医療詐欺分析市場

出版：MarketsandMarkets（マーケッツアンドマーケッツ）　出版年月：2021年10月

医療詐欺分析市場：ソリューションタイプ（記述的、予測的、規範的）、用途（保険金請求、支払いの整合性）、配信（オンプレミス、クラウド）、エンドユーザー（政府、雇用者、支払者）、COVID-19Impac – 2026年までの世界予測

Healthcare Fraud Analytics Market by Solution Type (Descriptive, Predictive, Prescriptive), Application (Insurance Claim, Payment Integrity), Delivery (On-premise, Cloud), End User (Government, Employers, Payers), COVID-19 Impac – Global Forecast to 2026

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The global healthcare fraud analytics market is projected to reach USD 5.0 billion by 2026 from USD 1.5 billion in 2021, at a CAGR of 26.7% during the forecast period. Market growth can be attributed to a large number of fraudulent activities in healthcare, increasing number of patients seeking health insurance, high returns on investment, and the rising number of pharmacy claims-related frauds. However, the dearth of skilled personnel is expected to restrain the growth of this market.

The on-demand segment is expected to grow at the highest CAGR during the forecast period
On the basis of delivery model, the healthcare fraud analytics market is segmented into on-premise and on-demand models. The on-demand models include the cloud-based and web-based models. The on-demand segment is projected to register the highest CAGR during the forecast period. Factors such as on-demand self-serving analytics, the lack of up-front capital investments for hardware, extreme capacity flexibility, and a pay-as-you-go pricing model are driving the demand for on-demand fraud detection solutions.
The prepayment review model segment is projected to witness the highest growth during the forecast period
On the basis of application, the healthcare fraud analytics market is segmented into insurance claims review, pharmacy billing misuse, payment integrity, and other applications. The insurance claims review segment is further divided into postpayment and prepayment review, with the latter expected to register the highest growth during the forecast period. This is mainly because the use of prepayment review protocols and analytics can help organizations proactively prevent fraud prior to payment, allowing rapid action to be taken. As a result, prepayment review solutions are expected to garner greater attention in the coming years.
North America accounted for the largest share of the healthcare fraud analytics market
The healthcare fraud analytics market is segmented into five major regions, namely, North America, Europe, Asia, Pacific, Latin America, and the Middle East & Africa. North America accounted for the largest share of this market in 2020 majorly due to the high penetration of health insurance in the region, high number of healthcare fraud cases, favorable government initiatives to combat healthcare fraud, and wider product and service availability in this region. Moreover, a majority of leading players in the healthcare fraud analytics market have their headquarters in North America
Break of primary participants was as mentioned below:
•By Company Type – Tier 1–45%, Tier 2–18%, and Tier 3–37%
•By Designation – C-level–35%, Director-level–50%, Others–15%
•By Region – North America–60%, Europe–22%, Asia–13%, Latin America- 3%, Middle East and Africa–2%

Key players in the Healthcare Fraud Analytics market
Major players in this market include IBM Corporation (US), Optum, Inc. (US), Cotiviti, Inc. (US), Change Healthcare (US), Fair Isaac Corporation (US), SAS Institute Inc. (US), EXLService Holdings, Inc. (US), Wipro Limited (India), Conduent, Incorporated (US), CGI Inc. (Canada), HCL Technologies Limited (India), Qlarant, Inc. (US), DXC Technology (US), Northrop Grumman Corporation (US), LexisNexis (US), Healthcare Fraud Shield (US), Sharecare, Inc. (US), FraudLens, Inc. (US), HMS Holding Corp. (US), Codoxo (US), H20.ai (US), Pondera Solutions, Inc. (US), FRISS (The Netherlands), Multiplan (US), FraudScope (US), and OSP Labs (US).
Research Coverage:
The report analyzes the healthcare fraud analytics market and aims at estimating the market size and future growth potential of this market based on various segments such as solution type, application, delivery model, end user, and region. The report also includes a product portfolio matrix of various healthcare fraud analytic solutions available in the market. The report also provides a competitive analysis of the key players in this market, along with their company profiles, product & service offerings, and key market strategies.
