Healthcare Fraud Detection Market: Introduction

Health care fraud is defined as criminal deception intended to result in financial gain during drug manufacturing, quality of the product, medical practice, and health insurance. Health care fraud practice involves healthcare plans of the government, defrauding insurance company, company and consumer party etc. Currently, different data mining practices are adopted by leading life sciences companies to avoid these fraudulent activities. Data mining techniques involves examining databases to investigate new information for example health care insurance data, fraud techniques, health care information systems etc. According to U.S.-based Coalition Against Insurance Fraud, tens of billions of dollars are stolen each year by fraudulent means in the health care and pharma industries. In many of the cases, health care fraud is quite difficult to detect and may go unnoticed. Therefore, healthcare fraud detection products and services are expected to witness rapid growth in the next few years.

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Healthcare Fraud Detection Market: Drivers and Restraints

  • Increase in number of fraudulent events in health care, rise in number of patients opting for health care insurance, and rise in pressure to keep track of fraud & abuse in health care spending are projected to drive the global healthcare fraud detection market in the next few years
  • Rise in number of health care BPO and fraud identity management software, rapid acceptance of cloud-based analytical solutions, increase in influence of social media on the health care industry, and effectiveness of artificial intelligence in healthcare services and solutions are the other factors anticipated to propel the global healthcare fraud detection market. However, high cost of these health care fraud detection software & services, lack of skilled personnel, and less adoption and awareness about health care fraud analytics services in developing countries are expected to hamper the growth of the global healthcare fraud detection market.

North America to Account for Major Share of Global Healthcare Fraud Detection Market

  • North America accounted for major share of the global market in 2018 owing to rapid adoption of technologically advanced products, presence of prominent brands, better reimbursement policies, and increase in investments in health care analytical services. According to the findings of the National Healthcare Anti-Fraud Association (NHCAA), health care fraud costs the U.S. nearly US$ 68 Bn each year.

Key Players Operating in Global Healthcare Fraud Detection Market

The global healthcare fraud detection market is highly fragmented, with major manufacturers implementing various strategies to gain maximum market share.

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Leading players operating in the global healthcare fraud detection market are:

  • CGI Group
  • Conduent
  • DCX Technology
  • Fair Isaac (Fico)
  • HCL Technologies
  • IBM Corporation
  • Wipro
  • Verscend Technologies
  • Scio Health Analytics

Global Healthcare Fraud Detection Market, by Model

  • On-premise Delivery
  • On-demand Delivery

Global Healthcare Fraud Detection Market, by type

  • Predictive Analytics
  • Prescriptive Analytics
  • Descriptive Analytics

Global Healthcare Fraud Detection Market, by Component

  • Software
  • Services

Global Healthcare Fraud Detection Market, by Region

  • North America
    • U.S.
    • Canada
  • Europe
    • Germany
    • France
    • U.K.
    • Italy
    • Spain
    • Rest of Europe
  • Asia Pacific
    • China
    • Japan
    • India
    • Australia & New Zealand
    • Rest of Asia Pacific
  • Latin America
    • Brazil
    • Mexico
    • Rest of Latin America
  • Middle East & Africa
    • GCC Countries
    • South Africa
    • Israel
    • Rest of Middle East & Africa

This study by TMR is all-encompassing framework of the dynamics of the market. It mainly comprises critical assessment of consumers' or customers' journeys, current and emerging avenues, and strategic framework to enable CXOs take effective decisions.

Our key underpinning is the 4-Quadrant Framework EIRS that offers detailed visualization of four elements:

  • Customer Experience Maps
  • Insights and Tools based on data-driven research
  • Actionable Results to meet all the business priorities
  • Strategic Frameworks to boost the growth journey

The study strives to evaluate the current and future growth prospects, untapped avenues, factors shaping their revenue potential, and demand and consumption patterns in the global market by breaking it into region-wise assessment.

The following regional segments are covered comprehensively:

  • North America
  • Asia Pacific
  • Europe
  • Latin America
  • The Middle East and Africa

The EIRS quadrant framework in the report sums up our wide spectrum of data-driven research and advisory for CXOs to help them make better decisions for their businesses and stay as leaders.

Below is a snapshot of these quadrants.

1. Customer Experience Map

The study offers an in-depth assessment of various customers’ journeys pertinent to the market and its segments. It offers various customer impressions about the products and service use. The analysis takes a closer look at their pain points and fears across various customer touchpoints. The consultation and business intelligence solutions will help interested stakeholders, including CXOs, define customer experience maps tailored to their needs. This will help them aim at boosting customer engagement with their brands.

2. Insights and Tools

The various insights in the study are based on elaborate cycles of primary and secondary research the analysts engage with during the course of research. The analysts and expert advisors at TMR adopt industry-wide, quantitative customer insights tools and market projection methodologies to arrive at results, which makes them reliable. The study not just offers estimations and projections, but also an uncluttered evaluation of these figures on the market dynamics. These insights merge data-driven research framework with qualitative consultations for business owners, CXOs, policy makers, and investors. The insights will also help their customers overcome their fears.

3. Actionable Results

The findings presented in this study by TMR are an indispensable guide for meeting all business priorities, including mission-critical ones. The results when implemented have shown tangible benefits to business stakeholders and industry entities to boost their performance. The results are tailored to fit the individual strategic framework. The study also illustrates some of the recent case studies on solving various problems by companies they faced in their consolidation journey.

4. Strategic Frameworks

The study equips businesses and anyone interested in the market to frame broad strategic frameworks. This has become more important than ever, given the current uncertainty due to COVID-19. The study deliberates on consultations to overcome various such past disruptions and foresees new ones to boost the preparedness. The frameworks help businesses plan their strategic alignments for recovery from such disruptive trends. Further, analysts at TMR helps you break down the complex scenario and bring resiliency in uncertain times.

The report sheds light on various aspects and answers pertinent questions on the market. Some of the important ones are:

1. What can be the best investment choices for venturing into new product and service lines?

2. What value propositions should businesses aim at while making new research and development funding?

3. Which regulations will be most helpful for stakeholders to boost their supply chain network?

4. Which regions might see the demand maturing in certain segments in near future?

5. What are the some of the best cost optimization strategies with vendors that some well-entrenched players have gained success with?

6. Which are the key perspectives that the C-suite are leveraging to move businesses to new growth trajectory?

7. Which government regulations might challenge the status of key regional markets?

8. How will the emerging political and economic scenario affect opportunities in key growth areas?

9. What are some of the value-grab opportunities in various segments?

10. What will be the barrier to entry for new players in the market?

Note: Although care has been taken to maintain the highest levels of accuracy in TMR’s reports, recent market/vendor-specific changes may take time to reflect in the analysis.

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