Healthcare fraud analytics is a rapidly growing field that utilizes sophisticated data analysis techniques to detect and prevent healthcare fraud. This type of analytics combines multiple data sources and applies advanced analytics to identify anomalies or patterns that may indicate fraudulent activity.

Healthcare fraud analytics relies on the analysis of both structured and unstructured data sources. Structured data sources include claims data, patient records, and billing records. Unstructured data sources include social media, public records, and news articles.

Once the data is collected and analyzed, it is used to create predictive models that can identify potentially fraudulent behavior. Healthcare fraud analytics is not only used to detect fraud but also to prevent it from occurring. By analyzing data from multiple sources, healthcare organizations can identify patterns and behaviors that may indicate fraudulent activity. 


This information can then be used to create policies and processes that reduce the chances of fraud occurring or limit the damage that can be caused if it does occur. Healthcare fraud analytics is a powerful tool that can help healthcare organizations to identify and prevent fraud.

By combining data from multiple sources and applying advanced analytics, healthcare organizations can gain valuable insights that can help to reduce the amount of fraud that occurs. 

Currently, "Healthcare Fraud Analytics Market Size, Growth by Solution Type (Descriptive, Predictive, Prescriptive), Application (Insurance Claim, Payment Integrity), Delivery (On-premise, Cloud), End User (Government, Employers, Payers) - Global Forecast to 2026 is projected to reach USD 5.0 Billion by 2026, at a CAGR of 26.7%. 

Request for assumptions & how numbers were triangulated.

https://www.marketsandmarkets.com/requestsampleNew.asp?id=221837663

The number of people utilising various healthcare programmes has increased significantly over the years. The ageing population, increased healthcare expenditure, and increased disease burden are all factors contributing to the growth of the health insurance market. In the US, the number of citizens without health insurance has significantly decreased, from 48 million in 2010 to 28.6 million in 2016. In 2017, 12.2 million people signed up for or renewed their health insurance during the 2017 open enrollment period (source: National Center for Health Statistics).

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

Major players in this healthcare fraud analytics 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).

Download an Illustrative Overview:

https://www.marketsandmarkets.com/pdfdownloadNew.asp?id=221837663

Recent Developments

  •       In January 2019, LexisNexis Risk Solutions collaborated with QuadraMed to enable patient identification capabilities and reduce the number of duplicate identities & fraudulent claims. 
  •    In August 2018, Verscend Technologies acquired Cotiviti Holdings. This acquisition helped improve the affordability of fraud detection solutions.