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Healthcare Fraud Detection Market Sales Will Significantly Gain Momentum With AI Technology

A recent study by Fact.MR on the Healthcare Fraud Detection market Outlook offers a 10-year forecast for 2028. The study analyzes crucial trends that are currently determining the Sales growth and demand of market.

The report begins with a brief presentation and overview of the Healthcare Fraud Detection market, about the current market landscape, trends, major Key players, product type, application, and region. It also includes the impact of COVID-19 on the global Healthcare Fraud Detection market future forecasts, growth opportunities, end-user industries.

Market overview:

A surprising number of medical fraud cases have come to the fore with misrepresentation about Medicare and Medicaid. Many of these scams were accompanied by false service invoices that were never submitted. This situation can certainly be denied with the advent of AI.

Advanced AI algorithms can be used for financial fraud, insurance fraud, and transaction fraud. Several studies have shown that AI-based automated fraud detection systems help offset financial losses, reduce the examiner’s workload, and generate more resources for patients.

Here the machine learning program provides two subsets of accounting data. One is a doctor-generated claim and the other is identified fraudulent case data. The abuse of the health insurance system is extremely worrying and fraud in the medical industry has become a serious problem in recent years.

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The Healthcare Fraud Detection Demand market study encompasses the current market scenario on the global platform as well as the evolution of the Healthcare Fraud Detection market over the forecast period.

The Healthcare Fraud Detection Market survey report provides estimates of the size of the Healthcare Fraud Detection Market and the total share of key regional segments in a comprehensive manner.

Healthcare Fraud Detection Market Report Highlights & Forecasts:

Elaborated Scenario of the Parent Market.

Transformations in Market Dynamics for Healthcare Fraud Detection

Detailed Segmentation of Target Market.

Historical, Current, and Forecasted Healthcare Fraud Detection Market Size based on Value and Volume Latest.

Industry Developments and Market Trends of Healthcare Fraud Detection Market .

Competitive Analysis of Healthcare Fraud Detection Market .

Participants Strategies and product developments adopted for fraud detection in the healthcare sector.

Potential and niche segments as well as their regional analysis.

Unbiased analysis of the market size of fraud detection in the healthcare sector.

The research report analyzes healthcare fraud detection market demand by various segments.

Business leaders insight into healthcare fraud detection and how to increase their market share

The report provides a breakdown of the market and its sales, consumption, production analysis and forecasts by categorizing it based on parameters such as type, application / end-user, and region.

This research report contains the analysis and forecast of Sales, Production, Price, Healthcare Fraud Detection Market Share and Growth Trend for various Products such as:

Healthcare Fraud Detection Market – Segmentation

The healthcare fraud detection market can be bifurcated on the basis of:


  • Services
  • Software

Delivery Model

  • On-premise delivery models
  • On-demand delivery models


  • Predictive analytics
  • Descriptive analytics
  • Prescriptive analytics


  • Insurance claims review
  • Payment integrity

End User

  • Private insurance payers
  • Government agencies
  • Employers
  • Others

Regional analysis and forecast

Additionally, this Healthcare Fraud Detection Sales research study analyzes market size, production, consumption, and advancement trends on a global, regional, and country level.

Reluctance to Introduce
Healthcare Fraud Detection Software In the healthcare industry, healthcare fraud analytics are used to use analytics to identify duplicate claims.

With insurance companies reviewing extensive data such as medical history, medication history and surgery, etc., it has become imperative for companies to use analytics to get their work done correctly.

However, due to a lack of adequate IT infrastructure, technological advances, underdeveloped medical records databases, and inadequate regulations to address privacy concerns, companies in developing countries are very reluctant to adopt analytical technologies used in the healthcare fraud detection market.

In addition, such software is time consuming and requires regular upgrades to deploy, which further drives companies to adopt healthcare fraud detection software, which in turn hinders the growth of the healthcare fraud detection market.

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Healthcare Fraud Detection Market – Market Dynamics

The rise in fraudulent activity in the healthcare industry, coupled with the growing number of patients with health insurance in mind, has spurred the adoption of healthcare fraud detection software and services.

The healthcare fraud detection market is likely to grow due to factors such as increasing fraud pressures, waste and abuse in healthcare spending, and high return on investment. For example, in 2017, government agencies said their annual healthcare fraud cleanup included 400 people indicted in healthcare fraud systems, equivalent to $ 1.3 billion in fake bills to Medicaid and Medicare.

Verification model for prepayments

The prepayment review model has changed the health industry for the better, even Medicare claims are checked by prepayment reviews. With this model, the Center for Medicare and Medicaid Services (CMS) can save money while relieving the burden on hospitals.

This model not only triggers system-wide process improvements, but also has a significant positive impact on the cash flow of hospitals. In this model, the state holds money until the eligibility certificate becomes valid.

Although this variant of the healthcare fraud detection model puts some strain on hospitals as the number of claims examined will increase dramatically over time, hospitals will no longer have to worry about audits once payment has been received as cash flow will stop until claims are made have been checked.

