INC.    167
13.2.4    HMS HOLDINGS CORP.    167
13.2.5    CODOXO    168
*Details on Business Overview, Products Offered, Recent Developments, SWOT Analysis, MnM View might not be captured in case of unlisted companies.
14    APPENDIX    169
14.1    DISCUSSION GUIDE    169
14.2    KNOWLEDGE STORE: MARKETSANDMARKETS’ SUBSCRIPTION PORTAL    173
14.3    AVAILABLE CUSTOMIZATIONS    175
14.4    RELATED REPORTS    175
14.5    AUTHOR DETAILS    176"