The Healthcare Fraud Analytics Market is projected to reach USD 4.6 billion by 2025 from USD 1.2 billion in 2020, at a CAGR of 29.8% during the forecast period.
The growth of this market is mainly due to a rise in the number of fraudulent activities in healthcare, combined with the increasing number of patients seeking medical insurance and rising pharmacy claim-related frauds. Emerging markets like APAC and Latin America provide significant growth opportunities in this market.
The prescriptive analytics segment registered the highest growth during the forecast period.
Fraud analytics solutions vary from vendor to vendor. Some vendors offer rule-based models while others offer AI-based technologies, but broadly, these solutions are classified based on the type of analytics used—descriptive analytics, predictive analytics, and prescriptive analytics. The prescriptive analytics segment registered the highest growth in the healthcare fraud analytics market during the forecast period.
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In 2019, public & government agencies accounted for the largest share of the healthcare fraud analytics market, by end user.
Based on end user, the healthcare fraud detection market is segmented into public & government agencies, private insurance payers, employers, and third-party service providers. The public & government agencies segment accounted for the largest share of the healthcare fraud analytics market in 2019.
North America dominated the market in 2019
North America accounted for the largest share of the healthcare fraud analytics market in 2019, followed by Europe. Factors such as the high number of cases of healthcare fraud, including pharmacy-related fraud, favorable government initiatives, technological advancements, and the availability of solutions in this region are some factors contributing to North America’s large share in the global healthcare fraud analytics space.
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IBM Corporation (US), Optum (US), SAS Institute (US), Change Healthcare (US), EXL Service Holdings (US), Cotiviti (US), Wipro Limited (Wipro) (India), Conduent (US), HCL (India), Canadian Global Information Technology Group (Canada), DXC Technology Company (US), Northrop Grumman Corporation (US), LexisNexis Group (US), and Pondera Solutions (US).