Report Detail
US Healthcare Fraud Analytics Market to 2027 - Country Analysis and Forecasts by Solution (Predictive Analytics, Descriptive Analytics, Prescriptive Analytics); Mode of Delivery (On-Premise Delivery Models, Cloud-Based Delivery Models); Application (Insurance Claims Review, Pharmacy Billing Misuse, Payment Integrity, Medical Identity Theft, Other Applications); End User (Government Agencies, Private Insurance Payers, Third-party Service Providers, Employers)
- RnM3926468 |
- 13 March, 2020 |
- Global |
- 77 Pages |
- The Insight Partners |
- Other
The US Healthcare Fraud Analytics Market is expected to reach US$ 3,483.12 Mn in 2027 from US$ 517.28 Mn in 2019. The market is estimated to grow with a CAGR of 27.4% from 2020-2027.
The growth of the healthcare fraud analytics market is primarily attributed to the increasing number of healthcare fraudulent cases in the US and growing health insurance industry in the US. However, concerns regarding healthcare fraud analytics may hinder the growth of the market during the forecast period. The hospital industry is growing at a faster pace in the US. The hospital industry in the US is growing. Though the average hospital stay for a single person has been slightly decreased from 7 days to 5-6 days over the last couple of decades in the US, but, the total number of hospital admissions increased to 36.5 million in 2017. An increase in the elder population is a major reason for driving the hospital market in the US.
For instance, as per the National Health Care Anti-Fraud Association (NHCAA) estimated that every year, losses due to healthcare frauds are in the tens of billions of dollars. Some government and law enforcement agencies also estimated that healthcare frauds cost around 10% of the total annual health expenditure, which could be around US$ 300 billion. Thus, an increasing number of fraudulent healthcare cases is likely to demand healthcare fraud analytics solutions
In 2019, the predictive analytics segment held the largest market share of the healthcare fraud analytics market, by solution. This segment is also anticipated to dominate the market in 2027 owing to its analytics detection and identification patterns. Also, the segment is anticipated to witness growth at a significant rate during the forecast period, 2020 to 2027.
The US healthcare fraud analytics market by mode of delivery is segmented into on-premise delivery models, cloud-based delivery models. The US healthcare fraud analytics market is dominated by on-premise delivery models segment in 2019 with a considerable market share by mode of delivery. This segment is also predicted to dominate the market in 2027. However, cloud-based delivery models segment is anticipated to witness growth at a significant rate during the forecast period, 2020 to 2027, because it is an extremely manageable alternative which helps in the accessing real-time information.
In 2019, the insurance claims review held a largest market share of the healthcare fraud analytics market, by the application. This segment is also predicted to dominate the market in 2027 because it is very common and costly to the healthcare insurance system when fraud is detected and the number of health insurance frauds are increasing every year. Also, the insurance claims segment is anticipated to witness growth at a significant rate during the forecast period, 2020 to 2027.
In 2019, the government agencies segment held the largest market share of the healthcare fraud analytics market, by end user. This segment is also anticipated to dominate the market in 2027 as data analytics allows the government agencies to observe the billing patterns and then spot the unusual and suspicious cases. Also, the segment is anticipated to witness growth at a significant rate during the forecast period, 2020 to 2027.
Some of the major primary and secondary sources for healthcare fraud analytics included in the report are Medicare & Medicaid Services, World Health Organization, Health Maintenance Organization, U.S. Department of Justice, and others.
TABLE OF CONTENTS
1. Introduction
- 1.1 Scope of the Study
- 1.2 The Insight Partners Research Report Guidance
- 1.3 Market Segmentation
- 1.3.1 US Healthcare Fraud Analytics Market – By Solution
- 1.3.2 US Healthcare Fraud Analytics Market – By Mode of Delivery
- 1.3.3 US Healthcare Fraud Analytics Market – By Application
- 1.3.4 US Healthcare Fraud Analytics Market – By End User
2. Healthcare Fraud Analytics Market – Key Takeaways
3. Research Methodology
- 3.1 Coverage
- 3.2 Secondary Research
- 3.3 Primary Research
4. Healthcare Fraud Analytics– Market Landscape
- 4.1 Overview
- 4.2 Pest Analysis
- 4.2.1 Healthcare Fraud Analytics Market in US: PEST Analysis
- 4.3 Expert Opinion
5. Healthcare Fraud Analytics Market – Key Dynamics
- 5.1 Drivers
- 5.1.1 Increasing Number of Healthcare Fraudulent Cases in the US
- 5.1.2 Growing Health Insurance Industry in the US
- 5.2 Restraints
- 5.2.1 Concerns Regarding Healthcare Fraud Analytics
- 5.3 Opportunities
- 5.3.1 Growing Hospital Industry
- 5.4 Future Trends
- 5.4.1 AI in Healthcare Fraud Detection
- 5.5 Impact Analysis
6. Healthcare Fraud Analytics Market – US Analysis
- 6.1 US Healthcare Fraud Analytics Market Revenue Forecast And Analysis
- 6.2 Positioning of Key Players
- 6.2.1 Fair, Isaac and Company (FICO)
- 6.2.2 Conduent Inc.
