Healthcare Fraud Analytics Market worth $ 5.0 billion by 2026

CHICAGO, October 15, 2021 / PRNewswire / – According to the new market research report Market for fraud analysis in the health care system by type of solution (descriptive, predictive, prescriptive), application (insurance requirements, payment integrity), delivery (local, cloud), end user (government, employers, payers), COVID-19 Impac Global Forecast for 2026 “, published by MarketsandMarkets ™, the market is expected to reach 5.0 billion USD in 2026 from $ 1.5 billion in 2021, with a CAGR of 26.7% in the forecast period.

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The market growth can be attributed to a large number of fraudulent activities within the healthcare system, increasing number of patients seeking health insurance, high investment returns and the increasing number of pharmacy requirements-related fraud. However, the lack of qualified staff is expected to limit growth in this market.

The prescriptive analysis segment is expected to grow at the highest CAGR in the forecast period

Fraud analysis 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 analytics-type used, descriptive analytics, predictive analytics, and prescriptive analytics. The regulatory analysis segment recorded the highest growth in the market for fraud analysis in the healthcare sector during the forecast period. The high use of this technology is attributed to its benefits, such as rapid detection and investigation of suspects, plaintiffs and behavior at the level of claims from unstructured and / or semi-structured data.

The public and public agency segment is expected to account for the largest share of the market for fraud analysis in the health care system

Based on end users, the market for the detection of healthcare fraud is divided into public and public authorities, private insurers, employers and third-party providers. The public and public agency segment accounted for the largest share of the market for healthcare fraud analysis in 2019. The increasing cost burden due to healthcare fraud is proving to be an economic threat to public and public authorities globally. These factors force payment organizations affiliated with these agencies to adopt analytics solutions to avoid losses due to FWA and incorrect payments, which drives market growth.

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North America is expected to represent the highest CAGR for players operating in the healthcare fraud market;

The North American market is expected to grow with the highest CAGR from 2021 to 2026. Factors such as The large number of cases of healthcare fraud, including pharmacy fraud, favorable government initiatives, technological advances and the availability of solutions in this region are expected to drive growth in the North American market during the forecast period.

Major players in this market for healthcare fraud analysis include IBM Corporation (USA), Optum, Inc. (USA), Cotiviti, Inc. (USA), Change Healthcare (USA), Fair Isaac Corporation (USA), SAS Institute Inc. (USA)), EXLService Holdings, Inc. (USA), 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), (US), Pondera Solutions, Inc. (US), FRISS (Netherlands), Multiplan (US), FraudScope (US) and OSP Labs (US).

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