Healthcare Fraud Detection Market by Type (Descriptive, Prescriptive), Application (Insurance Claim, Prepay, Post payment), Component (Service, Software), Delivery (On-premise, Cloud), End user (Insurance Payer, Private, Public) - Global Forecast to 2022

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Date: 08-Jan-2018
No. of pages: 160
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“Global healthcare fraud detection market projected to grow at a CAGR of 28.9%”

The healthcare fraud detection market is expected to reach USD 2,242.7 million by 2022 from USD 631.0 million in 2017, at a CAGR of 28.9%. Factors such as the large number of fraudulent activities in healthcare; increasing number of patients seeking health insurance; the prepayment review model; growing pressure of fraud, waste, and abuse on healthcare spending; and high returns on investments are driving the growth of the healthcare fraud detection arket. On the other hand, market growth is likely to be negatively affected by the dearth of skilled personnel and reluctance to adopt healthcare fraud analytics in emerging countries, are expected to limit the growth of this market to a certain extent.

“The prescriptive analytics segment is expected to grow at the highest CAGR during the forecast period”

By type, the healthcare fraud detection market is segmented into descriptive, predictive, and prescriptive analytics. The prescriptive analytics segment is expected grow at a highest CAGR during the forecast period. The high growth of this segment is attributed to the ability of prescriptive analytics to ensure the synergistic integration of predictions and prescriptions.

“The services segment is expected to dominate the market during the forecast period”

Based on component, the healthcare fraud detection market is segmented into services, software, and hardware. The services segment accounted for the largest share of the healthcare fraud detection market in 2016. With the increasing need for business analytics services and the introduction of technologically advanced healthcare fraud detection software, which requires extensive training to use as well as regular upgrades, the services segment is expected to grow at the highest CAGR during the forecast period.

“North America to witness high growth during the forecast period”

In 2017, North America is expected to account for the largest share of the market followed by Europe. This regional segment is expected to register the highest CAGR during the forecast period. Factors such as increase in the number of people seeking health insurance, increasing cases of healthcare fraud, favorable government initiatives to combat healthcare fraud, rising pressure to reduce healthcare costs, technological advancements, and greater product and service availability in this region are expected to drive market growth in North America.

The primary interviews conducted for this report can be categorized as follows:


  • By Company Type: Tier 1 – 33%; Tier 2 -45%; Tier 3 - 22%.

  • By Designation (Supply Side): C-level- 22%; D-level- 27%; others- 51%.

  • By Region: North America-62%; Europe-13%;Asia-21%; South America- 3%, and Middle East & Africa- 1%.


List of companies profiled in the report


  • IBM (US)

  • Optum(US)

  • SAS (US)

  • McKesson (US)

  • SCIO (US)

  • Verscend (US)

  • Wipro (India)

  • Conduent(US)

  • HCL (India)

  • CGI (Canada)

  • DXC (US)

  • Northrop Grumman (US)

  • LexisNexis (US)

  • Pondera (US)


Research Coverage:

The report provides an overview of the healthcare fraud detection market. It aims at estimating the market size and future growth potential of this market across different segments such as type, application, component, delivery model, end user, and region. Furthermore, the report also includes an in-depth competitive analysis of the key players in the market along with their company profiles, recent developments, and key market strategies.

Key Benefits of Buying the Report:

The report will help the market leaders/new entrants in this market by providing them with the closest approximations of revenues for the overall healthcare fraud detection market and its sub segments. This report will help stakeholders to understand the competitive landscape better and gain insights to position their businesses and help companies make suitable go-to-market strategies. The report also helps stakeholders understand the pulse of the market and provide them with information regarding key market drivers and opportunities.