7. Healthcare Fraud Analytics Market Analysis and Forecast to 2027 – Solution
- 7.1 Overview
- 7.2 Healthcare Fraud Analytics Market, By Solution, 2019 & 2027 (%)
- 7.3 US Healthcare Fraud Analytics Market, Revenue and Forecast to 2027, By Solution (US$ Mn)
- 7.4 Predictive Analytics
- 7.4.1 Overview
- 7.4.2 Predictive Analytics Market Revenue and Forecast to 2027 (US$ Mn)
- 7.5 Descriptive Analytics
- 7.5.1 Overview
- 7.5.2 Descriptive Analytics Market Revenue and Forecast to 2027 (US$ Mn)
- 7.6 Prescriptive Analytics
- 7.6.1 Overview
- 7.6.2 Prescriptive Analytics Market Revenue and Forecast to 2027 (US$ Mn)
8. Healthcare Fraud Analytics Market Analysis and Forecast to 2027 – Mode of Delivery
- 8.1 Overview
- 8.2 Healthcare Fraud Analytics Market, By Mode of Delivery, 2019 & 2027 (%)
- 8.3 US Healthcare Fraud Analytics Market, Revenue and Forecast to 2027, By Mode Of Delivery (US$ Mn)
- 8.4 On-Premise Delivery Models
- 8.4.1 Overview
- 8.4.2 On-Premise Delivery Models Market Revenue and Forecast to 2027 (US$ Mn)
- 8.5 Cloud-Based Delivery Mode
- 8.5.1 Overview
- 8.5.2 Cloud-Based Delivery Mode Market Revenue and Forecast to 2027 (US$ Mn)
9. Healthcare Fraud Analytics Market Analysis and Forecast to 2027 –Application
- 9.1 Overview
- 9.2 Healthcare Fraud Analytics Market, By Application, 2019 & 2027 (%)
- 9.3 US Healthcare Fraud Analytics Market, Revenue and Forecast to 2027, By Application (US$ Mn)
- 9.4 Insurance Claims Review
- 9.4.1 Overview
- 9.4.2 Insurance Claims Review Market Revenue and Forecast to 2027 (US$ Mn)
- 9.5 Pharmacy Billing Misuse
- 9.5.1 Overview
- 9.5.2 Pharmacy Billing Misuse Market Revenue and Forecast to 2027 (US$ Mn)
- 9.6 Payment Integrity
- 9.6.1 Overview
- 9.6.2 Payment Integrity Market Revenue and Forecast to 2027 (US$ Mn)
- 9.7 Medical Identity Theft
- 9.7.1 Overview
- 9.7.2 Medical Identity Theft Market Revenue and Forecast to 2027 (US$ Mn)
- 9.8 Other Applications
- 9.8.1 Overview
- 9.8.2 Other Applications Market Revenue and Forecast to 2027 (US$ Mn)
10. Healthcare Fraud Analytics Market Analysis and Forecast to 2027 –End User
- 10.1 Overview
- 10.2 Healthcare Fraud Analytics Market, By End User, 2019 & 2027 (%)
- 10.3 US Healthcare Fraud Analytics Market, Revenue and Forecast to 2027, End User (US$ Mn)
- 10.4 Government Agencies
- 10.4.1 Overview
- 10.4.2 Government Agencies Review Market Revenue and Forecast to 2027 (US$ Mn)
- 10.5 Private Insurance Payers
- 10.5.1 Overview
- 10.5.2 Private Insurance Payers Market Revenue and Forecast to 2027 (US$ Mn)
- 10.6 Third-party Service Providers
- 10.6.1 Overview
- 10.6.2 Third-party Service Providers Market Revenue and Forecast to 2027 (US$ Mn)
- 10.7 Employers
- 10.7.1 Overview
- 10.7.2 Employers Market Revenue and Forecast to 2027 (US$ Mn)
11. Healthcare Fraud Analytics Market to 2027– Industry Landscape
- 11.1 Overview
- 11.2 Growth Strategies Done By The Companies In The Market, (%)
- 11.3 Organic Developments Done By The Companies In The Market
- 11.4 Inorganic Developments Done By The Companies In The Market
12. Healthcare Fraud Analytics Market – Key Company Profiles
- 12.1 Conduent, Inc.
