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Global Healthcare Fraud Analytics Market (2022-2027) by Type, Delivery Model, Applications, End-Users, Geography, Competitive Analysis and the Impact of Covid-19 with Ansoff Analysis

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  • 188 Pages
  • June 2022
  • Region: Global
  • Infogence Global Research
  • ID: 5635936

In the year 2020, USSC reported 330 health care fraud offenders, who accounted for 77% of all theft, property destruction, and fraud offenses

The Global Healthcare Fraud Analytics Market is estimated to be USD 1.86 Bn in 2022 and is expected to reach USD 5.69 Bn by 2027, growing at a CAGR of 25.06%.

Market Dynamics

Market dynamics are forces that impact the prices and behaviors of the Global Healthcare Fraud Analytics Market stakeholders. These forces create pricing signals which result from the changes in the supply and demand curves for a given product or service. Forces of Market Dynamics may be related to macro-economic and micro-economic factors. There are dynamic market forces other than price, demand, and supply. Human emotions can also drive decisions, influence the market, and create price signals. As the market dynamics impact the supply and demand curves, decision-makers aim to determine the best way to use various financial tools to stem various strategies for speeding the growth and reducing the risks.

Market Segmentations

The Global Healthcare Fraud Analytics Market is segmented based on Type, Delivery Model, Applications, End-Users, and Geography.
  • By Type, the market is classified into Descriptive Analytics, Predictive Analytics, and Prescriptive Analytics.
  • By Delivery Model, the market is classified into On-premise and Cloud.
  • By Applications, the market is classified into Insurance Claims Review, Pharmacy Billing Misuse, Payment Integrity, and Other Applications.
  • By End-Users, the market is classified into Employers, Private Insurance Payers, Public & Government Agencies, and Third-party Service Providers.
  • By Geography, the market is classified into Americas, Europe, Middle-East & Africa and Asia-Pacific.

Company Profiles

The report provides a detailed analysis of the competitors in the market. It covers the financial performance analysis for the publicly listed companies in the market. The report also offers detailed information on the companies' recent development and competitive scenario. Some of the companies covered in this report are CGI Inc., Codoxo, Conduent Inc., Fair Isaac Corp., HCL Technologies Ltd., Optum, Inc. (Unitedhealth Group), SAS Institute Inc., Wipro Ltd., etc.

Countries Studied

  • America (Argentina, Brazil, Canada, Chile, Colombia, Mexico, Peru, United States, Rest of Americas)
  • Europe (Austria, Belgium, Denmark, Finland, France, Germany, Italy, Netherlands, Norway, Poland, Russia, Spain, Sweden, Switzerland, United Kingdom, Rest of Europe)
  • Middle-East and Africa (Egypt, Israel, Qatar, Saudi Arabia, South Africa, United Arab Emirates, Rest of MEA)
  • Asia-Pacific (Australia, Bangladesh, China, India, Indonesia, Japan, Malaysia, Philippines, Singapore, South Korea, Sri Lanka, Thailand, Taiwan, Rest of Asia-Pacific)

Competitive Quadrant

The report includes Competitive Quadrant, a proprietary tool to analyze and evaluate the position of companies based on their Industry Position score and Market Performance score. The tool uses various factors for categorizing the players into four categories. Some of these factors considered for analysis are financial performance over the last 3 years, growth strategies, innovation score, new product launches, investments, growth in market share, etc.

Ansoff Analysis

The report presents a detailed Ansoff matrix analysis for the Global Healthcare Fraud Analytics Market. Ansoff Matrix, also known as Product/Market Expansion Grid, is a strategic tool used to design strategies for the growth of the company. The matrix can be used to evaluate approaches in four strategies viz. Market Development, Market Penetration, Product Development and Diversification. The matrix is also used for risk analysis to understand the risk involved with each approach. The analyst analyses the Global Healthcare Fraud Analytics Market using the Ansoff Matrix to provide the best approaches a company can take to improve its market position. Based on the SWOT analysis conducted on the industry and industry players, the analyst has devised suitable strategies for market growth.

