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Healthcare Fraud Analytics Market – By Solution Type (Descriptive Analytics, Predictive Analytics, and Prescriptive Analytics), By Delivery Model (On-premise and On-Demand), By Component (Services and Software), By Application (Insurance Claims Review, Pharmacy Billing Misuse, Payment Integrity, and Others), By End-User (Private Insurance Payers, Public & Government Agencies, Third-Party Service Providers, and Employers), and By Region: Global Industry Perspective, Comprehensive Analysis, and Forecast, 2019 – 2025

Published Date: 24-Feb-2020 Category: Healthcare Report Format : PDF Pages: 110 Report Code: ZMR-5291 Status : Published

Global demand for the Healthcare Fraud Analytics market was valued over USD 1 Billion in 2019 and is expected to reach a CAGR of 29.10% between 2019 and 2025.

Description

This report analyzes and estimates the Healthcare Fraud Analytics market at global, regional, and country level. The research study provides historic data from 2015 to 2019 along with forecast from 2020 to 2025 based on value (USD Billion). The report offers detailed insights of the Healthcare Fraud Analytics market drivers and restraints along with their impact analysis at global level from 2015 to 2025.

The report covers in-depth analysis of the strategies adopted by major competitors in the global Healthcare Fraud Analytics market. To understand the competitive landscape in the global Healthcare Fraud Analytics market, an analysis of Porter’s Five Forces model is also included. The research study comprises of market attractiveness analysis, wherein all the segments are benchmarked on the basis of their market size and growth rate.

Global Healthcare Fraud Analytics Market

The research study provides a decisive view on the global Healthcare Fraud Analytics market based on Solution Type, Delivery Model, Component, Application, End-User, and Region. All the segments of the market have been analyzed based on the past, present, and future trends. The market is estimated from 2019 to 2025.

Healthcare Fraud Analytics market growth is primarily attributed to the increasing number of fraudulent activities in the healthcare sector and the mounting number of patients opting for health insurance. On the other hand, the increasing reimbursement policies and surging pharmacy claim-related frauds are expected to augment the market growth during the forecast period.  Descriptive analytics role in forming the base for the effective application of predictive or prescriptive analytics will supplement the expansion of the global Healthcare Fraud Analytics market. In addition to this, the growing acceptance of the prepayment review model will supplement the growth of this category in the upcoming years.

Additionally, the supportive government anti-fraud initiatives are majorly helping in the easy acceptance of healthcare fraud analytics across various regions. The pressure to lower healthcare costs, technological innovations, and the increasing availability of product and service across the globe is expected to augment the market growth. Moreover, the rising presence of headquarters of many of the leading players in the Healthcare Fraud Analytics market in various regions will further aid in the market growth. However, the lack of skilled personnel is likely to hamper the growth of Healthcare Fraud Analytics market.

On the basis of solution type, the global Healthcare Fraud Analytics market is divided into Descriptive Analytics, Predictive Analytics, and Prescriptive Analytics. Based on delivery model, the market is segregated into On-premise and On-Demand. By component, the market for healthcare fraud analytics is segmented into Services and Software. In terms of application, the Healthcare Fraud Analytics market is categorized into Insurance Claims Review, Pharmacy Billing Misuse, Payment Integrity, and Others. Based on end-user, the market is classified into Private Insurance Payers, Public & Government Agencies, Third-Party Service Providers, and Employers. The regional segmentation comprises the past, present, and estimated demand for the Middle East & Africa, North America, Asia Pacific, Latin America, and Europe. The regional segment is further split into the U.S., Canada, Mexico, UK, France, Germany, China, Japan, India, South Korea, Brazil, and Argentina among others.

Some of the key players of the global Healthcare Fraud Analytics market include Optum, EXL Service Holdings, SAS Institute, IBM Corporation, DXC Technology Company, Change Healthcare, Cotiviti, Conduent, HCL, Wipro Limited, LexisNexis Group, Canadian Global Information Technology Group, Northrop Grumman Corporation, and Pondera Solutions.