- 12.1.1 Key Facts
- 12.1.2 Business Description
- 12.1.3 Products and Services
- 12.1.4 Financial Overview
- 12.1.5 SWOT Analysis
- 12.1.6 Key Developments
- 12.2 DXC Technology Company
- 12.2.1 Key Facts
- 12.2.2 Business Description
- 12.2.3 Products and Services
- 12.2.4 Financial Overview
- 12.2.5 SWOT Analysis
- 12.2.6 Key Developments
- 12.3 SCIOInspire, Corp. (EXL Service Holdings, Inc.)
- 12.3.1 Key Facts
- 12.3.2 Business Description
- 12.3.3 Products and Services
- 12.3.4 Financial Overview
- 12.3.5 SWOT Analysis
- 12.3.6 Key Developments
- 12.4 OPTUM, INC (UnitedHealth Group)
- 12.4.1 Key Facts
- 12.4.2 Business Description
- 12.4.3 Products and Services
- 12.4.4 Financial Overview
- 12.4.5 SWOT Analysis
- 12.4.6 Key Developments
- 12.5 SAS Institute
- 12.5.1 Key Facts
- 12.5.2 Business Description
- 12.5.3 Products and Services
- 12.5.4 Financial Overview
- 12.5.5 SWOT Analysis
- 12.5.6 Key Developments
- 12.6 Pondera Solutions
- 12.6.1 Key Facts
- 12.6.2 Business Description
- 12.6.3 Products and Services
- 12.6.4 Financial Overview
- 12.6.5 SWOT Analysis
- 12.6.6 Key Developments
- 12.7 LexisNexis Risk Solutions (RELX plc)
- 12.7.1 Key Facts
- 12.7.2 Business Description
- 12.7.3 Products and Services
- 12.7.4 Financial Overview
- 12.7.5 SWOT Analysis
- 12.7.6 Key Developments
- 12.8 Fair, Isaac and Company (FICO)
- 12.8.1 Key Facts
- 12.8.2 Business Description
- 12.8.3 Financial Overview
- 12.8.4 Product Portfolio
- 12.8.5 SWOT Analysis
- 12.8.6 Key Developments
- 12.9 Cotiviti, Inc. (Verscend Technologies, Inc.)
- 12.9.1 Key Facts
- 12.9.2 Business Description
- 12.9.3 Financial Overview
- 12.9.4 Product Portfolio
- 12.9.5 SWOT Analysis
- 12.9.6 Key Developments
- 12.10 WhiteHatAI
- 12.10.1 Key Facts
- 12.10.2 Business Description
- 12.10.3 Financial Overview
- 12.10.4 Product Portfolio
- 12.10.5 SWOT Analysis
- 12.10.6 Key Developments
13. Appendix
- 13.1 About The Insight Partners
Summary:
Get latest Market Research Reports on US Healthcare Fraud Analytics . Industry analysis & Market Report on US Healthcare Fraud Analytics is a syndicated market report, published as US Healthcare Fraud Analytics Market to 2027 - Country Analysis and Forecasts by Solution (Predictive Analytics, Descriptive Analytics, Prescriptive Analytics); Mode of Delivery (On-Premise Delivery Models, Cloud-Based Delivery Models); Application (Insurance Claims Review, Pharmacy Billing Misuse, Payment Integrity, Medical Identity Theft, Other Applications); End User (Government Agencies, Private Insurance Payers, Third-party Service Providers, Employers). It is complete Research Study and Industry Analysis of US Healthcare Fraud Analytics market, to understand, Market Demand, Growth, trends analysis and Factor Influencing market.
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