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- Global Healthcare Fraud Detection Market – Size, Outlook, Trends and Forecast (2023 – 2030)
The fraud detection solution enables healthcare firms in accounting, and auditing by predictive data methodologies. Healthcare fraud are difficult to detect and are unnoticed, and detection of such fraudulent claims is necessary. The healthcare fraud detection market is expected to reach $2,851.7 Million by 2022 from USD 631.0 Million in 2017, at a CAGR of 28.9%. A large number of fraudulent activities in healthcare and growing pressure of fraud, waste, and abuse of health care spending are the drivers boosting the growth of the market. On the flipside, Reluctance to adopt healthcare fraud analytics in emerging countries, Time-consuming deployment and need for frequent upgrades are the factors hampering the market growth. The emergence of social media and its impact on the healthcare industry and cloud-based analytics are the opportunities for enhancing the growth of the market.
Research Study Objectives:
- Define, estimate, and forecast the Healthcare Fraud Detection market statistics by component, delivery model, type, application, end user and regions concerning the individual growth drivers, market trends and their contribution toward the Healthcare Fraud Detection market growth
- Provides comprehensive information regarding the key factors influencing the market growth (Drivers, Restraints & Challenges, and Opportunities)
- Estimate & forecast the market size of all the segments concerning geographies including North America, Europe, Asia Pacific (APAC), South America and the Middle East and Africa (MEA).
- Recent competitive developments including M&A (Mergers and Acquisitions), Partnerships, and Product Innovations are provided in the Healthcare Fraud Detection Market Analysis
- Analysis and conclusions on the future Healthcare Fraud Detection market outlook.
Top-down and bottom-up approaches are used to validate the Healthcare Fraud Detection Market Size and are used to estimate the size of other dependent submarkets. Key players in the market are identified through various secondary sources; databases including Bloomberg Businessweek, Hoovers, Factiva, journals and associations and the market revenues are estimated and are thoroughly validated through primary and secondary research. Secondary research involves the study of annual and financial reports of top players in the market, whereas primary research includes extensive interviews with the KoL’s such as CEOs, directors, board members, VP’s, sales managers, engineers, marketing executives, technicians, account managers, investors, strategic decision makers and others. The Healthcare Fraud Detection Market shares and breakdowns are determined using secondary sources and are verified by the primary sources. All possible parameters/factors that are affecting the Healthcare Fraud Detection market demand are covered in the research study are verified through primary research, analysed and interpreted to get the final qualitative and quantitative data. This data is collected and added with detailed analysis from Envision Inteligence and presented in this report.
The scope of the Report
The Healthcare Fraud Detection market segmentation is as follows:
By Component
- Software
- Services
By Delivery Model
- On-Premise Delivery Models
- On-Demand Delivery Models
By Type
- Descriptive Analytics
- Predictive Analytics
- Prescriptive Analytics
By Application
- Insurance Claims Review
- Payment Integrity
- Other Applications
By End User
- Private Insurance Payers
- Public/Government Agencies
- Third-Party Service Providers
- Employers
Geographical Analysis:
Healthcare Fraud Detection market is segmented by geography into North America, South America, Europe, APAC and Middle East & Africa. U.S., Canada, Mexico and Costa Rica are analysed under North American region which is usually turning as the hotspot in the market. The South American region is further segregated into Brazil, Argentina, Chile, Columbia and some other emerging economies. In Europe, the market is extensively examined by covering U.K., Germany, France, Italy, Spain, Netherlands, Poland, Switzerland and some other promising economies. APAC is further categorised by countries into China, India, Japan, South Korea, Australia & New Zealand, Malaysia, Singapore and many other emerging nations. In the Middle East & African region, Saudi Arabia, UAE, Iran, Iraq, Qatar, South Africa, Algeria, Morocco, Nigeria and so on countries are evaluated to understand the market growth lucidly.