Reasons to Buy the Report
The report will enrich established firms as well as new entrants/smaller firms to gauge the pulse of the market, which in turn would help them, garner a more significant share of the market. Firms purchasing the report could use one or any combination of the below-mentioned strategies to strengthen their position in the market.

This report provides insights into the following pointers:
•Market Penetration: Comprehensive information on product portfolios offered by the top players in the global healthcare fraud analytics market. The report analyzes this market by solution type, application, delivery model, and end user
•Solution Enhancement/Innovation: Detailed insights on upcoming trends and solution launches in the global healthcare fraud analytics market
•Market Development: Comprehensive information on the lucrative emerging markets by products and services, and end user
•Market Diversification: Exhaustive information about new solutions or service enhancements, growing geographies, recent developments, and investments in the global healthcare fraud analytics market
•Competitive Assessment: In-depth assessment of market shares, growth strategies, solution offerings, competitive leadership mapping, and capabilities of leading players in the global healthcare fraud analytics market.

目次

1INTRODUCTION22
1.1OBJECTIVES OF THE STUDY22
1.2MARKET DEFINITION & SCOPE22
1.2.1INCLUSIONS & EXCLUSIONS OF THE STUDY23
1.2.2MARKET SEGMENTATION24
FIGURE 1HEALTHCARE FRAUD ANALYTICS MARKET SEGMENTATION24
1.2.3YEARS CONSIDERED FOR THE STUDY24
1.3CURRENCY25
TABLE 1EXCHANGE RATES UTILIZED FOR CONVERSION TO USD25
1.4LIMITATIONS25
1.5STAKEHOLDERS25
2RESEARCH METHODOLOGY26
2.1RESEARCH APPROACH26
FIGURE 2RESEARCH DESIGN26
2.1.1SECONDARY SOURCES27
2.1.1.1Key data from secondary sources28
2.1.2PRIMARY SOURCES28
TABLE 2LIST OF STAKEHOLDERS INTERVIEWED FOR THE STUDY28
2.1.2.1Key data from primary sources29
FIGURE 3BREAKDOWN OF PRIMARY INTERVIEWS: BY COMPANY TYPE, DESIGNATION, AND REGION29
2.2MARKET SIZE ESTIMATION30
2.3MARKET BREAKDOWN AND DATA TRIANGULATION32
FIGURE 4DATA TRIANGULATION METHODOLOGY32
2.4ASSUMPTIONS FOR THE STUDY33
3EXECUTIVE SUMMARY34
FIGURE 5HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2021 VS. 2026 (USD MILLION)34
FIGURE 6HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL,
2021 VS. 2026 (USD MILLION)35
FIGURE 7HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2021 VS. 2026 (USD MILLION)35
FIGURE 8HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2021 VS. 2026 (USD MILLION)36
FIGURE 9GEOGRAPHICAL SNAPSHOT OF THE HEALTHCARE FRAUD ANALYTICS MARKET37
 
4PREMIUM INSIGHTS38
4.1HEALTHCARE FRAUD ANALYTICS MARKET OVERVIEW38
FIGURE 10LARGE NUMBER OF FRAUDULENT ACTIVITIES IN HEALTHCARE TO DRIVE MARKET GROWTH38
4.2ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE AND COUNTRY39
FIGURE 11DESCRIPTIVE ANALYTICS SEGMENT ACCOUNTED FOR THE LARGEST SHARE OF THE ASIAN HEALTHCARE FRAUD ANALYTICS MARKET IN 202039
4.3HEALTHCARE FRAUD ANALYTICS MARKET: GEOGRAPHIC GROWTH OPPORTUNITIES40
FIGURE 12US TO REGISTER THE HIGHEST REVENUE GROWTH DURING FORECAST PERIOD40
4.4HEALTHCARE FRAUD ANALYTICS MARKET: REGIONAL MIX40
FIGURE 13NORTH AMERICA WILL CONTINUE TO DOMINATE THE MARKET IN 202640