The report on the global Healthcare Fraud Analytics market is segmented into:

Global Healthcare Fraud Analytics Market: By Solution Type Segmentation Analysis

  • Descriptive Analytics
  • Predictive Analytics
  • Prescriptive Analytics

Global Healthcare Fraud Analytics Market: By Delivery Model Segmentation Analysis

  • On-Premise
  • On-Demand

Global Healthcare Fraud Analytics Market: By Application Segmentation Analysis

  • Insurance Claims Review
    • Postpayment Review
    • Prepayment Review
  • Pharmacy Billing Misuse
  • Payment Integrity
  • Others

Global Healthcare Fraud Analytics Market: By End-User Segmentation Analysis

  • Public & Government Agencies
  • Private Insurance Payers
  • Third-party Service Providers
  • Employers

Global Healthcare Fraud Analytics Market: By Regional Segmentation Analysis

  • North America
    • The U.S.
    • Canada
  • Europe
    • France
    • The UK
    • Spain
    • Germany
    • Italy
    • Rest of Europe
  • Asia Pacific
    • China
    • Japan
    • India
    • South Korea
    • Southeast Asia
    • Rest of Asia Pacific
  • Latin America
    • Brazil
    • Mexico
    • Rest of Latin America
  • Middle East & Africa
    • GCC
    • South Africa
    • Rest of Middle East & Africa

