The most recent study conducted by Report Ocean, titled “Global Healthcare Fraud Analytics Market Size, Share, Pricing, Trends, Growth, Report and Forecast 2023-2030,” presents a comprehensive analysis of the worldwide market. This research delves into the factors driving the market, emerging trends, opportunities for development, as well as potential limitations that may affect the Healthcare Fraud Analytics. The report provides an estimation of the global market size and examines recent strategic actions taken by prominent international competitors.
Global healthcare fraud analytics market to reach USD 6.3 billion by 2027. Global healthcare fraud analytics market is valued approximately at USD 1.2 billion in 2020 and is anticipated to grow with a healthy growth rate of about 26.7% over the forecast period 2021-2027. Healthcare fraud analytics is the fraud detection solutions and software that assist in early detection of frauds in healthcare sector such as errors in claim submissions, duplication of claims, prescription fraud by pharmacists and health insurance frauds.
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According to data from the U.S. Bureau of Economic Analysis and the U.S. Census Bureau, the goods and services deficit increased by $1.9 billion from $68.7 billion in January 2023 to $70.5 billion in February. The increase in the goods and services deficit in February was due to a $2.7 billion increase in the goods deficit to $93.0 billion and a $0.8 billion increase in the services surplus to $22.4 billion. Compared to the same period in 2022, the goods and services deficit has dropped this year by $35.5 billion, or 20.3%. $49.5 billion or 10.8% more was exported. 2.2% or $14.0 billion more was spent on imports.
The global healthcare fraud analytics market is being driven by large number of fraudulent activities in healthcare and increased number of patients seeking health insurance. Furthermore, role of AI in healthcare fraud detection will provide new opportunities for the global healthcare fraud analytics industry.
There has been a significant rise in the population seeking health insurance in different countries across the globe. For instance, as per Statista, 297 million people in the United States had health insurance, as of 2020, an increase from approximately 257 million health insured people in 2010. Also, health insurance sector market size in India was about USD 4.94 billion in 2018 which is expected to reach USD 26.72 billion by 2030.
Such growth in the demand for health insurance is expected to increase the demand and adoption of healthcare fraud analytics which is likely to promote the marker growth. However, limitations in the data capturing process in Medicaid services may impede market growth over the forecast period of 2021-2027.
The regional analysis of the global healthcare fraud analytics market is considered for the key regions such as Asia Pacific, North America, Europe, Latin America, and Rest of the World. North America accounts for the largest share in terms of market revenue in the global healthcare fraud analytics market over the forecast period 2021-2027. Factors such as growing incidences of healthcare fraud, large number of people seeking health insurance, pressure to reduce healthcare costs, favorable government anti-fraud initiatives, greater service and product availability, technological advancements, etc. contribute towards the largest market share of the region in the forecast years.
Major market player included in this report are:
International Business Machines Corporation (IBM)
Optum, Inc. (Optum)
SAS Institute, Inc. (SAS)
Change Healthcare
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EXL Service Holdings, Inc.
Cotiviti
Wipro Limited
Conduent, Inc.
Hindustan Computers Limited Technologies Limited (HCL)
Canadian Global Information Technology Group Inc. (CGI)
The objective of the study is to define market sizes of different segments & countries in recent years and to forecast the values to the coming eight years. The report is designed to incorporate both qualitative and quantitative aspects of the industry within each of the regions and countries involved in the study. Furthermore, the report also caters the detailed information about the crucial aspects such as driving factors & challenges which will define the future growth of the market. Additionally, the report shall also incorporate available opportunities in micro markets for stakeholders to invest along with the detailed analysis of competitive landscape and product offerings of key players. The detailed segments and sub-segment of the market are explained below:
By Solution Type:
Descriptive Analytics
Predictive Analytics
Prescriptive Analytics
By Delivery Model:
On-premise
Cloud-based
By Application:
Insurance Claims Review
Pharmacy Billing Misuse
Payment Integrity
Other applications
By End User:
Public & Government Agencies
Private Insurance Payers
Third-party service providers
Employers
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By Region:
North America
U.S.
Canada
Europe
UK
Germany
France
Spain
Italy
ROE
Asia Pacific
China
India
Japan
Australia
South Korea
RoAPAC
Latin America
Brazil
Mexico
Rest of the World
Russia-Ukraine War on Market
The market is anticipated to suffer because of the Russia-Ukraine War. The demand for the market has decreased as a result of the political unrest and economic unrest in the area. The war had a detrimental impact on global economic activity, adding to inflationary pressures globally and hindering the post-pandemic recovery, even if it was not the primary cause of the slower-than-anticipated economic growth in 2022 and revised estimates for 2023.
The Five Forces analysis examines the following factors:
- Bargaining power of buyers
- Bargaining power of suppliers
- Threat of new entrants
- Threat of substitutes
- Threat of rivalry
The PESTLE analysis takes into account the following dimensions:
- Political factors: This includes political policies, stability, and factors related to trade, fiscal policies, and taxation policies.
- Economic factors: This involves analyzing interest rates, employment or unemployment rates, raw material costs, and foreign exchange rates.
- Social factors: These encompass changing family demographics, education levels, cultural trends, shifts in attitudes, and changes in lifestyles.
- Technological factors: This examines changes in digital or mobile technology, automation, and research and development in the relevant industry.
- Legal factors: This entails analyzing employment legislation, consumer law, health and safety regulations, as well as international trade regulations and restrictions.
- Environmental factors: This dimension considers aspects such as climate change, recycling procedures, carbon footprint, waste disposal, and sustainability practices.
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