4.5HEALTHCARE FRAUD ANALYTICS MARKET: DEVELOPING VS. DEVELOPED REGIONS41
FIGURE 14DEVELOPED MARKETS TO REGISTER HIGHER GROWTH DURING FORECAST PERIOD41
5MARKET OVERVIEW42
5.1INTRODUCTION42
5.2MARKET DYNAMICS42
FIGURE 15HEALTHCARE FRAUD ANALYTICS MARKET: DRIVERS, RESTRAINTS, OPPORTUNITIES, AND CHALLENGES42
5.2.1DRIVERS43
5.2.1.1Large number of fraudulent activities in healthcare43
FIGURE 16US NATIONAL HEALTHCARE FRAUD AND OPIOID TAKEDOWN TRENDS43
FIGURE 17INCIDENCE OF FRAUDULENT CLAIMS—GLOBAL SCENARIO (2019)44
5.2.1.2Increased number of patients seeking health insurance44
5.2.1.3Prepayment review model45
5.2.1.4High returns on investment45
5.2.1.5Rise in pharmacy claims-related fraud45
5.2.2RESTRAINTS45
5.2.2.1Limitations in the data capturing process in Medicaid services45
5.2.3OPPORTUNITIES46
5.2.3.1Adoption of healthcare fraud analytics in developing countries46
5.2.3.2Emergence of social media and its impact on the healthcare industry46
5.2.3.3Role of AI in healthcare fraud detection46
5.2.4CHALLENGES47
5.2.4.1Dearth of skilled personnel47
5.2.4.2Time-consuming deployment and the need for frequent upgrades47
6INDUSTRY INSIGHTS48
6.1INDUSTRY TRENDS48
6.1.1SHIFTING FOCUS FROM ON-PREMISE MODELS TO CLOUD-BASED ON-DEMAND MODELS48
6.1.2MERGERS AND ACQUISITIONS: THE MOST ADOPTED STRATEGY48
FIGURE 18MAJOR MERGERS AND ACQUISITIONS IN THE HEALTHCARE FRAUD ANALYTICS MARKET48
6.1.3TECHNOLOGICAL ADVANCEMENTS49
TABLE 3COMPANIES OFFERING INNOVATIVE FRAUD ANALYTICS SOLUTIONS49
6.1.4NEW USE CASE: OPIOID EPIDEMIC CRISIS50
6.1.5END-USER TRENDS: ADOPTION OF HEALTHCARE FRAUD ANALYTICS SOLUTIONS BY PHARMACY BENEFIT MANAGERS50
7HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE51
7.1INTRODUCTION52
TABLE 4HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)52
7.2DESCRIPTIVE ANALYTICS52
7.2.1DESCRIPTIVE ANALYTICS SEGMENT ACCOUNTED FOR THE LARGEST MARKET SHARE52
TABLE 5DESCRIPTIVE ANALYTICS SOLUTIONS FOR HEALTHCARE FRAUD DETECTION53
TABLE 6DESCRIPTIVE ANALYTICS MARKET, BY REGION, 2019–2026 (USD MILLION)53
TABLE 7DESCRIPTIVE ANALYTICS MARKET, BY COUNTRY, 2019–2026 (USD MILLION)54
7.3PREDICTIVE ANALYTICS54
7.3.1PREDICTIVE ANALYTICS HELPS IN SIMULATING FUTURE EVENTS AND TRENDS THAT CAN ENABLE PAYERS TO PREDICT PREVENTABLE EVENTS54
TABLE 8PREDICTIVE ANALYTICS SOLUTIONS FOR HEALTHCARE FRAUD DETECTION55
TABLE 9PREDICTIVE ANALYTICS MARKET, BY REGION, 2019–2026 (USD MILLION)55
TABLE 10PREDICTIVE ANALYTICS MARKET, BY COUNTRY, 2019–2026 (USD MILLION)56
7.4PRESCRIPTIVE ANALYTICS56
7.4.1PRESCRIPTIVE MODELS OFFER ADDITIONAL ADVANTAGES RELATING TO THE INVESTIGATION OF SUSPICIOUS BEHAVIOR TO GENERATE COMPREHENSIVE INSIGHTS56
TABLE 11PRESCRIPTIVE ANALYTICS SOLUTIONS FOR HEALTHCARE FRAUD DETECTION57
TABLE 12PRESCRIPTIVE ANALYTICS MARKET, BY REGION, 2019–2026 (USD MILLION)57
TABLE 13PRESCRIPTIVE ANALYTICS MARKET, BY COUNTRY, 2019–2026 (USD MILLION)57
8HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL58
8.1INTRODUCTION59
TABLE 14HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL,
2019–2026 (USD MILLION)59
8.2ON-PREMISE DELIVERY MODELS59
8.2.1ON-PREMISE MODELS ACCOUNT FOR THE LARGEST SHARE OF THE MARKET59
TABLE 15KEY VENDORS OFFERING ON-PREMISE SOLUTIONS IN THE MARKET60