Customization Options:
With the given research report, Envision Inteligence offers customisations as per the client’s specific requirements. The following customisation options offered for the Healthcare Fraud Detection Market include:
- Scope Revision
- Geographic Analysis
- Company Profiles
- Historical Data & Forecasting
- Key Contact Persons in companies
Global Healthcare Fraud Detection Market Research Report Includes:
- An executive summary condensing the whole report such that essential authority can rapidly twist up doubtlessly acquainted with brief overview and conclusion.
- To have a complete market analysis through industry value chain analysis, Porter’s Five Force Model, PESTLE, SWOT analysis, and Y-o-Y analysis.
- Regional and global diversity is analysed with the major countries and the unions. Scrutinizing the revenue generation on year–on–year
- Identifying DROC in the current market and their impact on altering market dynamics.
- Competitive landscape analysis to identify the merger and acquisition which will have a comparative financial study with significant competitors.
- Expertise investment opportunities by an analyst to the individual and organisation to have a better foothold in the market.
- Identify the latest developments, market shares and strategies that are employed by the significant Healthcare Fraud Detection market players, such as
- IBM Corporation
- Verscend Technologies
- Mckesson Corporation
- Fair Isaac (Fico)
- Wipro Limited
- Along with these companies, many other companies are considered in the report while analysing the Global Healthcare Fraud Detection competitive strategies and environment. These companies held substantial share-owning to the nature of the industry whereas, the rest of the market shares are marginal chunks to regional and local level manufacturers. Other players also have considerable presence owing to its robust brand image, geographical reach and stable customer base.
