List of Figures

FIGURE 1 RESEARCH DESIGN 20
FIGURE 2 BREAKDOWN OF PRIMARY INTERVIEWS: BY COMPANY TYPE, DESIGNATION AND REGION 24
FIGURE 3 DATA TRIANGULATION METHODOLOGY 26
FIGURE 4 HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE 2020 VS. 2025 (USD MILLION) 28
FIGURE 5 HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL 2020 VS. 2025 (USD MILLION) 29
FIGURE 6 HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION 2020 VS. 2025 (USD MILLION) 29
FIGURE 7 HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER 2020 VS. 2025 (USD MILLION) 30
FIGURE 8 GEOGRAPHICAL SNAPSHOT OF THE HEALTHCARE FRAUD ANALYTICS MARKET 31
FIGURE 9 LARGE NUMBER OF FRAUDULENT ACTIVITIES IN HEALTHCARE
TO DRIVE MARKET GROWTH 32
FIGURE 10 DESCRIPTIVE ANALYTICS SEGMENT ACCOUNTED FOR THE LARGEST SHARE OF THE APAC HEALTHCARE FRAUD ANALYTICS MARKET IN 2019 33
FIGURE 11 APAC MARKET TO REGISTER THE HIGHEST GROWTH DURING
THE FORECAST PERIOD 34
FIGURE 12 NORTH AMERICA WILL CONTINUE TO DOMINATE THE MARKET IN 2025 34
FIGURE 13 DEVELOPING REGIONS TO REGISTER HIGHER GROWTH DURING
THE FORECAST PERIOD 35
FIGURE 14 HEALTHCARE FRAUD ANALYTICS MARKET: DRIVERS, RESTRAINTS, OPPORTUNITIES, AND CHALLENGES 36
FIGURE 15 US NATIONAL HEALTHCARE FRAUD AND OPIOID TAKEDOWN TRENDS 37
FIGURE 16 INCIDENCE OF FRAUDULENT CLAIMSGLOBAL SCENARIO (2017) 38
FIGURE 17 MAJOR MERGERS AND ACQUISITIONS IN THE HEALTHCARE FRAUD ANALYTICS MARKET 42
FIGURE 18 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET SNAPSHOT 78
FIGURE 19 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET SNAPSHOT 86
FIGURE 20 ASIA PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET SNAPSHOT 98
FIGURE 21 KEY DEVELOPMENTS IN THE HEALTHCARE FRAUD ANALYTICS MARKET BETWEEN JANUARY 2017 AND DECEMBER 2019 105
FIGURE 22 HEALTHCARE FRAUD ANALYTICS MARKET: COMPETITIVE LEADERSHIP
MAPPING, 2019 109
FIGURE 23 COMPANY SNAPSHOT: IBM 110
FIGURE 24 COMPANY SNAPSHOT: FAIR ISAAC CORPORATION 114
FIGURE 25 COMPANY SNAPSHOT: EXL SERVICE HOLDINGS, INC. 118
FIGURE 26 COMPANY SNAPSHOT: WIPRO LIMITED 120
FIGURE 27 COMPANY SNAPSHOT: CONDUENT, INC. 122
FIGURE 28 COMPANY SNAPSHOT: HCL TECHNOLOGIES 124
FIGURE 29 COMPANY SNAPSHOT: CGI GROUP 126
FIGURE 30 COMPANY SNAPSHOT: DXC TECHNOLOGY COMPANY 128
FIGURE 31 COMPANY SNAPSHOT: NORTHROP GRUMMAN CORPORATION 130
FIGURE 32 COMPANY SNAPSHOT: RELX GROUP 132

 

List of Tables

TABLE 1 LIST OF STAKEHOLDERS INTERVIEWED FOR THE STUDY 22
TABLE 2 COMPANIES OFFERING INNOVATIVE FRAUD ANALYTICS SOLUTIONS 43
TABLE 3 HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE 2018–2025 (USD MILLION) 46
TABLE 4 DESCRIPTIVE ANALYTICS SOLUTIONS FOR HEALTHCARE FRAUD DETECTION 47
TABLE 5 DESCRIPTIVE ANALYTICS MARKET, BY REGION, 2018–2025 (USD MILLION) 47
TABLE 6 DESCRIPTIVE ANALYTICS MARKET, BY COUNTRY, 2018–2025 (USD MILLION) 47
TABLE 7 PREDICTIVE ANALYTICS SOLUTIONS FOR HEALTHCARE FRAUD DETECTION 48
TABLE 8 PREDICTIVE ANALYTICS MARKET, BY REGION, 2018–2025 (USD MILLION) 49
TABLE 9 PREDICTIVE ANALYTICS MARKET, BY COUNTRY, 2018–2025 (USD MILLION) 49
TABLE 10 PRESCRIPTIVE ANALYTICS SOLUTIONS FOR HEALTHCARE FRAUD DETECTION 50
TABLE 11 PRESCRIPTIVE ANALYTICS MARKET, BY REGION, 2018–2025 (USD MILLION) 50
TABLE 12 PRESCRIPTIVE ANALYTICS MARKET, BY COUNTRY, 2018–2025 (USD MILLION) 51
TABLE 13 HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL 2018–2025 (USD MILLION) 53
TABLE 14 KEY VENDORS OFFERING ON-PREMISE SOLUTIONS IN THE MARKET 54
TABLE 15 HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-PREMISE DELIVERY MODELS, BY REGION, 2018–2025 (USD MILLION) 54
TABLE 16 HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-PREMISE DELIVERY MODELS, BY COUNTRY, 2018–2025 (USD MILLION) 55
TABLE 17 KEY VENDORS PROVIDING ON-DEMAND SOLUTIONS 56
TABLE 18 HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-DEMAND DELIVERY MODELS, BY REGION, 2018–2025 (USD MILLION) 56
TABLE 19 HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-DEMAND DELIVERY MODELS, BY COUNTRY, 2018–2025 (USD MILLION) 57
TABLE 20 HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION 2018–2025 (USD MILLION) 59