Why buy this report?

  • The report offers a comprehensive evaluation of the Global Healthcare Fraud Analytics Market. The report includes in-depth qualitative analysis, verifiable data from authentic sources, and projections about market size. The projections are calculated using proven research methodologies.
  • The report has been compiled through extensive primary and secondary research. The primary research is done through interviews, surveys, and observation of renowned personnel in the industry.
  • The report includes an in-depth market analysis using Porter's 5 forces model and the Ansoff Matrix. In addition, the impact of Covid-19 on the market is also featured in the report.
  • The report also includes the regulatory scenario in the industry, which will help you make a well-informed decision. The report discusses major regulatory bodies and major rules and regulations imposed on this sector across various geographies.
  • The report also contains the competitive analysis using Positioning Quadrants, the analyst's Proprietary competitive positioning tool.

Report Highlights:

  • A complete analysis of the market, including the parent industry
  • Important market dynamics and trends
  • Market segmentation
  • Historical, current, and projected size of the market based on value and volume
  • Market shares and strategies of key players
  • Recommendations to companies for strengthening their foothold in the market
Frequently Asked Questions about the Global Healthcare Fraud Analytics Market

What is the estimated value of the Global Healthcare Fraud Analytics Market?

The Global Healthcare Fraud Analytics Market was estimated to be valued at $1.86 Billion in 2022.

What is the growth rate of the Global Healthcare Fraud Analytics Market?

The growth rate of the Global Healthcare Fraud Analytics Market is 25.0%, with an estimated value of $5.69 Billion by 2027.

What is the forecasted size of the Global Healthcare Fraud Analytics Market?

The Global Healthcare Fraud Analytics Market is estimated to be worth $5.69 Billion by 2027.

Who are the key companies in the Global Healthcare Fraud Analytics Market?

Key companies in the Global Healthcare Fraud Analytics Market include CGI Inc., Codoxo, Conduent Inc., Cotiviti, Inc., DXC Technology, Exlservice Holdings, Inc., FICO, Fraudlens, Inc., FRISS, Inc. and H2O.ai.