CHAPTER 1. INTRODUCTION
1.1. Market Definition
1.2. Executive Summary
1.3. The Scope of the Study
CHAPTER 2. RESEARCH METHODOLOGY
2.1. Secondary Research
2.2. Primary Research
2.3. Analytic Tools and Model
2.4. Economic Indicator
2.4.1 Base Year, Base Currency, Forecasting Period
2.5. Expert Validation
2.6. Study Timeline
CHAPTER 3. MARKET ANALYSIS
3.1. Industry Value Chain Analysis
3.2. Porter’s Five Force Analysis
3.2.1. Bargaining Power of Buyers
3.2.2. Bargaining Power of Suppliers
3.2.3. Threats of Substitutes
3.2.4. Threats of New Entrants
3.2.5. Degree of Competition
3.3. PESTLE Analysis
3.3.1. Political
3.3.2. Economical
3.3.3. Social
3.3.4. Technological
3.3.5. Legal
3.3.6. Environmental
3.4. SWOT Analysis
3.4.1. Strengths
3.4.2. Weakness
3.4.3. Opportunities
3.4.4. Threats
3.5. Y-O-Y Analysis
CHAPTER 4. MARKET DYNAMICS
4.1. Market Drivers
4.1.1. A large number of fraudulent activities in healthcare
4.1.2. High returns on investment
4.1.3. Prepayment review mode
4.1.4. Growing pressure of fraud, waste, and abuse on healthcare spending
4.2. Market Restraints & Challenges
4.2.1. Reluctance to adopt healthcare fraud analytics in emerging countries
4.2.2. Time-consuming deployment and need for frequent upgrades
4.3. Market Opportunities
4.3.1. The emergence of social media and its impact on the healthcare industry
4.3.2. Cloud-Based Analytics
CHAPTER 5. GLOBAL HEALTHCARE FRAUD DETECTION MARKET – BY
COMPONENT
5.1. Software
5.2. Services
CHAPTER 6. GLOBAL HEALTHCARE FRAUD DETECTION MARKET – BY
DELIVERY MODEL
6.1. On-Premise Delivery Models
6.2. On-Demand Delivery Models
CHAPTER 7. GLOBAL HEALTHCARE FRAUD DETECTION MARKET – BY TYPE
7.1. Descriptive Analytics
7.2. Predictive Analytics
7.3. Prescriptive Analytics
CHAPTER 8. GLOBAL HEALTHCARE FRAUD DETECTION MARKET – BY
APPLICATION
8.1. Insurance Claims Review
8.2. Payment Integrity
8.3. Other Applications
CHAPTER 9. GLOBAL HEALTHCARE FRAUD DETECTION MARKET – BY END
USER
9.1. Private Insurance Payers
9.2. Public/Government Agencies
9.3. Third-Party Service Providers
9.4. Employers
CHAPTER 10. GLOBAL HEALTHCARE FRAUD DETECTION MARKET – BY
GEOGRAPHY
10.1. Introduction
10.2. North America
10.2.1. U.S.
10.2.2. Canada
10.2.3. Mexico
10.2.4. Costa Rica
10.3. South America
10.3.1. Brazil
10.3.2. Argentina
10.3.3. Chile
10.3.4. Columbia
10.3.5. Others
10.4. Europe
10.4.1. U.K.
10.4.2. Germany
10.4.3. France
10.4.4. Italy
10.4.5. Spain
10.4.6. Russia
10.4.7. Netherlands
10.4.8. Switzerland
10.4.9. Poland
10.4.10. Others
10.5. APAC
10.5.1. China
10.5.2. Japan
10.5.3. India
10.5.4. South Korea
10.5.5. Australia & New Zealand
10.5.6. Malaysia
10.5.7. Singapore
10.5.8. Others
10.6. Middle East & Africa
10.6.1. UAE
10.6.2. Saudi Arabia
10.6.3. Iran
10.6.4. Iraq
10.6.5. Qatar
10.6.6. South Africa
10.6.7. Algeria
10.6.8. Morocco
10.6.9. Nigeria
10.6.10. Egypt
10.6.11. Others
CHAPTER 11. GLOBAL HEALTHCARE FRAUD DETECTION MARKET –
COMPANY PROFILES
11.1 IBM Corporation
11.2 Optum (A Part of UnitedHealth Group)
11.3 Verscend Technologies
11.4 Mckesson Corporation
11.5 Fair Isaac (Fico)
11.6 SAS Institute
11.7 Scio Health Analytics
11.8 Wipro Limited
11.9 Conduent
11.10 HCL Technologies
11.11 CGI Group
11.12 DXC Technology
11.13 Northrop Grumman
11.14 LexisNexis (A Part of Relx Group)
11.15 Pondera Solutions
CHAPTER 12. GLOBAL HEALTHCARE FRAUD DETECTION MARKET –
COMPETITIVE LANDSCAPE
12.1. Market Share Analysis
12.2. Strategies adopted by top companies
12.3. Mergers, Acquisitions, Collaborations & Agreements
CHAPTER 13. MARKET INSIGHTS
13.1. Industry Experts Insights
13.2. Analysts Opinions
13.3. Investment Opportunities
CHAPTER 14. APPENDIX
14.1. List of Tables
12.2. List of Figures
- Competitive Analysis in marketing and strategic management is an assessment of the strengths and weaknesses of current and potential competitors.
- Monitoring the external and internal factors which affect the market dynamics with the aid of PESTLE analysis.
- The Regional and Global Variety is taken care of in the report.
- Year on Year basis generation of revenue is studied.
- Porter's Five Forces analyze the intensity of competition in an industry and its profitability level.
- The overview and the sustainability of the market are analyzed through SWOT.
- DROC (Drivers, Restraints, Opportunities and Challenges) is recognized in the current market scenario and see how its effect on market dynamics.
- The segment-level analysis in terms of type and technology.
- The value chain analysis, value that's created and captured by a company is the profit margin.
- Value Created and Captured – Cost of Creating that Value = Margin
- An executive summary consists of the whole report and the outcome is been given in the report to have brief knowledge about the report.
- Basis on the depth of the study we approach using analytical tools
- Expertise investment opportunities are given after analyzing the market to give the organization and the individual to have perfect knowledge about the market.