Table Of Content

  • Chapter 1. Executive Summary
  • Chapter 2. Healthcare Fraud Analytics market – Sulution Type Analysis
    • 2.1. Global Healthcare Fraud Analytics Market – Sulution Type Overview
    • 2.2. Global Healthcare Fraud Analytics Market Share, by Sulution Type, 2018 & 2025 (USD Billion)
    • 2.3. Descriptive Analytics
      • 2.3.1. Global Descriptive Analytics Healthcare Fraud Analytics Market, 2015-2025 (USD Billion)
    • 2.4. Predictive Analytics
      • 2.4.1. Global Predictive Analytics Healthcare Fraud Analytics Market, 2015-2025 (USD Billion)
    • 2.5. Prescriptive Analytics
      • 2.5.1. Global Prescriptive Analytics Healthcare Fraud Analytics Market, 2015-2025 (USD Billion)
  • Chapter 3. Healthcare Fraud Analytics market – Delivery Model Analysis
    • 3.1. Global Healthcare Fraud Analytics Market – Delivery Model Overview
    • 3.2. Global Healthcare Fraud Analytics Market Share, by Delivery Model, 2018 & 2025 (USD Billion)
    • 3.3. On-Premise
      • 3.3.1. Global On-Premise Healthcare Fraud Analytics Market, 2015-2025 (USD Billion)
    • 3.4. On-Demand
      • 3.4.1. Global On-Demand Healthcare Fraud Analytics Market, 2015-2025 (USD Billion)
  • Chapter 4. Healthcare Fraud Analytics market – Component Analysis
    • 4.1. Global Healthcare Fraud Analytics Market – Component Overview
    • 4.2. Global Healthcare Fraud Analytics Market Share, by Component, 2018 & 2025 (USD Billion)
    • 4.3. Services
      • 4.3.1. Global Services Healthcare Fraud Analytics Market, 2015-2025 (USD Billion)
    • 4.4. Software
      • 4.4.1. Global Software Healthcare Fraud Analytics Market, 2015-2025 (USD Billion)
  • Chapter 5. Healthcare Fraud Analytics market – Application Analysis
    • 5.1. Global Healthcare Fraud Analytics Market – Application Overview
    • 5.2. Global Healthcare Fraud Analytics Market Share, by Application, 2018 & 2025 (USD Billion)
    • 5.3. Insurance Claims Review
      • 5.3.1. Global Insurance Claims Review Healthcare Fraud Analytics Market, 2015-2025 (USD Billion)
    • 5.4. Pharmacy Billing Misuse
      • 5.4.1. Global Pharmacy Billing Misuse Healthcare Fraud Analytics Market, 2015-2025 (USD Billion)
    • 5.5. Payment Integrity
      • 5.5.1. Global Payment Integrity Healthcare Fraud Analytics Market, 2015-2025 (USD Billion)
    • 5.6. Others
      • 5.6.1. Global Others Healthcare Fraud Analytics Market, 2015-2025 (USD Billion)
  • Chapter 6. Healthcare Fraud Analytics market – End-User Analysis
    • 6.1. Global Healthcare Fraud Analytics Market – End-User Overview
    • 6.2. Global Healthcare Fraud Analytics Market Share, by End-User, 2018 & 2025 (USD Billion)
    • 6.3. Private Insurance Payers
      • 6.3.1. Global Private Insurance Payers Healthcare Fraud Analytics Market, 2015-2025 (USD Billion)
    • 6.4. Public & Government Agencies
      • 6.4.1. Global Public & Government Agencies Healthcare Fraud Analytics Market, 2015-2025 (USD Billion)
    • 6.5. Third-Party Service Providers
      • 6.5.1. Global Third-Party Service Providers Healthcare Fraud Analytics Market, 2015-2025 (USD Billion)
    • 6.6. Employers
      • 6.6.1. Global Employers Healthcare Fraud Analytics Market, 2015-2025 (USD Billion)
  • Chapter 7. Healthcare Fraud Analytics market – Regional Analysis
    • 7.1. Global Healthcare Fraud Analytics Market Regional Overview
    • 7.2. Global Healthcare Fraud Analytics Market Share, by Region, 2018 & 2025 (Value)
    • 7.3. North America
      • 7.3.1. North America Healthcare Fraud Analytics Market size and forecast, 2015-2025
      • 7.3.2. North America Healthcare Fraud Analytics Market, by Country, 2018 & 2025 (USD Billion)
      • 7.3.3. North America Healthcare Fraud Analytics Market, by Sulution Type, 2015-2025