Due to the innumerable advantages of the prepayment review model, hospitals are increasingly making system-wide operational improvements for error-free documentation and using predictive modeling techniques.

Here are the reasons to consider this Healthcare Fraud Detection Market report from Fact.MR – a provider of market research and competitive intelligence:

This ultimate guide will help you stay ahead in the market as it provides you with the profiles of healthcare fraud detection market participants, their working methods and decision-making skills.
The report analyzes various factors that act as drivers and barriers to the development and sale of the Healthcare Fraud Detection Market worldwide.
This report not only analyzes the current market situation, but also estimates how the Healthcare Fraud Detection Market will develop for the estimated time period.
It enables you to use smart methodologies and make better decisions by giving you a clear idea of ​​customer needs and preferences regarding the product in a given region.

To analyze the competitive landscape in the Healthcare Fraud Detection Market:

To provide decision makers with credible insights into their competitive landscape, the Healthcare Fraud Detection industry research report provides a detailed analysis of the healthcare fraud detection market competitive landscape.

The Competitive Landscape Analysis for Healthcare Fraud Detection Market includes detailed profiles of Tier 1, Tier 2, and Tier 3 players. The respective market share of healthcare fraud detection manufacturers is provided so that executives can understand the market scenario.

Leading companies in the healthcare fraud detection market include Optum, Verscend Technologies, Inc., DXC, Northrop Grumman, Fair Isaac Corporation, HCL Technologies Limited, LexisNexis, SAS Institute Inc., Pondera, Conduent, Inc., SCIOInspire, Corp ., CGI Group Inc., Wipro Limited, IBM Corporation, McKesson Corporation and others.

Healthcare Fraud Detection Market – Notable Highlights

In August 2018, Verscend Technologies, a portfolio company of Veritas Capital, acquired Cotiviti Holdings Inc, a payment accuracy and analytics solutions provider primarily focused on the healthcare industry. Together, the two companies operate under the Cotiviti name and are empowered with novel capabilities in risk, payment, quality, and the combination of financial and clinical data to help them create differentiated value for their customers.

In June 2018, another leader in the healthcare fraud detection market, SCIO Health Analytics, was certified for Veeva CRM MyInsights. With its patient personas and advanced predictive and prescriptive analytics capabilities, SCIO can provide actionable insights into patient risk and impact capacity, as well as profiling the different patients being treated at a care location.

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Big data and data analytics are another way a medical facility can compile data on patients’ “normal” purchasing behavior. When a patient uses services in an untypical way, hospitals can blacklist them

Fraud clusters of data can be identified through unsupervised machine learning. Sophisticated data mining techniques can then be applied to fraud tactics that turn out to be perfidious. The analysis performed is very powerful and a powerful tool that is adding traction to the healthcare fraud detection market.

Health care is an integral part of people’s lives and therefore needs to be affordable. The healthcare industry is a highly complex system that is expanding at a rapid pace with a multitude of moving components. Fraud in the healthcare industry has become a critical problem recently, with health insurance system abuse being the main concern.

Since manual healthcare fraud detection is a daunting task, healthcare companies are increasingly adopting healthcare fraud detection software that is powered by machine learning and data mining techniques. The ability of healthcare fraud detection software to automatically detect healthcare fraud has helped make the technology behind healthcare fraud detection so important.

Health care fraud is difficult to detect and tends to go unnoticed, which is why uncovering these types of fraudulent claims is of paramount importance as they add an extra burden to society. With the advent of healthcare fraud detection software, healthcare companies can conduct error-free accounting and auditing based on predictive data methods.

Healthcare fraud detection’s meticulous account review function can help businesses uncover suspicious providers and policyholders, and spot potential frauds before they occur.

Leading healthcare fraud detection companies vie to consistently innovate and use cutting edge technology in their healthcare fraud detection offerings to stay ahead of their competitors and become a leader in the healthcare fraud detection market.

Below are some of the main areas of focus of this research:

Provide an in-depth analysis of key operational strategies with a focus on corporate structure, R&D strategies, localization strategies,
manufacturing capabilities and sales performance of various companies

Provide an overview of the product portfolio including product planning, development and positioning -Discuss the role of technology companies in partnerships

Explore the regional sales activities

Analyze the market size for fraud detection in the healthcare sector and provide the forecast for the current and future market for contraceptives in the forecast 2018-2028

Analyze the competitive factors, competitors’ healthcare fraud detection market shares, product capabilities, and supply chain structures of the healthcare fraud detection market

In-depth analysis of various healthcare fraud detection market insights, namely healthcare fraud detection market trends, growth drivers, opportunities, and other related challenges.

The ability of suppliers and buyers to make better business decisions.

The report provides a comprehensive analysis of the key factors expected to drive the Healthcare Fraud Detection Market. This study also provides an in-depth look at the opportunities as well as current trends observed in the Selling Healthcare Fraud Detection Market.

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About Fact.MR

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Last Updated: 06-Oct-2021