TABLE 21 DEPLOYMENT OF PREPAYMENT VS. POSTPAYMENT ANALYTICS SYSTEMS 60
TABLE 22 HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW BY TYPE, 2018–2025 (USD MILLION) 60
TABLE 23 HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW BY REGION, 2018–2025 (USD MILLION) 60
TABLE 24 HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW BY COUNTRY, 2018–2025 (USD MILLION) 61
TABLE 25 HEALTHCARE FRAUD ANALYTICS MARKET FOR POSTPAYMENT CLAIMS REVIEW BY REGION, 2018–2025 (USD MILLION) 62
TABLE 26 HEALTHCARE FRAUD ANALYTICS MARKET FOR POSTPAYMENT CLAIMS REVIEW BY COUNTRY, 2018–2025 (USD MILLION) 62
TABLE 27 HEALTHCARE FRAUD ANALYTICS MARKET FOR PREPAYMENT CLAIMS REVIEW BY REGION, 2018–2025 (USD MILLION) 63
TABLE 28 HEALTHCARE FRAUD ANALYTICS MARKET FOR PREPAYMENT CLAIMS REVIEW BY COUNTRY, 2018–2025 (USD MILLION) 64
TABLE 29 HEALTHCARE FRAUD ANALYTICS MARKET FOR PHARMACY BILLING MISUSE APPLICATIONS, BY REGION, 2018–2025 (USD MILLION) 65
TABLE 30 HEALTHCARE FRAUD ANALYTICS MARKET FOR PHARMACY BILLING MISUSE APPLICATIONS, BY COUNTRY, 2018–2025 (USD MILLION) 65
TABLE 31 HEALTHCARE FRAUD ANALYTICS MARKET FOR PAYMENT INTEGRITY APPLICATIONS, BY REGION, 2018–2025 (USD MILLION) 66
TABLE 32 HEALTHCARE FRAUD ANALYTICS MARKET FOR PAYMENT INTEGRITY APPLICATIONS, BY COUNTRY, 2018–2025 (USD MILLION) 67
TABLE 33 HEALTHCARE FRAUD ANALYTICS MARKET FOR OTHER APPLICATIONS, BY REGION, 2018–2025 (USD MILLION) 68
TABLE 34 HEALTHCARE FRAUD ANALYTICS MARKET FOR OTHER APPLICATIONS BY COUNTRY, 2018–2025 (USD MILLION) 68
TABLE 35 HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER 2018–2025 (USD MILLION) 70
TABLE 36 HEALTHCARE FRAUD ANALYTICS MARKET FOR PUBLIC & GOVERNMENT AGENCIES, BY REGION, 2018–2025 (USD MILLION) 71
TABLE 37 HEALTHCARE FRAUD ANALYTICS MARKET FOR PUBLIC & GOVERNMENT AGENCIES, BY COUNTRY, 2018–2025 (USD MILLION) 71
TABLE 38 HEALTHCARE FRAUD ANALYTICS MARKET FOR PRIVATE INSURANCE PAYERS BY REGION, 2018–2025 (USD MILLION) 72
TABLE 39 HEALTHCARE FRAUD ANALYTICS MARKET FOR PRIVATE INSURANCE PAYERS BY COUNTRY, 2018–2025 (USD MILLION) 73
TABLE 40 HEALTHCARE FRAUD ANALYTICS MARKET FOR THIRD-PARTY SERVICE PROVIDERS, BY REGION, 2018–2025 (USD MILLION) 74
TABLE 41 HEALTHCARE FRAUD ANALYTICS MARKET FOR THIRD-PARTY SERVICE PROVIDERS, BY COUNTRY, 2018–2025 (USD MILLION) 74
TABLE 42 HEALTHCARE FRAUD ANALYTICS MARKET FOR EMPLOYERS, BY REGION 2018–2025 (USD MILLION) 75
TABLE 43 HEALTHCARE FRAUD ANALYTICS MARKET FOR EMPLOYERS, BY COUNTRY 2018–2025 (USD MILLION) 75
TABLE 44 HEALTHCARE FRAUD ANALYTICS MARKET, BY REGION, 2018–2025 (USD MILLION) 77
TABLE 45 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY COUNTRY 2018–2025 (USD MILLION) 78
TABLE 46 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2018–2025 (USD MILLION) 79
TABLE 47 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2018–2025 (USD MILLION) 79
TABLE 48 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2018–2025 (USD MILLION) 79
TABLE 49 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018–2025 (USD MILLION) 80
TABLE 50 NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER 2018–2025 (USD MILLION) 80
TABLE 51 US: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL 2018–2025 (USD MILLION) 81
TABLE 52 US: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE 2018–2025 (USD MILLION) 81
TABLE 53 US: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION 2018–2025 (USD MILLION) 82
TABLE 54 US: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018–2025 (USD MILLION) 82
TABLE 55 US: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER 2018–2025 (USD MILLION) 82
TABLE 56 CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL 2018–2025 (USD MILLION) 83
TABLE 57 CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE 2018–2025 (USD MILLION) 83
TABLE 58 CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION 2018–2025 (USD MILLION) 84
TABLE 59 CANADA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018–2025 (USD MILLION) 84
TABLE 60 CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER 2018–2025 (USD MILLION) 84