TABLE 16HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-PREMISE DELIVERY MODEL, BY REGION, 2019–2026 (USD MILLION)60
TABLE 17HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-PREMISE DELIVERY MODEL, BY COUNTRY, 2019–2026 (USD MILLION)61
 
8.3ON-DEMAND DELIVERY MODELS61
8.3.1CLOUD-BASED DELIVERY MODELS OFFER ORGANIZATIONS INCREASED SCALABILITY AND SPEED61
TABLE 18KEY VENDORS PROVIDING ON-DEMAND SOLUTIONS62
TABLE 19HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-DEMAND DELIVERY MODEL, BY REGION, 2019–2026 (USD MILLION)62
TABLE 20HEALTHCARE FRAUD ANALYTICS MARKET FOR ON-DEMAND DELIVERY MODEL, BY COUNTRY, 2019–2026 (USD MILLION)63
9HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION64
9.1INTRODUCTION65
TABLE 21HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)65
9.2INSURANCE CLAIMS REVIEW65
TABLE 22DEPLOYMENT OF PREPAYMENT VS. POSTPAYMENT ANALYTICS SYSTEMS66
TABLE 23HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)66
TABLE 24HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY REGION, 2019–2026 (USD MILLION)66
TABLE 25HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY COUNTRY, 2019–2026 (USD MILLION)67
9.2.1POSTPAYMENT REVIEW67
9.2.1.1Postpayment review dominates the healthcare fraud analytics insurance claims review market67
TABLE 26HEALTHCARE FRAUD ANALYTICS MARKET FOR POSTPAYMENT CLAIMS REVIEW, BY REGION, 2019–2026 (USD MILLION)68
TABLE 27HEALTHCARE FRAUD ANALYTICS MARKET FOR POSTPAYMENT CLAIMS REVIEW, BY COUNTRY, 2019–2026 (USD MILLION)68
9.2.2PREPAYMENT REVIEW69
9.2.2.1The majority of prepayment models use predictive analytics to detect fraud and stop fraudulent claims payments69
TABLE 28HEALTHCARE FRAUD ANALYTICS MARKET FOR PREPAYMENT CLAIMS REVIEW, BY REGION, 2019–2026 (USD MILLION)69
TABLE 29HEALTHCARE FRAUD ANALYTICS MARKET FOR PREPAYMENT CLAIMS REVIEW, BY COUNTRY, 2019–2026 (USD MILLION)70
9.3PHARMACY BILLING MISUSE70
9.3.1FRAUD, WASTE, AND ABUSE CASES IN PHARMACY AND PRESCRIPTION DRUG AREAS TO DRIVE THE DEMAND FOR ANALYTICS70
TABLE 30HEALTHCARE FRAUD ANALYTICS MARKET FOR PHARMACY BILLING MISUSE APPLICATION, BY REGION, 2019–2026 (USD MILLION)71
TABLE 31HEALTHCARE FRAUD ANALYTICS MARKET FOR PHARMACY BILLING MISUSE APPLICATION, BY COUNTRY, 2019–2026 (USD MILLION)71
9.4PAYMENT INTEGRITY72
9.4.1CHANGES IN REGULATORY GUIDELINES HAVE AIDED THE ADOPTION OF PAYMENT INTEGRITY SOFTWARE72
TABLE 32HEALTHCARE FRAUD ANALYTICS MARKET FOR PAYMENT INTEGRITY APPLICATION, BY REGION, 2019–2026 (USD MILLION)72
TABLE 33HEALTHCARE FRAUD ANALYTICS MARKET FOR PAYMENT INTEGRITY APPLICATION, BY COUNTRY, 2019–2026 (USD MILLION)73
9.5OTHER APPLICATIONS73
TABLE 34HEALTHCARE FRAUD ANALYTICS MARKET FOR OTHER APPLICATION,
BY REGION, 2019–2026 (USD MILLION)74
TABLE 35HEALTHCARE FRAUD ANALYTICS MARKET FOR OTHER APPLICATIONS,
BY COUNTRY, 2019–2026 (USD MILLION)74
10HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER75
10.1INTRODUCTION76
TABLE 36HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)76
10.2PUBLIC & GOVERNMENT AGENCIES76
10.2.1PUBLIC & GOVERNMENT AGENCIES DOMINATE THE HEALTHCARE FRAUD ANALYTICS MARKET76
TABLE 37HEALTHCARE FRAUD ANALYTICS MARKET FOR PUBLIC & GOVERNMENT AGENCIES, BY REGION, 2019–2026 (USD MILLION)77
TABLE 38HEALTHCARE FRAUD ANALYTICS MARKET FOR PUBLIC & GOVERNMENT AGENCIES, BY COUNTRY, 2019–2026 (USD MILLION)77
