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US Healthcare Fraud Detection Market - Growth, Trends, and Forecasts (2020 - 2025)

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  • 70 Pages
  • August 2020
  • Region: United States
  • Mordor Intelligence
  • ID: 5175950
The US healthcare fraud detection market is expected to register a 24.47% CAGR during the forecast period. The major factors attributing to the growth of the US healthcare fraud detection market are increasing fraudulent activities in the US healthcare, growing pressure to increase the operational efficiency and reduce healthcare spending, and prepayment review model.

According to the National Health Care Anti-Fraud Association, health insurance frauds in the United States cost around USD 80 billion per year to the consumers. Criminals are looking forward to profiting from the people across the country. As most of the people in the country are having health insurance, free medical treatments or complimentary consultation offers are being stolen.

Such cases of frauds in health insurance are causing damages to the medical history of people. A few years back, it was difficult for healthcare providers to identify the fraud, as criminals were using all types of patient identifications and insurance information. Due to such frauds, patients are compelled to pay higher premiums. Therefore, the US healthcare department is currently more focused toward the reduction of such cases by implementing the fraud detection technology. Therefore, it is believed that due to the rising fraudulent activities in the US healthcare department, the market studied may grow in the future.

Key Market Trends

In the Application Segment, the Review of Insurance Claims Segment is Expected to Hold the Major Share

The healthcare fraud detection solution plays a major role in the review of insurance claims, as most of the fraud cases occur while claiming the insurance. As per the estimates of the National Health Care Anti-Fraud Association (NHCAA), healthcare fraud costs the United States around USD 68 billion, annually. Health insurance fraud is a type of fraud, in which false or misleading information is provided to a health insurance company in an attempt to have them pay unauthorized benefits to the policy holder‚ another party‚ or the entity providing services. The offence can be committed by the insured individual or the provider of health services.

Most health insurances include specific benefits and health insurance fraud practices, such as overbilling for the type of services received. A central objective of the recent US healthcare policy reform has been to increase access to stable, affordable health insurance. Owing to the aforementioned factors, the review of insurance claims segment is expected to grow exponentially in the US healthcare fraud detection market.

Competitive Landscape

The US healthcare fraud detection market is moderately competitive and consists of several major players. In terms of market share, some of the major players currently dominate the market. With the rising adoption of healthcare IT and an increasing number of fraud cases, few other smaller players are expected to enter into the market in the coming years. Some of the major players in the market are Conduent Inc., DXC Technology Company, EXL (Scio Health Analytics), International Business Machines Corporation (IBM), and Mckesson, among others.

Reasons to Purchase this report:
  • The market estimate (ME) sheet in Excel format
  • 3 months of analyst support

Table of Contents

1.1 Study Deliverables
1.2 Study Assumptions
1.3 Scope of the Study
4.1 Market Overview
4.2 Market Drivers
4.2.1 Increasing Fraudulent Activities in the US Healthcare Sector
4.2.2 Growing Pressure to Increase the Operation Efficiency and Reduce Healthcare Spending
4.2.3 Prepayment Review Model
4.3 Market Restraints
4.3.1 Lack of Skilled Healthcare IT Labors in the Country
4.4 Porter's Five Forces Analysis
4.4.1 Threat of New Entrants
4.4.2 Bargaining Power of Buyers/Consumers
4.4.3 Bargaining Power of Suppliers
4.4.4 Threat of Substitute Products
4.4.5 Intensity of Competitive Rivalry
5.1 By Type
5.1.1 Descriptive Analytics
5.1.2 Predictive Analytics
5.1.3 Prescriptive Analytics
5.2 By Application
5.2.1 Review of Insurance Claims
5.2.2 Payment Integrity
5.3 By End User
5.3.1 Private Insurance Payers
5.3.2 Government Agencies
5.3.3 Other End Users
6.1 Company Profiles
6.1.1 Conduent Inc.
6.1.2 DXC Technology Company
6.1.3 EXL (Scio Health Analytics)
6.1.4 International Business Machines Corporation (IBM)
6.1.5 Mckesson
6.1.6 Northrop Grumman
6.1.7 OSP Labs
6.1.8 SAS Institute
6.1.9 Relx Group PLC (LexisNexis)
6.1.10 United Health Group Incorporated (Optum Inc.)

Companies Mentioned

A selection of companies mentioned in this report includes:

  • Conduent Inc.
  • DXC Technology Company
  • EXL (Scio Health Analytics)
  • International Business Machines Corporation (IBM)
  • Mckesson
  • Northrop Grumman
  • OSP Labs
  • SAS Institute
  • Relx Group PLC (LexisNexis)
  • United Health Group Incorporated (Optum Inc.)