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Additional information
Report Type | Extensive Report, Miniature report, Snapshot Report |
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Licence | Single User License, Team License, Corporate License |
The fraud detection solution enables healthcare firms in accounting, and auditing by predictive data methodologies. Healthcare fraud are difficult to detect and are unnoticed, and detection of such fraudulent claims is necessary. The healthcare fraud detection market is expected to reach $2,851.7 Million by 2022 from USD 631.0 Million in 2017, at a CAGR of 28.9%. A large number of fraudulent activities in healthcare and growing pressure of fraud, waste, and abuse of health care spending are the drivers boosting the growth of the market. On the flipside, Reluctance to adopt healthcare fraud analytics in emerging countries, Time-consuming deployment and need for frequent upgrades are the factors hampering the market growth. The emergence of social media and its impact on the healthcare industry and cloud-based analytics are the opportunities for enhancing the growth of the market.
Research Study Objectives:
- Define, estimate, and forecast the Healthcare Fraud Detection market statistics by component, delivery model, type, application, end user and regions concerning the individual growth drivers, market trends and their contribution toward the Healthcare Fraud Detection market growth
- Provides comprehensive information regarding the key factors influencing the market growth (Drivers, Restraints & Challenges, and Opportunities)
- Estimate & forecast the market size of all the segments concerning geographies including North America, Europe, Asia Pacific (APAC), South America and the Middle East and Africa (MEA).
- Recent competitive developments including M&A (Mergers and Acquisitions), Partnerships, and Product Innovations are provided in the Healthcare Fraud Detection Market Analysis
- Analysis and conclusions on the future Healthcare Fraud Detection market outlook.
Top-down and bottom-up approaches are used to validate the Healthcare Fraud Detection Market Size and are used to estimate the size of other dependent submarkets. Key players in the market are identified through various secondary sources; databases including Bloomberg Businessweek, Hoovers, Factiva, journals and associations and the market revenues are estimated and are thoroughly validated through primary and secondary research. Secondary research involves the study of annual and financial reports of top players in the market, whereas primary research includes extensive interviews with the KoL’s such as CEOs, directors, board members, VP’s, sales managers, engineers, marketing executives, technicians, account managers, investors, strategic decision makers and others. The Healthcare Fraud Detection Market shares and breakdowns are determined using secondary sources and are verified by the primary sources. All possible parameters/factors that are affecting the Healthcare Fraud Detection market demand are covered in the research study are verified through primary research, analysed and interpreted to get the final qualitative and quantitative data. This data is collected and added with detailed analysis from Envision Inteligence and presented in this report.
The scope of the Report
The Healthcare Fraud Detection market segmentation is as follows:
By Component
- Software
- Services
By Delivery Model
- On-Premise Delivery Models
- On-Demand Delivery Models
By Type
- Descriptive Analytics
- Predictive Analytics
- Prescriptive Analytics
By Application
- Insurance Claims Review
- Payment Integrity
- Other Applications
By End User
- Private Insurance Payers
- Public/Government Agencies
- Third-Party Service Providers
- Employers
Geographical Analysis:
Healthcare Fraud Detection market is segmented by geography into North America, South America, Europe, APAC and Middle East & Africa. U.S., Canada, Mexico and Costa Rica are analysed under North American region which is usually turning as the hotspot in the market. The South American region is further segregated into Brazil, Argentina, Chile, Columbia and some other emerging economies. In Europe, the market is extensively examined by covering U.K., Germany, France, Italy, Spain, Netherlands, Poland, Switzerland and some other promising economies. APAC is further categorised by countries into China, India, Japan, South Korea, Australia & New Zealand, Malaysia, Singapore and many other emerging nations. In the Middle East & African region, Saudi Arabia, UAE, Iran, Iraq, Qatar, South Africa, Algeria, Morocco, Nigeria and so on countries are evaluated to understand the market growth lucidly.