Healthcare Fraud Detection Market by Type (Descriptive, Prescriptive), Application (Insurance Claim, Prepay, Post payment), Component (Service, Software), Delivery (On-premise, Cloud), End user (Insurance Payer, Private, Public) - Global Forecast to 2022

Table of Contents

1 Introduction
1.1 Objectives of the Study
1.2 Market Definition
1.3 Market Scope
1.3.1 Markets Covered
1.3.2 Years Considered for the Study
1.4 Currency
1.5 Limitations
1.6 Stakeholders

2 Research Methodology
2.1 Research Data
2.1.1 Secondary Data
2.1.1.1 Secondary Sources
2.1.2 Primary Data
2.1.2.1 Primary Sources
2.1.2.2 Key Industry Insights
2.2 Market Size Estimation
2.2.1 Bottom-Up Approach
2.2.2 Top-Down Approach
2.3 Market Breakdown and Data Triangulation
2.4 Assumptions for the Study

3 Executive Summary

4 Premium Insights
4.1 Healthcare Fraud Detection: Market Overview
4.2 Healthcare Fraud Detection, By Product and Service
4.3 Healthcare Fraud Detection, By Type
4.4 Healthcare Fraud Detection, By Delivery Model

5 Market Overview
5.1 Introduction
5.2 Market Dynamics
5.2.1 Drivers
5.2.1.1 Large Number of Fraudulent Activities in Healthcare
5.2.1.2 Increasing Number of Patients Seeking Health Insurance
5.2.1.3 Prepayment Review Model
5.2.1.4 Growing Pressure of Fraud, Waste, and Abuse on Healthcare Spending
5.2.1.5 High Returns on Investment
5.2.2 Restraint
5.2.2.1 Reluctance to Adopt Healthcare Fraud Analytics in Emerging Countries
5.2.3 Opportunities
5.2.3.1 Cloud-Based Analytics
5.2.3.2 Emergence of Social Media and Its Impact on the Healthcare Industry
5.2.3.3 Ai in Healthcare Fraud Detection
5.2.4 Challenges
5.2.4.1 Dearth of Skilled Personnel
5.2.4.2 Time-Consuming Deployment and Need for Frequent Upgrades

6 Healthcare Fraud Detection Market, By Component
6.1 Introduction
6.2 Services
6.3 Software

7 Fraud Detection Market, By Delivery Model
7.1 Introduction
7.2 On-Premise Delivery Models
7.3 On-Demand Delivery Models

8 Healthcare Fraud Detection Market, By Type
8.1 Introduction
8.2 Descriptive Analytics
8.3 Predictive Analytics
8.4 Prescriptive Analytics

9 Healthcare Fraud Detection Market, By Application
9.1 Introduction
9.2 Insurance Claims Review
9.2.1 Postpayment Review
9.2.2 Prepayment Review
9.3 Payment Integrity
9.4 Other Applications

10 Healthcare Fraud Detection Market, By End User
10.1 Introduction
10.2 Private Insurance Payers
10.3 Public/Government Agencies
10.4 Third-Party Service Providers
10.5 Employers

11 Healthcare Fraud Detection Market, By Region
11.1 Introduction
11.2 North America
11.2.1 US
11.2.2 Canada
11.3 Europe
11.3.1 Germany
11.3.2 UK
11.3.3 France
11.3.4 Rest of Europe
11.4 Asia
11.5 Rest of the World (RoW)

12 Competitive Landscape
12.1 Overview
12.2 Market Player Ranking, 2016
12.3 Competitive Scenario
12.3.1 Agreements, Partnerships, Collaborations, and Contracts
12.3.2 Expansions
12.3.3 Acquisitions
12.3.4 Product Launches

13 Company Profiles
(Overview, Products Offered, Product Offering Scorecard, Business Strategy Scorecard, Recent Developments)*
13.1 IBM
13.2 Optum (A Part of Unitedhealth Group)
13.3 Verscend Technologies
13.4 Mckesson
13.5 Fair Isaac (Fico)
13.6 SAS Institute
13.7 Scio Health Analytics
13.8 Wipro
13.9 Conduent
13.10 HCL Technologies
13.11 CGI Group
13.12 DXC Technology
13.13 Northrop Grumman
13.14 Lexinexis (A Part of Relx Group)
13.15 Pondera Solutions

*Details on Marketsandmarkets View, Overview, Products Offered, Product Offering Scorecard, Business Strategy Scorecard, and Recent Developments Might Not Be Captured in Case of Unlisted Companies.