        • 7.3.3.1. North America Healthcare Fraud Analytics Market, by Sulution Type, 2015-2025 (USD Billion)
      • 7.3.4. North America Healthcare Fraud Analytics Market, by Delivery Model, 2015-2025
        • 7.3.4.1. North America Healthcare Fraud Analytics Market, by Delivery Model, 2015-2025 (USD Billion)
      • 7.3.5. North America Healthcare Fraud Analytics Market, by Component, 2015-2025
        • 7.3.5.1. North America Healthcare Fraud Analytics Market, by Component, 2015-2025 (USD Billion)
      • 7.3.6. North America Healthcare Fraud Analytics Market, by Application, 2015-2025
        • 7.3.6.1. North America Healthcare Fraud Analytics Market, by Application, 2015-2025 (USD Billion)
      • 7.3.7. North America Healthcare Fraud Analytics Market, by End-User, 2015-2025
        • 7.3.7.1. North America Healthcare Fraud Analytics Market, by End-User, 2015-2025 (USD Billion)
      • 7.3.8. U.S.
        • 7.3.8.1. U.S. Market size and forecast, 2015-2025 (USD Billion)
      • 7.3.9. Canada
        • 7.3.9.1. Canada Market size and forecast, 2015-2025 (USD Billion)
    • 7.4. Europe
      • 7.4.1. Europe Healthcare Fraud Analytics Market size and forecast, 2015-2025
      • 7.4.2. Europe Healthcare Fraud Analytics Market, by Country, 2018 & 2025 (USD Billion)
      • 7.4.3. Europe Healthcare Fraud Analytics Market, by Sulution Type, 2015-2025
        • 7.4.3.1. Europe Healthcare Fraud Analytics Market, by Sulution Type, 2015-2025 (USD Billion)
      • 7.4.4. Europe Healthcare Fraud Analytics Market, by Delivery Model, 2015-2025
        • 7.4.4.1. Europe Healthcare Fraud Analytics Market, by Delivery Model, 2015-2025 (USD Billion)
      • 7.4.5. Europe Healthcare Fraud Analytics Market, by Component, 2015-2025
        • 7.4.5.1. Europe Healthcare Fraud Analytics Market, by Component, 2015-2025 (USD Billion)
      • 7.4.6. Europe Healthcare Fraud Analytics Market, by Application, 2015-2025
        • 7.4.6.1. Europe Healthcare Fraud Analytics Market, by Application, 2015-2025 (USD Billion)
      • 7.4.7. Europe Healthcare Fraud Analytics Market, by End-User, 2015-2025
        • 7.4.7.1. Europe Healthcare Fraud Analytics Market, by End-User, 2015-2025 (USD Billion)
      • 7.4.8. Germany
        • 7.4.8.1. Germany Market size and forecast, 2015-2025 (USD Billion)
      • 7.4.9. France
        • 7.4.9.1. France Market size and forecast, 2015-2025 (USD Billion)
      • 7.4.10. U.K.
        • 7.4.10.1. U.K. Market size and forecast, 2015-2025 (USD Billion)
      • 7.4.11. Rest of Europe
        • 7.4.11.1. Rest of Europe Market size and forecast, 2015-2025 (USD Billion)
    • 7.5. Asia Pacific
      • 7.5.1. Asia Pacific Healthcare Fraud Analytics Market size and forecast, 2015-2025
      • 7.5.2. Asia Pacific Healthcare Fraud Analytics Market, by Country, 2018 & 2025 (USD Billion)
      • 7.5.3. Asia Pacific Healthcare Fraud Analytics Market, by Sulution Type, 2015-2025
        • 7.5.3.1. Asia Pacific Healthcare Fraud Analytics Market, by Sulution Type, 2015-2025 (USD Billion)
      • 7.5.4. Asia Pacific Healthcare Fraud Analytics Market, by Delivery Model, 2015-2025
        • 7.5.4.1. Asia Pacific Healthcare Fraud Analytics Market, by Delivery Model, 2015-2025 (USD Billion)
      • 7.5.5. Asia Pacific Healthcare Fraud Analytics Market, by Component, 2015-2025
        • 7.5.5.1. Asia Pacific Healthcare Fraud Analytics Market, by Component, 2015-2025 (USD Billion)
      • 7.5.6. Asia Pacific Healthcare Fraud Analytics Market, by Application, 2015-2025
        • 7.5.6.1. Asia Pacific Healthcare Fraud Analytics Market, by Application, 2015-2025 (USD Billion)
      • 7.5.7. Asia Pacific Healthcare Fraud Analytics Market, by End-User, 2015-2025
        • 7.5.7.1. Asia Pacific Healthcare Fraud Analytics Market, by End-User, 2015-2025 (USD Billion)