Customization Options:
With the given research report, Envision Inteligence offers customisations as per the client’s specific requirements. The following customisation options offered for the Healthcare Fraud Detection Market include:
- Scope Revision
- Geographic Analysis
- Company Profiles
- Historical Data & Forecasting
- Key Contact Persons in companies
Global Healthcare Fraud Detection Market Research Report Includes:
- An executive summary condensing the whole report such that essential authority can rapidly twist up doubtlessly acquainted with brief overview and conclusion.
- To have a complete market analysis through industry value chain analysis, Porter’s Five Force Model, PESTLE, SWOT analysis, and Y-o-Y analysis.
- Regional and global diversity is analysed with the major countries and the unions. Scrutinizing the revenue generation on year–on–year
- Identifying DROC in the current market and their impact on altering market dynamics.
- Competitive landscape analysis to identify the merger and acquisition which will have a comparative financial study with significant competitors.
- Expertise investment opportunities by an analyst to the individual and organisation to have a better foothold in the market.
- Identify the latest developments, market shares and strategies that are employed by the significant Healthcare Fraud Detection market players, such as
- IBM Corporation
- Verscend Technologies
- Mckesson Corporation
- Fair Isaac (Fico)
- Wipro Limited
- Along with these companies, many other companies are considered in the report while analysing the Global Healthcare Fraud Detection competitive strategies and environment. These companies held substantial share-owning to the nature of the industry whereas, the rest of the market shares are marginal chunks to regional and local level manufacturers. Other players also have considerable presence owing to its robust brand image, geographical reach and stable customer base.