Table of Contents

1 Report Description
1.1 Study Objectives
1.2 Market Definition
1.3 Currency
1.4 Years Considered
1.5 Language
1.6 Key Stakeholders
2 Research Methodology
2.1 Research Process
2.2 Data Collection and Validation
2.2.1 Secondary Research
2.2.2 Primary Research
2.2.3 Models
2.3 Market Size Estimation
2.3.1 Bottom-Up Approach
2.3.2 Top-Down Approach
2.4 Assumptions of the Study
2.5 Limitations of the Study
3 Executive Summary
3.1 Introduction
3.2 Market Size, Segmentations, and Outlook
4 Market Dynamics
4.1 Drivers
4.1.1 Increased Number of Health Insurance
4.1.2 Surge in Demand to Keep Trace of Fraud & Abuse in the Health Care Domain
4.2 Restraints
4.2.1 Limitations in the Data Capturing Process in Medicare Services
4.3 Opportunities
4.3.1 Integration of AI in Healthcare Services and Solutions
4.3.2 Introduction of Healthcare BPO and Fraud Identity Management Software
4.4 Challenges
4.4.1 Lack of Skilled Professionals
4.4.2 Time-consuming Deployment and the Need for Frequent Upgrades
5 Market Analysis
5.1 Regulatory Scenario
5.2 Porter's Five Forces Analysis
5.3 Impact of COVID-19
5.4 Ansoff Matrix Analysis
6 Global Healthcare Fraud Analytics Market, By Type
6.1 Introduction
6.2 Descriptive Analytics
6.3 Predictive Analytics
6.4 Prescriptive Analytics
7 Global Healthcare Fraud Analytics Market, By Delivery Model
7.1 Introduction
7.2 On-premise
7.3 Cloud
8 Global Healthcare Fraud Analytics Market, By Applications
8.1 Introduction
8.2 Insurance Claims Review
8.2.1 Post Payment Review
8.2.2 Prepayment Review
8.3 Pharmacy Billing Misuse
8.4 Payment Integrity
8.5 Other Applications
9 Global Healthcare Fraud Analytics Market, By End-Users
9.1 Introduction
9.2 Employers
9.3 Private Insurance Payers
9.4 Public & Government Agencies
9.5 Third-party Service Providers
10 Americas’ Healthcare Fraud Analytics Market
10.1 Introduction
10.2 Argentina
10.3 Brazil
10.4 Canada
10.5 Chile
10.6 Colombia
10.7 Mexico
10.8 Peru
10.9 United States
10.10 Rest of Americas
11 Europe’s Healthcare Fraud Analytics Market
11.1 Introduction
11.2 Austria
11.3 Belgium
11.4 Denmark
11.5 Finland
11.6 France
11.7 Germany
11.8 Italy
11.9 Netherlands
11.10 Norway
11.11 Poland
11.12 Russia
11.13 Spain
11.14 Sweden
11.15 Switzerland
11.16 United Kingdom
11.17 Rest of Europe
12 Middle East and Africa’s Healthcare Fraud Analytics Market
12.1 Introduction
12.2 Egypt
12.3 Israel
12.4 Qatar
12.5 Saudi Arabia
12.6 South Africa
12.7 United Arab Emirates
12.8 Rest of MEA
13 APAC’s Healthcare Fraud Analytics Market
13.1 Introduction
13.2 Australia
13.3 Bangladesh
13.4 China
13.5 India
13.6 Indonesia
13.7 Japan
13.8 Malaysia
13.9 Philippines
13.10 Singapore
13.11 South Korea
13.12 Sri Lanka
13.13 Thailand
13.14 Taiwan
13.15 Rest of Asia-Pacific
14 Competitive Landscape
14.1 Competitive Quadrant
14.2 Market Share Analysis
14.3 Strategic Initiatives
14.3.1 M&A and Investments
14.3.2 Partnerships and Collaborations
14.3.3 Product Developments and Improvements
15 Company Profiles
15.1 CGI Inc.
15.2 Codoxo
15.3 Conduent Inc.
15.4 Cotiviti, Inc.
15.5 DXC Technology
15.6 Exlservice Holdings, Inc.
15.7 FICO
15.8 Fraudlens, Inc.
15.9 FRISS, Inc.
15.10 H2O.ai
15.11 HCL Technologies Ltd.
15.12 Healthcare Fraud Shield
15.13 HMS Holdings Corp.
15.14 IBM Corp.
15.15 LexisNexis (Relx Group)
15.16 Multiplan
15.17 Northrop Grumman Corp.
15.18 Optum, Inc. (UnitedHealth Group)
15.19 OSP Labs
15.20 Pondera Solutions, Inc. (Thomson Reuters Corp)
15.21 Qlarant, Inc.
15.22 SAS Institute Inc.
15.23 Sharecare, Inc. (Falcon Capital Acquisition Corp.)
15.24 Wipro Ltd.
16 Appendix
16.1 Questionnaire

Companies Mentioned

  • CGI Inc.
  • Codoxo
  • Conduent Inc.
  • Cotiviti, Inc.
  • DXC Technology
  • Exlservice Holdings, Inc.
  • FICO
  • Fraudlens, Inc.
  • FRISS, Inc.
  • H2O.ai
  • HCL Technologies Ltd.
  • Healthcare Fraud Shield
  • HMS Holdings Corp.
  • IBM Corp.
  • LexisNexis (Relx Group)
  • Multiplan
  • Northrop Grumman Corp.
  • Optum, Inc.(UnitedHealth Group)
  • OSP Labs
  • Pondera Solutions, Inc.(Thomson Reuters Corp)
  • Qlarant, Inc.
  • SAS Institute Inc.
  • Sharecare, Inc.(Falcon Capital Acquisition Corp.)
  • Wipro Ltd.