      • 7.5.8. China
        • 7.5.8.1. China Market size and forecast, 2015-2025 (USD Billion)
      • 7.5.9. Japan
        • 7.5.9.1. Japan Market size and forecast, 2015-2025 (USD Billion)
      • 7.5.10. India
        • 7.5.10.1. India Market size and forecast, 2015-2025 (USD Billion)
      • 7.5.11. Rest of Asia Pacific
        • 7.5.11.1. Rest of Asia Pacific Market size and forecast, 2015-2025 (USD Billion)
    • 7.6. Latin America
      • 7.6.1. Latin America Healthcare Fraud Analytics Market size and forecast, 2015-2025
      • 7.6.2. Latin America Healthcare Fraud Analytics Market, by Country, 2018 & 2025 (USD Billion)
      • 7.6.3. Latin America Healthcare Fraud Analytics Market, by Sulution Type, 2015-2025
        • 7.6.3.1. Latin America Healthcare Fraud Analytics Market, by Sulution Type, 2015-2025 (USD Billion)
      • 7.6.4. Latin America Healthcare Fraud Analytics Market, by Delivery Model, 2015-2025
        • 7.6.4.1. Latin America Healthcare Fraud Analytics Market, by Delivery Model, 2015-2025 (USD Billion)
      • 7.6.5. Latin America Healthcare Fraud Analytics Market, by Component, 2015-2025
        • 7.6.5.1. Latin America Healthcare Fraud Analytics Market, by Component, 2015-2025 (USD Billion)
      • 7.6.6. Latin America Healthcare Fraud Analytics Market, by Application, 2015-2025
        • 7.6.6.1. Latin America Healthcare Fraud Analytics Market, by Application, 2015-2025 (USD Billion)
      • 7.6.7. Latin America Healthcare Fraud Analytics Market, by End-User, 2015-2025
        • 7.6.7.1. Latin America Healthcare Fraud Analytics Market, by End-User, 2015-2025 (USD Billion)
      • 7.6.8. Brazil
        • 7.6.8.1. Brazil Market size and forecast, 2015-2025 (USD Billion)
      • 7.6.9. Rest of Latin America
        • 7.6.9.1. Rest of Latin America Market size and forecast, 2015-2025 (USD Billion)
    • 7.7. The Middle-East and Africa
      • 7.7.1. The Middle-East and Africa Healthcare Fraud Analytics Market size and forecast, 2015-2025
      • 7.7.2. The Middle-East and Africa Healthcare Fraud Analytics Market, by Country, 2018 & 2025 (USD Billion)
      • 7.7.3. The Middle-East and Africa Healthcare Fraud Analytics Market, by Sulution Type, 2015-2025
        • 7.7.3.1. The Middle-East and Africa Healthcare Fraud Analytics Market, by Sulution Type, 2015-2025 (USD Billion)
      • 7.7.4. The Middle-East and Africa Healthcare Fraud Analytics Market, by Delivery Model, 2015-2025
        • 7.7.4.1. The Middle-East and Africa Healthcare Fraud Analytics Market, by Delivery Model, 2015-2025 (USD Billion)
      • 7.7.5. The Middle-East and Africa Healthcare Fraud Analytics Market, by Component, 2015-2025
        • 7.7.5.1. The Middle-East and Africa Healthcare Fraud Analytics Market, by Component, 2015-2025 (USD Billion)
      • 7.7.6. The Middle-East and Africa Healthcare Fraud Analytics Market, by Application, 2015-2025
        • 7.7.6.1. The Middle-East and Africa Healthcare Fraud Analytics Market, by Application, 2015-2025 (USD Billion)
      • 7.7.7. The Middle-East and Africa Healthcare Fraud Analytics Market, by End-User, 2015-2025
        • 7.7.7.1. The Middle-East and Africa Healthcare Fraud Analytics Market, by End-User, 2015-2025 (USD Billion)
  • Chapter 8. Healthcare Fraud Analytics market – Competitive Landscape
    • 8.1. Competitor Market Share – Revenue
    • 8.2. Market Concentration Rate Analysis, Top 3 and Top 5 Players
    • 8.3. Strategic Development
      • 8.3.1. Acquisitions and Mergers
      • 8.3.2. New Products
      • 8.3.3. Research & Development Activities
  • Chapter 9. Company Profiles
    • 9.1. Optum
      • 9.1.1. Company Overview
      • 9.1.2. Optum Revenue and Gross Margin
      • 9.1.3. Product portfulio