CHAPTER 1. INTRODUCTION
1.1. Market Definition
1.2. Executive Summary
1.3. The Scope of the Study
CHAPTER 2. RESEARCH METHODOLOGY
2.1. Secondary Research
2.2. Primary Research
2.3. Analytic Tools and Model
2.4. Economic Indicator
2.4.1 Base Year, Base Currency, Forecasting Period
2.5. Expert Validation
2.6. Study Timeline
CHAPTER 3. MARKET ANALYSIS
3.1. Industry Value Chain Analysis
3.2. Porter’s Five Force Analysis
3.2.1. Bargaining Power of Buyers
3.2.2. Bargaining Power of Suppliers
3.2.3. Threats of Substitutes
3.2.4. Threats of New Entrants
3.2.5. Degree of Competition
3.3. PESTLE Analysis
3.3.1. Political
3.3.2. Economical
3.3.3. Social
3.3.4. Technological
3.3.5. Legal
3.3.6. Environmental
3.4. SWOT Analysis
3.4.1. Strengths
3.4.2. Weakness
3.4.3. Opportunities
3.4.4. Threats
3.5. Y-O-Y Analysis
CHAPTER 4. MARKET DYNAMICS
4.1. Market Drivers
4.1.1. A large number of fraudulent activities in healthcare
4.1.2. High returns on investment
4.1.3. Prepayment review mode
4.1.4. Growing pressure of fraud, waste, and abuse on healthcare spending
4.2. Market Restraints & Challenges
4.2.1. Reluctance to adopt healthcare fraud analytics in emerging countries
4.2.2. Time-consuming deployment and need for frequent upgrades
4.3. Market Opportunities
4.3.1. The emergence of social media and its impact on the healthcare industry
4.3.2. Cloud-Based Analytics
CHAPTER 5. GLOBAL HEALTHCARE FRAUD DETECTION MARKET – BY
COMPONENT
5.1. Software
5.2. Services
CHAPTER 6. GLOBAL HEALTHCARE FRAUD DETECTION MARKET – BY
DELIVERY MODEL
6.1. On-Premise Delivery Models
6.2. On-Demand Delivery Models
CHAPTER 7. GLOBAL HEALTHCARE FRAUD DETECTION MARKET – BY TYPE
7.1. Descriptive Analytics
7.2. Predictive Analytics
7.3. Prescriptive Analytics
CHAPTER 8. GLOBAL HEALTHCARE FRAUD DETECTION MARKET – BY
APPLICATION
8.1. Insurance Claims Review
8.2. Payment Integrity
8.3. Other Applications
CHAPTER 9. GLOBAL HEALTHCARE FRAUD DETECTION MARKET – BY END
USER
9.1. Private Insurance Payers
9.2. Public/Government Agencies
9.3. Third-Party Service Providers
9.4. Employers
CHAPTER 10. GLOBAL HEALTHCARE FRAUD DETECTION MARKET – BY
GEOGRAPHY
10.1. Introduction
10.2. North America
10.2.1. U.S.
10.2.2. Canada
10.2.3. Mexico
10.2.4. Costa Rica
10.3. South America
10.3.1. Brazil
10.3.2. Argentina
10.3.3. Chile
10.3.4. Columbia
10.3.5. Others
10.4. Europe
10.4.1. U.K.
10.4.2. Germany
10.4.3. France
10.4.4. Italy
10.4.5. Spain
10.4.6. Russia
10.4.7. Netherlands
10.4.8. Switzerland
10.4.9. Poland
10.4.10. Others
10.5. APAC
10.5.1. China
10.5.2. Japan
10.5.3. India
10.5.4. South Korea
10.5.5. Australia & New Zealand
10.5.6. Malaysia
10.5.7. Singapore
10.5.8. Others
10.6. Middle East & Africa
10.6.1. UAE
10.6.2. Saudi Arabia
10.6.3. Iran
10.6.4. Iraq
10.6.5. Qatar
10.6.6. South Africa
10.6.7. Algeria
10.6.8. Morocco
10.6.9. Nigeria
10.6.10. Egypt
10.6.11. Others
CHAPTER 11. GLOBAL HEALTHCARE FRAUD DETECTION MARKET –
COMPANY PROFILES
11.1 IBM Corporation
11.2 Optum (A Part of UnitedHealth Group)
11.3 Verscend Technologies
11.4 Mckesson Corporation
11.5 Fair Isaac (Fico)
11.6 SAS Institute
11.7 Scio Health Analytics
11.8 Wipro Limited
11.9 Conduent
11.10 HCL Technologies
11.11 CGI Group
11.12 DXC Technology
11.13 Northrop Grumman
11.14 LexisNexis (A Part of Relx Group)
11.15 Pondera Solutions
CHAPTER 12. GLOBAL HEALTHCARE FRAUD DETECTION MARKET –
COMPETITIVE LANDSCAPE
12.1. Market Share Analysis
12.2. Strategies adopted by top companies
12.3. Mergers, Acquisitions, Collaborations & Agreements
CHAPTER 13. MARKET INSIGHTS
13.1. Industry Experts Insights
13.2. Analysts Opinions
13.3. Investment Opportunities
CHAPTER 14. APPENDIX
14.1. List of Tables
12.2. List of Figures
- Competitive Analysis in marketing and strategic management is an assessment of the strengths and weaknesses of current and potential competitors.
- Monitoring the external and internal factors which affect the market dynamics with the aid of PESTLE analysis.
- The Regional and Global Variety is taken care of in the report.
- Year on Year basis generation of revenue is studied.
- Porter's Five Forces analyze the intensity of competition in an industry and its profitability level.
- The overview and the sustainability of the market are analyzed through SWOT.
- DROC (Drivers, Restraints, Opportunities and Challenges) is recognized in the current market scenario and see how its effect on market dynamics.
- The segment-level analysis in terms of type and technology.
- The value chain analysis, value that's created and captured by a company is the profit margin.
- Value Created and Captured – Cost of Creating that Value = Margin
- An executive summary consists of the whole report and the outcome is been given in the report to have brief knowledge about the report.
- Basis on the depth of the study we approach using analytical tools
- Expertise investment opportunities are given after analyzing the market to give the organization and the individual to have perfect knowledge about the market.
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