Global Healthcare Fraud Detection Market: Information by Type (Descriptive Analytics, Predictive Analytics and Prescriptive Analytics), by Component (Services and Software), by Delivery Model (On-Premise and Cloud-Based), by Application (Insurance Claims Review and Payment Integrity), by End User (Private Insurance Payers, Public/Government Agencies and Third Party Service Providers) and by Region (North America, Europe, Asia-Pacific and the Middle East & Africa) – Global Trends, Share, Share, Growth, And, Industry, Analysis By 2023
Worldwide Healthcare Fraud Detection Market –Overview
The global healthcare fraud detection market is projected to expand significantly at an astonishing 26.7% CAGR over the estimated years (2018-2023). Healthcare fraud takes places when a healthcare provider or an insured person offers misleading or false information to health insurance companies with an intention to have it paid to another party, individual, healthcare provider or policy holder for unauthorized benefits. Health care fraud comprise of medical fraud, drug fraud and health insurance fraud. Some common examples of such fraud include misrepresenting dates, duration, description of services and frequency, submitting claims for services that is not provided, numerous claims filed for same patients by different providers, data falsification by physicians. Healthcare fraud detection will help to prevent healthcare fraud, abuse and waste.
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Healthcare Fraud Detection is basically a software that utilizing the detection technology in real time, spots the fraudulent who commit/ follow unauthentic billing patterns and trends. Thus saving potential waste and preventing a scam from actually taking place. Altogether, healthcare frauds involve drug frauds, medical insurance frauds, and medicine frauds. Generally, Fraud damages are compensated as per the ‘False Claims Act’.
Attributing to a number of medical scams that have cost further heavily to the organizations; the Healthcare Fraud Detection software perceives a high uptake across the globe. This software, integrating with eHealth, mHealth and HER has been able to decrease communication breach between patients and caregivers. Over the past couple of years, the market is gaining absolutely a phenomenal traction due to the increasing number of care giving facilities (healthcare infrastructures). other factors that contribute the market growth include increasing population, urbanization and improving economic situations in the countries across the globe. Moreover, exploitation of medical funds and more patients seeking medical insurance also steer the market growth. Augmenting demand for controlling the medical expenses across suppliers & hospitals is expected to propel the market growth to an extent.
On the other hand, factors such as constant improvisations, complexities, and technological incompetency would restrict the market growth.
Worldwide Healthcare Fraud Detection Market – Competitive Landscape
Characterized with the presence of numerous small & large players, the market appears to be fiercely competitive & fragmented. Incorporating acquisition, partnership, collaboration, technology launch and expansion, the well established market players gain competitive advantage in the market maintaining their market position. These Players invest substantially in the R&D to develop a technology with unrivalled design and features that is on a completely different level compared to their competition.
February 27, 2018 – Covered California (US) one of the leading global health insurance provider under the Patient Protection and Affordable Care Act; announced that it has ventured into artificial intelligence to validate customer eligibility for subsidies. Which is expected to enhance fraud detection and to foster data quality.
March 18, 2018 – A group of alumni of Stanford University (US) gave a demo to potential investors and media officials giving the glimpse of potential health tech holds to grow hugely in the future.
November 2017 – HHS OIG (Office of Inspector General (Department of Health & Human Services)) in its fiscal year 2019 budget request, requested ~ USD $23 Mn. for additional funding for fraud programs that have historically relied heavily on the use of data analytics.
Worldwide Healthcare Fraud Detection Market – Segmentations
For the convenience of the report and enhanced understanding; the report is segmented in to5 key dynamics
By Components : Comprises Services & Software.
By Types : Predictive Analytics, Descriptive Analytics, Prescriptive Analytics & other.
By End Users : Regulatory or Public Agencies, Employers, Private Insurance Payers, Third Party Services, Insurance Claim Reviews, Payment Integrity, Identity & Case Management among others.
By Delivery Models : On-demand & On-premise.
By Regions : North America, Europe, APAC and Rest of the World.
Segment Services, on the basis of Components has accounted for the largest market share. While, segment ‘Descriptive Analytics’ by Types, accounted for the largest revenue generating segment. Segment Prescriptive, on the contrary, would grow at the maximum rate.
Segment Private Insurance Payers by End-user accounts for the biggest market shares owing to the extensive spending on fraud analytics.
Whereas, owing to its largest uptake & the need for self-driven analytics, segment on-demand by delivery models, is expected to grow at the maximum rate during 2017 to 2023.
Worldwide Healthcare Fraud Detection Market – Geographical Analysis
Attributing to the technological developments, accessibility to products & services, and the emphasis on cost cutting; Americas region accounted for the largest market for Healthcare Fraud Detection. The region is further expected to continue with its dominance followed by the Europe region during the forecast period.
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