10.3PRIVATE INSURANCE PAYERS78
10.3.1PRIVATE INSURANCE PAYERS ARE FOCUSED ON DEPLOYING ANALYTICS TO COMBAT INCREASING MONETARY LOSSES78
TABLE 39HEALTHCARE FRAUD ANALYTICS MARKET FOR PRIVATE INSURANCE PAYERS, BY REGION, 2019–2026 (USD MILLION)78
TABLE 40HEALTHCARE FRAUD ANALYTICS MARKET FOR PRIVATE INSURANCE PAYERS, BY COUNTRY, 2019–2026 (USD MILLION)79
10.4THIRD-PARTY SERVICE PROVIDERS79
10.4.1ADOPTION OF FRAUD ANALYTICS SOLUTIONS BY PUBLIC INSURERS PUTS PRIVATE BODIES AT RISK, DRIVING ATTENTION TOWARD OUTSOURCING79
TABLE 41HEALTHCARE FRAUD ANALYTICS MARKET FOR THIRD-PARTY SERVICE PROVIDERS, BY REGION, 2019–2026 (USD MILLION)80
TABLE 42HEALTHCARE FRAUD ANALYTICS MARKET FOR THIRD-PARTY SERVICE PROVIDERS, BY COUNTRY, 2019–2026 (USD MILLION)80
10.5EMPLOYERS81
10.5.1EMPLOYERS ARE CONSIDERING FRAUD ANALYTICS SOLUTIONS AS A STEP TOWARD BETTER COST MANAGEMENT81
TABLE 43HEALTHCARE FRAUD ANALYTICS MARKET FOR EMPLOYERS, BY REGION, 2019–2026 (USD MILLION)81
TABLE 44HEALTHCARE FRAUD ANALYTICS MARKET FOR EMPLOYERS, BY COUNTRY, 2019–2026 (USD MILLION)82
11HEALTHCARE FRAUD ANALYTICS MARKET, BY REGION83
11.1INTRODUCTION84
TABLE 45HEALTHCARE FRAUD ANALYTICS MARKET, BY REGION,
2019–2026 (USD MILLION)84
11.2NORTH AMERICA84
FIGURE 19NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET SNAPSHOT85
TABLE 46NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY COUNTRY, 2019–2026 (USD MILLION)85
TABLE 47NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)86
TABLE 48NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)86
TABLE 49NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET,
BY APPLICATION, 2019–2026 (USD MILLION)86
TABLE 50NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)87
TABLE 51NORTH AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)87
11.2.1US87
11.2.1.1US dominates the global healthcare fraud analytics market87
TABLE 52US: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL,
2019–2026 (USD MILLION)88
TABLE 53US: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)88
TABLE 54US: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)89
TABLE 55US: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)89
TABLE 56US: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)89
11.2.2CANADA90
11.2.2.1Growing adoption of data-crunching technologies like predictive analytics to drive market growth90
TABLE 57CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)90
TABLE 58CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)90
TABLE 59CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)91
TABLE 60CANADA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)91
TABLE 61CANADA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)91
11.3EUROPE92
TABLE 62LIST OF SOME OF THE EHFCN MEMBER ORGANIZATIONS ACROSS EUROPE92
TABLE 63EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY COUNTRY,
2019–2026 (USD MILLION)93
TABLE 64EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)93
TABLE 65EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)93
TABLE 66EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)94
TABLE 67EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)94
TABLE 68EUROPE: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)94