      • 9.1.4. Recent initiatives
    • 9.2. EXL Service Huldings
      • 9.2.1. Company Overview
      • 9.2.2. EXL Service Huldings Revenue and Gross Margin
      • 9.2.3. Product portfulio
      • 9.2.4. Recent initiatives
    • 9.3. SAS Institute
      • 9.3.1. Company Overview
      • 9.3.2. SAS Institute Revenue and Gross Margin
      • 9.3.3. Product portfulio
      • 9.3.4. Recent initiatives
    • 9.4. IBM Corporation
      • 9.4.1. Company Overview
      • 9.4.2. IBM Corporation Revenue and Gross Margin
      • 9.4.3. Product portfulio
      • 9.4.4. Recent initiatives
    • 9.5. DXC Technology Company
      • 9.5.1. Company Overview
      • 9.5.2. DXC Technology Company Revenue and Gross Margin
      • 9.5.3. Product portfulio
      • 9.5.4. Recent initiatives
    • 9.6. Change Healthcare
      • 9.6.1. Company Overview
      • 9.6.2. Change Healthcare Revenue and Gross Margin
      • 9.6.3. Product portfulio
      • 9.6.4. Recent initiatives
    • 9.7. Cotiviti
      • 9.7.1. Company Overview
      • 9.7.2. Cotiviti Revenue and Gross Margin
      • 9.7.3. Product portfulio
      • 9.7.4. Recent initiatives
    • 9.8. Conduent
      • 9.8.1. Company Overview
      • 9.8.2. Conduent Revenue and Gross Margin
      • 9.8.3. Product portfulio
      • 9.8.4. Recent initiatives
    • 9.9. HCL
      • 9.9.1. Company Overview
      • 9.9.2. HCL Revenue and Gross Margin
      • 9.9.3. Product portfulio
      • 9.9.4. Recent initiatives
    • 9.10. Wipro Limited
      • 9.10.1. Company Overview
      • 9.10.2. Wipro Limited Revenue and Gross Margin
      • 9.10.3. Product portfulio
      • 9.10.4. Recent initiatives
    • 9.11. LexisNexis Group
      • 9.11.1. Company Overview
      • 9.11.2. LexisNexis Group Revenue and Gross Margin
      • 9.11.3. Product portfulio
      • 9.11.4. Recent initiatives
    • 9.12. Canadian Global Information Technology Group
      • 9.12.1. Company Overview
      • 9.12.2. Canadian Global Information Technology Group Revenue and Gross Margin
      • 9.12.3. Product portfulio
      • 9.12.4. Recent initiatives
    • 9.13. Northrop Grumman Corporation
      • 9.13.1. Company Overview
      • 9.13.2. Northrop Grumman Corporation Revenue and Gross Margin
      • 9.13.3. Product portfulio
      • 9.13.4. Recent initiatives
    • 9.14. Pondera Sulutions
      • 9.14.1. Company Overview
      • 9.14.2. Pondera Sulutions Revenue and Gross Margin
      • 9.14.3. Product portfulio
      • 9.14.4. Recent initiatives
  • Chapter 10. Healthcare Fraud Analytics — Industry Analysis
    • 10.1. Healthcare Fraud Analytics Market – Key Trends
      • 10.1.1. Market Drivers
      • 10.1.2. Market Restraints
      • 10.1.3. Market Opportunities
    • 10.2. Value Chain Analysis
    • 10.3. Technology Roadmap and Timeline
    • 10.4. Healthcare Fraud Analytics Market – Attractiveness Analysis
      • 10.4.1. By Sulution Type
      • 10.4.2. By Delivery Model
      • 10.4.3. By Component
      • 10.4.4. By Application
      • 10.4.5. By End-User
      • 10.4.6. By Region
  • Chapter 11. Marketing Strategy Analysis, Distributors
    • 11.1. Marketing Channel
    • 11.2. Direct Marketing
    • 11.3. Indirect Marketing
    • 11.4. Marketing Channel Development Trend
    • 11.5. Economic/Pulitical Environmental Change
  • Chapter 12. Report Conclusion
  • Chapter 13. Research Approach & Methodology
    • 13.1. Report Description
    • 13.2. Research Scope
    • 13.3. Research Methodology
      • 13.3.1. Secondary Research
      • 13.3.2. Primary Research
      • 13.3.3. Models
        • 13.3.3.1. Company Share Analysis Model
        • 13.3.3.2. Revenue Based Modeling
        • 13.3.3.3. Research Limitations

Methodology

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