The North America Healthcare Fraud Analytics Market would witness market growth of 22.5% CAGR during the forecast period (2022-2028).
A simple numerical study of a surgeon's costs, for instance, may reveal that surgeons are charging far more than his peers, implying that the patient is committing fraud. A more thorough examination, however, may discover that surgeon is qualified to undertake resource- and labor-intensive neuro-surgeries that nobody else in the state can. Many hours of work go into training massive data to avoid false positives. Healthcare and billing processes are always evolving, and historical data that was relevant a few months ago may become obsolete if a specialty undergoes significant changes. Experts in healthcare fraud data analytics, on the other hand, are more than capable of meeting the difficulties of this ever-changing industry.
Computer data analytics programs have advanced tremendously, and fraud detection software is used in a variety of financial sectors. Insurance companies must utilize every instrument at their disposal to enhance profit margins and stay competitive. As part of a wider digital transformation for the twenty-first century, health insurance firms can collaborate with data analytics companies that specialize in healthcare to build cloud computing solutions.
There is a rising healthcare spending, increased implementation of healthcare IT, and an increase in the number of fraud instances. According to the website Consumer Information section of the National Health Care Anti-Fraud Association (NHCAA) updated in 2021, the United States spent multiple trillions on health care each year. According to the NHCAA, health care fraud costs the US economy multiple billions each year, with another multiple billion being deceived and stolen. The actions, as well as the loss of income as a result of fraud and illicit operations, make healthcare fraud the country's most serious problem.
The US market dominated the North America Predictive Analytics Market by Country in 2021, and would continue to be a dominant market till 2028; thereby, achieving a market value of $507.7 million by 2028. The Canada market is experiencing a CAGR of 25.4% during (2022 - 2028). Additionally, The Mexico market would witness a CAGR of 24.3% during (2022 - 2028).
Based on Delivery Model, the market is segmented into On-premise and Cloud. Based on Application, the market is segmented into Insurance Claim Review, Pharmacy billing Issue, Payment Integrity, and Others. Based on End User, the market is segmented into Public & Government Agencies, Private Insurance Payers, Third-party Service Providers, and Employers. Based on Solution Type, the market is segmented into Descriptive Analytics, Predictive Analytics, and Prescriptive Analytics. Based on countries, the market is segmented into U.S., Mexico, Canada, and Rest of North America.
Free Valuable Insights: The Global Healthcare Fraud Analytics Market is Estimated to reach $6.6 Billion by 2028, at a CAGR of 23%
The market research report covers the analysis of key stake holders of the market. Key companies profiled in the report include Wipro Limited, IBM Corporation, DXC Technology Company, SAS Institute, Inc., Conduent, Incorporated, HCL Technologies Ltd., UnitedHealth Group, Inc. (Optum, Inc.), OSP Labs, Cotiviti, Inc., and ExlService Holdings, Inc.
Scope of the Study
Market Segments Covered in the Report:
By Delivery Model
By Application
- Insurance Claim Review
- Pharmacy billing Issue
- Payment Integrity
- Others
By End User
- Public & Government Agencies
- Private Insurance Payers
- Third-party Service Providers
- Employers
By Solution Type
- Descriptive Analytics
- Predictive Analytics
- Prescriptive Analytics
By Country
- US
- Canada
- Mexico
- Rest of North America
Key Market Players
List of Companies Profiled in the Report:
- Wipro Limited
- IBM Corporation
- DXC Technology Company
- SAS Institute, Inc.
- Conduent, Incorporated
- HCL Technologies Ltd.
- UnitedHealth Group, Inc. (Optum, Inc.)
- OSP Labs
- Cotiviti, Inc.
- ExlService Holdings, Inc.