TABLE 61 LIST OF SOME OF THE EHFCN MEMBER ORGANIZATION ACROSS EUROPE 85
TABLE 62 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY COUNTRY 2018–2025 (USD MILLION) 87
TABLE 63 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL 2018–2025 (USD MILLION) 87
TABLE 64 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE 2018–2025 (USD MILLION) 87
TABLE 65 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION 2018–2025 (USD MILLION) 88
TABLE 66 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018–2025 (USD MILLION) 88
TABLE 67 EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER 2018–2025 (USD MILLION) 88
TABLE 68 GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2018–2025 (USD MILLION) 89
TABLE 69 GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE 2018–2025 (USD MILLION) 90
TABLE 70 GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION 2018–2025 (USD MILLION) 90
TABLE 71 GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018–2025 (USD MILLION) 90
TABLE 72 GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER 2018–2025 (USD MILLION) 91
TABLE 73 UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL 2018–2025 (USD MILLION) 92
TABLE 74 UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE 2018–2025 (USD MILLION) 92
TABLE 75 UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION 2018–2025 (USD MILLION) 92
TABLE 76 UK: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018–2025 (USD MILLION) 93
TABLE 77 UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER 2018–2025 (USD MILLION) 93
TABLE 78 FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL 2018–2025 (USD MILLION) 94
TABLE 79 FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE 2018–2025 (USD MILLION) 94
TABLE 80 FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION 2018–2025 (USD MILLION) 94
TABLE 81 FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018–2025 (USD MILLION) 95
TABLE 82 FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER 2018–2025 (USD MILLION) 95
TABLE 83 ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL 2018–2025 (USD MILLION) 96
TABLE 84 ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE 2018–2025 (USD MILLION) 96
TABLE 85 ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION 2018–2025 (USD MILLION) 96
TABLE 86 ROE: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018–2025 (USD MILLION) 97
TABLE 87 ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER 2018–2025 (USD MILLION) 97
TABLE 88 ASIA PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2018–2025 (USD MILLION) 99
TABLE 89 ASIA PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2018–2025 (USD MILLION) 99
TABLE 90 ASIA PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION 2018–2025 (USD MILLION) 99
TABLE 91 ASIA PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018–2025 (USD MILLION) 100
TABLE 92 ASIA PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER 2018–2025 (USD MILLION) 100
TABLE 93 LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2018–2025 (USD MILLION) 101
TABLE 94 LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2018–2025 (USD MILLION) 101
TABLE 95 LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2018–2025 (USD MILLION) 101
TABLE 96 LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018–2025 (USD MILLION) 102
TABLE 97 LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER 2018–2025 (USD MILLION) 102
TABLE 98 MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL 2018–2025 (USD MILLION) 103
TABLE 99 MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE 2018–2025 (USD MILLION) 103
TABLE 100 MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION 2018–2025 (USD MILLION) 103
TABLE 101 MEA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2018–2025 (USD MILLION) 104
TABLE 102 MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER 2018–2025 (USD MILLION) 104
TABLE 103 MERGERS, ACQUISITIONS, AND JOINT VENTURES: JANUARY
2017–DECEMBER 2019 106
TABLE 104 COLLABORATIONS, PARTNERSHIPS, AND AGREEMENTS: JANUARY
2017–DECEMBER 2019 107
TABLE 105 EXPANSIONS: JANUARY 2017–DECEMBER 2019 107