11.3.1GERMANY95
11.3.1.1Germany is the fastest-growing market for healthcare fraud analytics solutions in Europe95
TABLE 69GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)95
TABLE 70GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)96
TABLE 71GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)96
TABLE 72GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)96
TABLE 73GERMANY: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)97
11.3.2UK97
11.3.2.1Launch of initiatives such as NHSCFA will support the market for fraud analytics solutions in the UK97
TABLE 74UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL,
2019–2026 (USD MILLION)98
TABLE 75UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)98
TABLE 76UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)98
TABLE 77UK: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)99
TABLE 78UK: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)99
11.3.3FRANCE99
11.3.3.1Increasing adoption of information technology for the detection of healthcare fraud—a key factor driving market growth99
TABLE 79FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)100
TABLE 80FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)100
TABLE 81FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)100
TABLE 82FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)101
TABLE 83FRANCE: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)101
11.3.4ITALY101
11.3.4.1Increasing government support for the adoption of fraud analytics solutions101
TABLE 84ITALY: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)102
TABLE 85ITALY: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)102
TABLE 86ITALY: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)102
TABLE 87ITALY: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)103
TABLE 88ITALY: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)103
11.3.5SPAIN103
11.3.5.1Advanced healthcare infrastructure to propel the adoption of innovative technologies like fraud analytics103
TABLE 89SPAIN: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)104
TABLE 90SPAIN: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)104
TABLE 91SPAIN: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)104
TABLE 92SPAIN: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)105
TABLE 93SPAIN: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)105
11.3.6REST OF EUROPE105
TABLE 94ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL,
2019–2026 (USD MILLION)106
TABLE 95ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)106
TABLE 96ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)106
TABLE 97ROE: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)107
TABLE 98ROE: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)107
11.4ASIA107
FIGURE 20ASIA PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET SNAPSHOT108
TABLE 99ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY COUNTRY,
2019–2026 (USD MILLION)108
TABLE 100ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL,
2019–2026 (USD MILLION)109
TABLE 101ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)109
TABLE 102ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)109
TABLE 103ASIA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)110