Chapter 1. Market Scope & Methodology
1.1 Market Definition
1.2 Objectives
1.3 Market Scope
1.4 Segmentation
1.4.1 North America Healthcare Fraud Analytics Market, by Delivery Model
1.4.2 North America Healthcare Fraud Analytics Market, by Application
1.4.3 North America Healthcare Fraud Analytics Market, by End User
1.4.4 North America Healthcare Fraud Analytics Market, by Solution Type
1.4.5 North America Healthcare Fraud Analytics Market, by Country
1.5 Methodology for the research
Chapter 2. Market Overview
2.1 Introduction
2.1.1 Overview
2.1.1.1 Market Composition and Scenario
2.2 Key Factors Impacting the Market
2.2.1 Market Drivers
2.2.2 Market Restraints
Chapter 3. Competition Analysis - Global
3.1 Market Share Analysis, 2021
3.2 Strategies Deployed in Healthcare Fraud Analytics Market
Chapter 4. North America Healthcare Fraud Analytics Market by Delivery Model
4.1 North America On-premise Market by Country
4.2 North America Cloud Market by Country
Chapter 5. North America Healthcare Fraud Analytics Market by Application
5.1 North America Insurance Claim Review Market by Country
5.2 North America Pharmacy billing Issue Market by Country
5.3 North America Payment Integrity Market by Country
5.4 North America Others Market by Country
Chapter 6. North America Healthcare Fraud Analytics Market by End User
6.1 North America Public & Government Agencies Market by Country
6.2 North America Private Insurance Payers Market by Country
6.3 North America Third-party Service Providers Market by Country
6.4 North America Employers Market by Country
Chapter 7. North America Healthcare Fraud Analytics Market by Solution Type
7.1 North America Descriptive Analytics Market by Country
7.2 North America Predictive Analytics Market by Country
7.3 North America Prescriptive Analytics Market by Country
Chapter 8. North America Healthcare Fraud Analytics Market by Country
8.1 US Healthcare Fraud Analytics Market
8.1.1 US Healthcare Fraud Analytics Market by Delivery Model
8.1.2 US Healthcare Fraud Analytics Market by Application
8.1.3 US Healthcare Fraud Analytics Market by End User
8.1.4 US Healthcare Fraud Analytics Market by Solution Type
8.2 Canada Healthcare Fraud Analytics Market
8.2.1 Canada Healthcare Fraud Analytics Market by Delivery Model
8.2.2 Canada Healthcare Fraud Analytics Market by Application
8.2.3 Canada Healthcare Fraud Analytics Market by End User
8.2.4 Canada Healthcare Fraud Analytics Market by Solution Type
8.3 Mexico Healthcare Fraud Analytics Market
8.3.1 Mexico Healthcare Fraud Analytics Market by Delivery Model
8.3.2 Mexico Healthcare Fraud Analytics Market by Application
8.3.3 Mexico Healthcare Fraud Analytics Market by End User
8.3.4 Mexico Healthcare Fraud Analytics Market by Solution Type
8.4 Rest of North America Healthcare Fraud Analytics Market
8.4.1 Rest of North America Healthcare Fraud Analytics Market by Delivery Model
8.4.2 Rest of North America Healthcare Fraud Analytics Market by Application
8.4.3 Rest of North America Healthcare Fraud Analytics Market by End User
8.4.4 Rest of North America Healthcare Fraud Analytics Market by Solution Type
Chapter 9. Company Profiles
9.1 Wipro Limited
9.1.1 Company Overview
9.1.2 Financial Analysis
9.1.3 Segmental and Regional Analysis
9.1.4 Research & Development Expenses
9.1.5 Recent strategies and developments:
9.1.5.1 Partnerships, Collaborations, and Agreements:
9.1.5.2 Acquisition and Mergers:
9.2 IBM Corporation
9.2.1 Company Overview
9.2.2 Financial Analysis
9.2.3 Regional & Segmental Analysis
9.2.4 Research & Development Expenses
9.2.5 Recent strategies and developments:
9.2.5.1 Partnerships, Collaborations, and Agreements:
9.2.6 SWOT Analysis
9.3 DXC Technology Company
9.3.1 Company Overview
9.3.2 Financial Analysis
9.3.3 Segmental and Regional Analysis
9.4 SAS Institute, Inc.
9.4.1 Company Overview
9.4.2 Recent strategies and developments:
9.4.2.1 Partnerships, Collaborations, and Agreements:
9.5 Conduent, Incorporated
9.5.1 Company Overview
9.5.2 Financial Analysis
9.5.3 Segmental and Regional Analysis
9.5.4 Research & Development Expense
9.6 HCL Technologies Ltd. (HCL Enterprises)
