Market Details:

The global healthcare fraud detection market is set to grow at nearly 30 percent CAGR during 2017 to 2023 (forecast period). Growth of the industry is attributed to medical scams, heavy returns on investments, and fraudulent pressures. Alongside these factors, exploitation of medical funds and more patients seeking medical insurance also steer the market.

As a whole, healthcare frauds involve drug frauds, medical insurance frauds, and medicine frauds. Health insurance frauds happen when people or firms defraud government medical programs or insurers. The process via which these frauds are committed differ from time to time and the swindlers manage to come up with new ways & means of executing their crimes.

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Fraud damages are generally compensated for, through the adoption of ‘False Claims Act.’ As per an analysis by MRFR (Market Research Future Reports), rising demand for reduction in medical expenses across suppliers & hospitals should drive the need for healthcare fraud detection. With eHealth, mHealth, EHR, and other info-enriched devices, any kind of communication breach between patients and caregivers has decreased.

The said factor has led to the production of massive information, enabling customized therapies and fraud prevention. Normally, patients are apprehensive about the adoption of such fraud detection tools. But, with the amalgamation of human & artificial intelligence, healthcare approaches are further personalized. Hence; the need for healthcare analytics rises, boosting the revenues of healthcare fraud detection.

Industry - Fragmentation:

The healthcare fraud detection market is segmented on the basis of components, kinds, end-users, delivery models, and geographies. Services and software form the components. Predictive analytics, descriptive analytics, and prescriptive analytics constitute the kinds. Some of the end-users consist of employers, regulatory/public agencies, private insurance payers, and third party services.

The remaining comprise payment integrity, insurance claim reviews, and identity & case management. Various delivery models are on-demand and on-premise. Americas, Asia Pacific, Europe, and the Middle East & Africa are the different regional markets.

Sub-Segment Leaders:

By components, services captured the largest shares. With the advent of newer fraud detection software and demand for fraud analytics, services are reported to grow at the maximum CAGR in the forecast period. Among kinds, descriptive analytics produced the largest incomes.

Prescriptive, on the contrary, would grow at the maximum rate. Its growth will owe to it making sure that the synergistic incorporation of prescriptions & predictions is aptly carried out. The end-user, private insurance payers occupied the biggest shares and are coerced into spending on fraud analytics. Their shares arose from significant ‘cost-saving’ prospects and agreement with strict terms & conditions.

By delivery models, on-demand can grow at the maximum rate during 2017 to 2023. On-demand’s huge CAGR is ascribed to more adaptability, the need for self-driven analytics, and shortage of hardware funds. Americas, with regards to regions, led the worldwide healthcare fraud detection market.

This region was followed by Europe and propelled by technological developments, accessibility to products & services, and emphasis on pricing cut backs. While this industry opens novel prospects for many companies, its growth could be hampered by regular improvisations, time-consuming usage, and lack of proficient experts.

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Prominent Market Companies and Innovations

SAS, Optum, IBM, Conduent, Pondera, and Wipro are some of the eminent players operating in the global market. CMS (Centers for Medicare and Medicaid Services), lately, optimized predictive modeling to detect fraud claims prior to them being paid. This cutting-edge technology is akin to what credit card firms adopt to detect fraudulent activities and distrustful conduct. It offers an active anti-fraud solution to the CMS. Some of the growth strategies employed by the above players are product launches and research & development initiatives.



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