TABLE 104ASIA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)110
11.4.1JAPAN110
11.4.1.1Increasing fraud cases in medical billing to drive market growth110
TABLE 105JAPAN: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)111
TABLE 106JAPAN: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)111
TABLE 107JAPAN: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)111
TABLE 108JAPAN: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)112
TABLE 109JAPAN: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)112
11.4.2CHINA112
11.4.2.1Growing need for advanced healthcare systems for a better outcome to drive the demand for fraud analytics solutions112
TABLE 110CHINA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)113
TABLE 111CHINA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)113
TABLE 112CHINA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)113
TABLE 113CHINA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)114
TABLE 114CHINA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)114
11.4.3ROA114
11.4.3.1Increasing initiatives for establishing healthcare IT solutions to support market growth114
TABLE 115ROA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL,
2019–2026 (USD MILLION)115
TABLE 116ROA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)115
TABLE 117ROA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)115
TABLE 118ROA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)116
TABLE 119ROA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)116
11.5PACIFIC116
11.5.1GROWING NEED FOR INSURANCE COVERAGES AND MEDICAL CLAIMS TO DRIVE MARKET GROWTH116
TABLE 120PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)117
TABLE 121PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)117
TABLE 122PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)117
TABLE 123PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)118
TABLE 124PACIFIC: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)118
 
11.6LATIN AMERICA118
11.6.1INCREASING PENETRATION OF HEALTH INSURANCE TO DRIVE VOLUME OF CLAIMS PROCESSING IN LATIN AMERICAN COUNTRIES118
TABLE 125LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL, 2019–2026 (USD MILLION)118
TABLE 126LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE, 2019–2026 (USD MILLION)119
TABLE 127LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION, 2019–2026 (USD MILLION)119
TABLE 128LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)119
TABLE 129LATIN AMERICA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER, 2019–2026 (USD MILLION)120
11.7MIDDLE EAST & AFRICA120
11.7.1HEALTHCARE FRAUD IS ONE OF THE LEADING CRIMES IN SOUTH AFRICA120
TABLE 130MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY DELIVERY MODEL,
2019–2026 (USD MILLION)121
TABLE 131MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY SOLUTION TYPE,
2019–2026 (USD MILLION)121
TABLE 132MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION,
2019–2026 (USD MILLION)121
TABLE 133MEA: HEALTHCARE FRAUD ANALYTICS MARKET FOR INSURANCE CLAIMS REVIEW, BY TYPE, 2019–2026 (USD MILLION)122
TABLE 134MEA: HEALTHCARE FRAUD ANALYTICS MARKET, BY END USER,
2019–2026 (USD MILLION)122
12COMPETITIVE LANDSCAPE123
12.1INTRODUCTION123