9.6.1 Company Overview
9.6.2 Financial Analysis
9.6.3 Segmental and Regional Analysis
9.6.4 Research & Development Expense
9.6.5 Recent strategies and developments:
9.6.5.1 Partnerships, Collaborations, and Agreements:
9.7 UnitedHealth Group, Inc. (Optum, Inc.)
9.7.1 Company Overview
9.7.2 Financial Analysis
9.7.3 Segmental Analysis
9.8 OSP Labs
9.8.1 Company Overview
9.9 Cotiviti, Inc.
9.9.1 Company Overview
9.10. ExlService Holdings, Inc.
9.10.1 Company Overview
9.10.2 Financial Analysis
9.10.3 Segmental and Regional Analysis
9.10.4 Research & Development Expenses
9.10.5 Recent strategies and developments:
9.10.5.1 Partnerships, Collaborations, and Agreements:
TABLE 1 North America Healthcare Fraud Analytics Market, 2018 - 2021, USD Million
TABLE 2 North America Healthcare Fraud Analytics Market, 2022 - 2028, USD Million
TABLE 3 North America Healthcare Fraud Analytics Market by Delivery Model, 2018 - 2021, USD Million
TABLE 4 North America Healthcare Fraud Analytics Market by Delivery Model, 2022 - 2028, USD Million
TABLE 5 North America On-premise Market by Country, 2018 - 2021, USD Million
TABLE 6 North America On-premise Market by Country, 2022 - 2028, USD Million
TABLE 7 North America Cloud Market by Country, 2018 - 2021, USD Million
TABLE 8 North America Cloud Market by Country, 2022 - 2028, USD Million
TABLE 9 North America Healthcare Fraud Analytics Market by Application, 2018 - 2021, USD Million
TABLE 10 North America Healthcare Fraud Analytics Market by Application, 2022 - 2028, USD Million
TABLE 11 North America Insurance Claim Review Market by Country, 2018 - 2021, USD Million
TABLE 12 North America Insurance Claim Review Market by Country, 2022 - 2028, USD Million
TABLE 13 North America Pharmacy billing Issue Market by Country, 2018 - 2021, USD Million
TABLE 14 North America Pharmacy billing Issue Market by Country, 2022 - 2028, USD Million
TABLE 15 North America Payment Integrity Market by Country, 2018 - 2021, USD Million
TABLE 16 North America Payment Integrity Market by Country, 2022 - 2028, USD Million
TABLE 17 North America Others Market by Country, 2018 - 2021, USD Million
TABLE 18 North America Others Market by Country, 2022 - 2028, USD Million
TABLE 19 North America Healthcare Fraud Analytics Market by End User, 2018 - 2021, USD Million
TABLE 20 North America Healthcare Fraud Analytics Market by End User, 2022 - 2028, USD Million
TABLE 21 North America Public & Government Agencies Market by Country, 2018 - 2021, USD Million
TABLE 22 North America Public & Government Agencies Market by Country, 2022 - 2028, USD Million
TABLE 23 North America Private Insurance Payers Market by Country, 2018 - 2021, USD Million
TABLE 24 North America Private Insurance Payers Market by Country, 2022 - 2028, USD Million
TABLE 25 North America Third-party Service Providers Market by Country, 2018 - 2021, USD Million
TABLE 26 North America Third-party Service Providers Market by Country, 2022 - 2028, USD Million
TABLE 27 North America Employers Market by Country, 2018 - 2021, USD Million
TABLE 28 North America Employers Market by Country, 2022 - 2028, USD Million
TABLE 29 North America Healthcare Fraud Analytics Market by Solution Type, 2018 - 2021, USD Million
TABLE 30 North America Healthcare Fraud Analytics Market by Solution Type, 2022 - 2028, USD Million
TABLE 31 North America Descriptive Analytics Market by Country, 2018 - 2021, USD Million
TABLE 32 North America Descriptive Analytics Market by Country, 2022 - 2028, USD Million
TABLE 33 North America Predictive Analytics Market by Country, 2018 - 2021, USD Million
TABLE 34 North America Predictive Analytics Market by Country, 2022 - 2028, USD Million
TABLE 35 North America Prescriptive Analytics Market by Country, 2018 - 2021, USD Million
TABLE 36 North America Prescriptive Analytics Market by Country, 2022 - 2028, USD Million
TABLE 37 North America Healthcare Fraud Analytics Market by Country, 2018 - 2021, USD Million
TABLE 38 North America Healthcare Fraud Analytics Market by Country, 2022 - 2028, USD Million
TABLE 39 US Healthcare Fraud Analytics Market, 2018 - 2021, USD Million
