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Healthcare Fraud Detection Market Competitive Strategies, Growth, Recent Trends Analysis and Forecasts to 2027

Healthcare fraud has led to a significant addition of expenses in the healthcare system. As per GAO (General Accounting Office), ‘federal spending on major health care programs to grow from 5.9% of GDP in the fiscal year 2020 to 8.0% of GDP in the fiscal year 2050’. The enormous volume of money involved in the healthcare sector and its size make it an attractive fraud target. The demand for healthcare fraud detection is increasing on account of rising number of health insurers, an increase in the number of frauds in pharmacy bills, and government initiatives to reduce fraud related to healthcare data. Programs such as the Medicare Fraud Strike Force (OIG 2017), endorsed to help reduce fraud, but continued efforts are necessary to better alleviate the effects of fraud. As per NCBI reporting, between 2005-2019, the total number of individuals affected by healthcare data breaches totaled 249.1 million. Among these 157.4 million individuals were affected in the last five years alone globally. In the year 2018, the number of data breaches reported was 2,216 from 65 countries. Out of these, the healthcare industry faced 536 breaches, which implies that the industry is facing the highest number of breaches, compared to other industrial sectors. There were 2,013 data breaches reported from 86 countries in 2019. In 2019, total number of healthcare records that were exposed, stolen, or illegally disclosed stood at 41.2 million, from 505 healthcare data breaches. According to IBM, the average cost of a data breach in 2019 stood at US$ 3.92 million, while a healthcare industry breach usually costs US$ 6.45 million. The cost was highest in the US, compared to other countries.

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Insights Presented in the Report

“Amongst components, Software segment dominates the market in 2020.”

Based on components, the market is fragmented into Services and Software. The healthcare fraud detection market is expected to record the high growth owing to advancements in software technology, a high adoption rate of fraud detection software by insurance companies, rise in software availability in the developed regions, among others. For instance, healthcare cloud has launched patient analytics software for the tracking of patient outcomes and utilizes extensive database and proprietary analytics to recommend procedures based on patient comorbidities. The software segment generated revenue of USD XX million in 2020 and is expected to grow at a CAGR of XX% during the forecast period to reach a market valuation of USD XX million by 2027.

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“Amongst delivery models, On-Premise’s segment holds the major share.”

Based on delivery models, the market is bifurcated into on-premises and on-demand delivery model. On-premises delivery model is expected to record highest growth owing to high flexibility, pay-as-you-go pricing, and the lack of upfront capital investments for hardware. The On-premises delivery model generated revenue of USD XX million in 2020 and is expected to grow at a CAGR of XX% during the forecast period to reach a market valuation of USD XX million by 2027.

“Amongst solutions type, descriptive analytics is anticipated to grow at the highest CAGR”

Based on solutions type, the market is divided into descriptive analytics, predictive analytics, and prescriptive analytics. Descriptive analytics holds the major share owing to its high assistance in predictive and prescriptive analytics. For instance, Vidence and NTT DATA announced a partnership to deliver predictive analytics in oncology. This collaboration will make use of a combination of medical imaging scans, clinical and outcomes data to build a predictive model that will improve treatment regimens.

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Amongst applications, the review of insurance claims holds the major share”

Based on applications, the market is segmented into insurance claims, payment integrity, pharmacy bill and others. The review of insurance claims holds the largest share owing to a high number of people seeking health insurance, an increase in the uptake of the prepayment review model amongst the patients, an increase in fraud activities, and the rising need to control these frauds. For instance, Care Shield insurance announced the launch of Care Shield, which will cover numerous medical expenses and the protection of No Claim Bonus (NCB) benefit from lapsing.

“Government Agencies were the largest end-users of Healthcare fraud detection system.”

Based on end-user, the market is fragmented into private insurance payers, government agencies, third-party service providers, and others. Government agencies dominates the market on account of rising fraudulent activities coupled with emerging need for data security. For instance, Criminal Division, Fraud Section’s Health Care Fraud (HCF) Unit is comprised of more than 70 prosecutors whose core mission is to prosecute health care fraud-related cases involving patient harm and huge financial loss.

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“North America signifies one of the largest markets of Global Healthcare Fraud Detection Market.”

For a better understanding of the adoption of Healthcare Fraud Analytics, the market is analyzed based region/ countries including North America (US, Canada, and the Rest of North America), Europe (Germany, France, Italy, Spain, UK, and Rest of Europe), Asia-Pacific (China, Japan, India, Australia, and Rest of APAC), and Rest of World. North America dominates the healthcare fraud analytics market in 2020, on account of the rising number of people seeking health insurance, rising fraudulent activities, and rise in government anti-fraud initiatives and advancements in technology. As per the National Healthcare Anti-Fraud Association (NHCAA), health care fraud costs the U.S. nearly US$ 68 billion every year.

Customization Options:

Healthcare Fraud Detection Market can further be customized as per the requirement or any other market segment. Besides this, UMI understands that you may have your own business needs, hence feel free to connect with us to get a report that completely suits your requirements.

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Last Updated: 04-Jun-2021