FIGURE 21KEY DEVELOPMENTS IN THE HEALTHCARE FRAUD ANALYTICS MARKET BETWEEN JANUARY 2018 AND AUGUST 2021124
12.2COMPETITIVE SITUATION AND TRENDS125
12.2.1DEALS125
TABLE 135DEALS, 2018-2021125
12.3COMPETITIVE LEADERSHIP MAPPING126
12.3.1STARS126
12.3.2EMERGING LEADERS126
12.3.3PERVASIVE PLAYERS126
12.3.4PARTICIPANTS126
FIGURE 22HEALTHCARE FRAUD ANALYTICS MARKET: COMPETITIVE LEADERSHIP MAPPING, 2020127
13COMPANY PROFILES128
(Business Overview, Products Offered, Recent Developments, SWOT Analysis, MnM View)*
13.1KEY PLAYERS128
13.1.1IBM CORPORATION128
TABLE 136IBM CORPORATION: BUSINESS OVERVIEW128
FIGURE 23IBM CORPORATION: COMPANY SNAPSHOT (2020)129
13.1.2OPTUM, INC. (A PART OF UNITEDHEALTH GROUP)131
TABLE 137OPTUM, INC.: BUSINESS OVERVIEW131
13.1.3COTIVITI, INC.133
TABLE 138COTIVITI, INC.: BUSINESS OVERVIEW133
13.1.4FAIR ISAAC CORPORATION135
TABLE 139FAIR ISAAC CORPORATION: BUSINESS OVERVIEW135
FIGURE 24FAIR ISAAC CORPORATION: COMPANY SNAPSHOT (2020)136
13.1.5SAS INSTITUTE INC.138
TABLE 140SAS INSTITUTE INC.: BUSINESS OVERVIEW138
13.1.6CHANGE HEALTHCARE140
TABLE 141CHANGE HEALTHCARE: BUSINESS OVERVIEW140
13.1.7PONDERA SOLUTIONS, INC. (A SUBSIDIARY OF THOMSON REUTERS CORPORATION)141
TABLE 142PONDERA SOLUTIONS, INC.: BUSINESS OVERVIEW141
13.1.8EXLSERVICE HOLDINGS, INC.143
TABLE 143EXLSERVICE HOLDINGS, INC.: BUSINESS OVERVIEW143
FIGURE 25EXLSERVICE HOLDINGS, INC.: COMPANY SNAPSHOT (2020)144
13.1.9WIPRO LIMITED146
TABLE 144WIPRO LIMITED: BUSINESS OVERVIEW146
FIGURE 26WIPRO LIMITED: COMPANY SNAPSHOT (2021)147
13.1.10CONDUENT INCORPORATED148
TABLE 145CONDUENT INCORPORATED: BUSINESS OVERVIEW148
FIGURE 27CONDUENT INCORPORATED: COMPANY SNAPSHOT (2020)149
13.1.11HCL TECHNOLOGIES LIMITED150
TABLE 146HCL TECHNOLOGIES LIMITED.: BUSINESS OVERVIEW150
FIGURE 28HCL TECHNOLOGIES LIMITED.: COMPANY SNAPSHOT (2021)151
13.1.12CGI INC.152
TABLE 147CGI INC.: BUSINESS OVERVIEW152
FIGURE 29CGI INC.: COMPANY SNAPSHOT (2020)153
13.1.13DXC TECHNOLOGY154
TABLE 148DXC TECHNOLOGY COMPANY: BUSINESS OVERVIEW154
FIGURE 30DXC TECHNOLOGY COMPANY: COMPANY SNAPSHOT (2021)155
13.1.14NORTHROP GRUMMAN CORPORATION156
TABLE 149NORTHROP GRUMMAN CORPORATION: BUSINESS OVERVIEW156
FIGURE 31NORTHROP GRUMMAN CORPORATION: COMPANY SNAPSHOT (2020)157
13.1.15LEXISNEXIS (A PART OF RELX GROUP)158
TABLE 150LEXISNEXIS: BUSINESS OVERVIEW158
FIGURE 32RELX GROUP: COMPANY SNAPSHOT (2020)159
13.1.16QLARANT, INC.161
TABLE 151QLARANT, INC.: BUSINESS OVERVIEW161
13.1.17H2O.AI162
TABLE 152H2O.AI: BUSINESS OVERVIEW162
13.1.18MULTIPLAN163
TABLE 153MULTIPLAN: BUSINESS OVERVIEW163
13.1.19FRISS164
TABLE 154FRISS: BUSINESS OVERVIEW164
13.1.20OSP LABS165
TABLE 155OSP LABS: BUSINESS OVERVIEW165
13.2OTHER PLAYERS166
13.2.1SHARECARE, INC. (A SUBSIDIARY OF FALCON CAPITAL ACQUISITION CORP.)166
13.2.2HEALTHCARE FRAUD SHIELD166
13.2.3FRAUDLENS, INC.167
13.2.4HMS HOLDINGS CORP.167
13.2.5CODOXO168
*Details on Business Overview, Products Offered, Recent Developments, SWOT Analysis, MnM View might not be captured in case of unlisted companies.
14APPENDIX169
14.1DISCUSSION GUIDE169
14.2KNOWLEDGE STORE: MARKETSANDMARKETS’ SUBSCRIPTION PORTAL173
14.3AVAILABLE CUSTOMIZATIONS175
14.4RELATED REPORTS175
14.5AUTHOR DETAILS176

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