TABLE 40 US Healthcare Fraud Analytics Market, 2022 - 2028, USD Million
TABLE 41 US Healthcare Fraud Analytics Market by Delivery Model, 2018 - 2021, USD Million
TABLE 42 US Healthcare Fraud Analytics Market by Delivery Model, 2022 - 2028, USD Million
TABLE 43 US Healthcare Fraud Analytics Market by Application, 2018 - 2021, USD Million
TABLE 44 US Healthcare Fraud Analytics Market by Application, 2022 - 2028, USD Million
TABLE 45 US Healthcare Fraud Analytics Market by End User, 2018 - 2021, USD Million
TABLE 46 US Healthcare Fraud Analytics Market by End User, 2022 - 2028, USD Million
TABLE 47 US Healthcare Fraud Analytics Market by Solution Type, 2018 - 2021, USD Million
TABLE 48 US Healthcare Fraud Analytics Market by Solution Type, 2022 - 2028, USD Million
TABLE 49 Canada Healthcare Fraud Analytics Market, 2018 - 2021, USD Million
TABLE 50 Canada Healthcare Fraud Analytics Market, 2022 - 2028, USD Million
TABLE 51 Canada Healthcare Fraud Analytics Market by Delivery Model, 2018 - 2021, USD Million
TABLE 52 Canada Healthcare Fraud Analytics Market by Delivery Model, 2022 - 2028, USD Million
TABLE 53 Canada Healthcare Fraud Analytics Market by Application, 2018 - 2021, USD Million
TABLE 54 Canada Healthcare Fraud Analytics Market by Application, 2022 - 2028, USD Million
TABLE 55 Canada Healthcare Fraud Analytics Market by End User, 2018 - 2021, USD Million
TABLE 56 Canada Healthcare Fraud Analytics Market by End User, 2022 - 2028, USD Million
TABLE 57 Canada Healthcare Fraud Analytics Market by Solution Type, 2018 - 2021, USD Million
TABLE 58 Canada Healthcare Fraud Analytics Market by Solution Type, 2022 - 2028, USD Million
TABLE 59 Mexico Healthcare Fraud Analytics Market, 2018 - 2021, USD Million
TABLE 60 Mexico Healthcare Fraud Analytics Market, 2022 - 2028, USD Million
TABLE 61 Mexico Healthcare Fraud Analytics Market by Delivery Model, 2018 - 2021, USD Million
TABLE 62 Mexico Healthcare Fraud Analytics Market by Delivery Model, 2022 - 2028, USD Million
TABLE 63 Mexico Healthcare Fraud Analytics Market by Application, 2018 - 2021, USD Million
TABLE 64 Mexico Healthcare Fraud Analytics Market by Application, 2022 - 2028, USD Million
TABLE 65 Mexico Healthcare Fraud Analytics Market by End User, 2018 - 2021, USD Million
TABLE 66 Mexico Healthcare Fraud Analytics Market by End User, 2022 - 2028, USD Million
TABLE 67 Mexico Healthcare Fraud Analytics Market by Solution Type, 2018 - 2021, USD Million
TABLE 68 Mexico Healthcare Fraud Analytics Market by Solution Type, 2022 - 2028, USD Million
TABLE 69 Rest of North America Healthcare Fraud Analytics Market, 2018 - 2021, USD Million
TABLE 70 Rest of North America Healthcare Fraud Analytics Market, 2022 - 2028, USD Million
TABLE 71 Rest of North America Healthcare Fraud Analytics Market by Delivery Model, 2018 - 2021, USD Million
TABLE 72 Rest of North America Healthcare Fraud Analytics Market by Delivery Model, 2022 - 2028, USD Million
TABLE 73 Rest of North America Healthcare Fraud Analytics Market by Application, 2018 - 2021, USD Million
TABLE 74 Rest of North America Healthcare Fraud Analytics Market by Application, 2022 - 2028, USD Million
TABLE 75 Rest of North America Healthcare Fraud Analytics Market by End User, 2018 - 2021, USD Million
TABLE 76 Rest of North America Healthcare Fraud Analytics Market by End User, 2022 - 2028, USD Million
TABLE 77 Rest of North America Healthcare Fraud Analytics Market by Solution Type, 2018 - 2021, USD Million
TABLE 78 Rest of North America Healthcare Fraud Analytics Market by Solution Type, 2022 - 2028, USD Million
TABLE 79 Key Information – Wipro Limited
TABLE 80 Key information – IBM Corporation
TABLE 81 key information – DXC Technology Company
TABLE 82 Key information – SAS Institute, Inc.
TABLE 83 Key Information –Conduent, Incorporated
TABLE 84 Key Information – HCL Technologies Ltd.
TABLE 85 Key Information – UnitedHealth Group, Inc.
TABLE 86 Key Information – OSP Labs
TABLE 87 Key Information – Cotiviti, Inc.
TABLE 88 Key Information – ExlService Holdings, Inc.
List of Figures
FIG 1 Methodology for the research
FIG 2 Market Share Analysis, 2021
FIG 3 Swot analysis: IBM Corporation