The healthcare fraud analytics market is projected to reach USD 4.6 billion by 2025 from USD 1.2 billion in 2020 at a CAGR of 29.8%. The emergence of social network analytics, the adoption of technologies such as AI and blockchain, and the growing use of healthcare analytics for fraud detection in emerging nations like the APAC provide growth opportunities in this market. However, the time-consuming deployment of these solutions and the need for frequent updates are some challenges faced by end users of this market.
The on-demand segment is projected to witness the highest growth during the forecast period
On the basis of delivery model, the healthcare fraud analytics market is segmented into on-premise and on-demand models. The on-demand models include the cloud-based and web-based models. The on-demand segment is projected to register the highest CAGR during the forecast period. Factors such as on-demand self-serving analytics, the lack of up-front capital investments for hardware, extreme capacity flexibility, and a pay-as-you-go pricing model are driving the demand for on-demand fraud detection solutions.
The prepayment review model is projected to witness the highest growth during the forecast period
On the basis of application, the healthcare fraud analytics market is segmented into insurance claims review, pharmacy billing misuse, payment integrity, and other applications. The insurance claims review segment is further divided into postpayment and prepayment review, with the latter expected to register the highest growth during the forecast period. This is mainly because the use of prepayment review protocols and analytics can help organizations proactively prevent fraud prior to payment, allowing rapid action to be taken. As a result, prepayment review solutions are expected to garner greater attention in the coming years.
The Asia Pacific to witness the highest growth during the forecast period
The Asia Pacific is expected to witness the highest growth during the forecast period (2020 to 2025), owing to factors such as the growing demand for health insurance and increasing collaborations & partnerships between governments and tech giants for leveraging fraud analytics capabilities.
A breakdown of primary participants involved in making this report is mentioned below:
- By Company Type: Tier 1–45%, Tier 2–18%, and Tier 3–37%
- By Designation: C Level–35%, Director Level–50%, Others–15%
- By Region: North America–60%, Asia Pacific–22%, Europe–13%, Latin America–2%, Middle East and Africa–3%
Some of the major market players in the healthcare fraud analytics market are IBM Corporation (US), Optum (US), SAS Institute (US), Change Healthcare (US), EXL Service Holdings (US), Cotiviti (US), Wipro Limited (India), Conduent (US), HCL (India), Canadian Global Information Technology Group (Canada), DXC Technology Company (US), Northrop Grumman Corporation (US), LexisNexis Group (US), and Pondera Solutions (US).
The report analyzes the healthcare fraud analytics market and aims at estimating the market size and future growth potential of this market based on various segmentations, such as solution type, delivery model, application, end user, and region. It also covers the competitive leadership mapping, which analyzes the position of key market players and classifies them based on their capabilities. The report provides a competitive analysis of the key players in this market, along with their profiles, offerings, recent developments, and key market strategies.
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This report provides insights into the following pointers:
- Market Penetration: Comprehensive information on the portfolios of top players in the global healthcare fraud analytics market. The report analyzes this market by solution type, delivery model, application, end user, and region.
- Product Enhancement/Innovation: Detailed insights on upcoming technology trends in the global healthcare fraud analytics market
- Market Development: Comprehensive information on the lucrative emerging markets
- Market Diversification: Exhaustive information about growing geographies, recent developments, and collaborations in the healthcare fraud analytics market
- Competitive Assessment: In-depth assessment of growth strategies, offerings, and capabilities of leading players in the global healthcare fraud analytics market