14 Appendix
14.1 Insights From Industry Experts
14.2 Discussion Guide
14.3 Knowledge Store: Marketsandmarkets’ Subscription Portal
14.4 Introducing RT: Real-Time Market Intelligence
14.5 Available Customizations
14.6 Related Reports
14.7 Author Details

List of Tables

Table 1 Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 2 Healthcare Fraud Detection Services Market, By Region, 2015–2022 (USD Million)
Table 3 North America: Healthcare Fraud Detection Services Market, By Country, 2015–2022 (USD Million)
Table 4 Europe: Healthcare Fraud Detection Services Market, By Country, 2015–2022 (USD Million)
Table 5 Healthcare Fraud Detection Software Market, By Region, 2015–2022 (USD Million)
Table 6 North America: Healthcare Fraud Detection Software Market, By Country, 2015–2022 (USD Million)
Table 7 Europe: Healthcare Fraud Detection Software Market, By Country, 2015–2022 (USD Million)
Table 8 Healthcare Fraud Detection Market, By Delivery Model, 2015–2022 (USD Million)
Table 9 Healthcare Fraud Detection Market for On-Premise Delivery Models, By Region, 2015–2022 (USD Million)
Table 10 North America: Healthcare Fraud Detection Market for On-Premise Delivery Models, By Country, 2015–2022 (USD Million)
Table 11 Europe: Healthcare Fraud Detection Market for On-Premise Delivery Models, By Country, 2015–2022 (USD Million)
Table 12 Healthcare Fraud Detection Market for On-Demand Delivery Models, By Region, 2015–2022 (USD Million)
Table 13 North America: Healthcare Fraud Detection Market for On-Demand Delivery Models, By Country, 2015–2022 (USD Million)
Table 14 Europe: Healthcare Fraud Detection Market for On-Demand Delivery Models, By Country, 2015–2022 (USD Million)
Table 15 Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 16 Descriptive Analytics Market, By Region, 2015–2022 (USD Million)
Table 17 North America: Descriptive Analytics Market, By Country, 2015–2022 (USD Million)
Table 18 Europe: Descriptive Analytics Market, By Country, 2015–2022 (USD Million)
Table 19 Predictive Analytics Market, By Region, 2015–2022 (USD Million)
Table 20 North America: Predictive Analytics Market, By Country, 2015–2022 (USD Million)
Table 21 Europe: Predictive Analytics Market, By Country, 2015–2022 (USD Million)
Table 22 Prescriptive Analytics Market, By Region, 2015–2022 (USD Million)
Table 23 North America: Prescriptive Analytics Market, By Country, 2015–2022 (USD Million)
Table 24 Europe: Prescriptive Analytics Market, By Country, 2015–2022 (USD Million)
Table 25 Healthcare Fraud Detection Market, By Application, 2015–2022 (USD Million)
Table 26 Healthcare Fraud Detection Market for Insurance Claims Review, By Type, 2015–2022 (USD Million)
Table 27 Healthcare Fraud Detection Market for Insurance Claims Review, By Region, 2015–2022 (USD Million)
Table 28 North America: Healthcare Fraud Detection Market for Insurance Claims Review, By Country, 2015–2022 (USD Million)
Table 29 Healthcare Fraud Detection Market for Postpayment Review, By Region, 2015–2022 (USD Million)
Table 30 Healthcare Fraud Detection Market for Prepayment Review, By Region, 2015–2022 (USD Million)
Table 31 Healthcare Fraud Detection Market for Payment Integrity, By Region, 2015–2022 (USD Million)
Table 32 Healthcare Fraud Detection Market for Other Applications, By Region, 2015–2022 (USD Million)
Table 33 Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 34 Healthcare Fraud Detection Market for Private Insurance Payers, By Region, 2015–2022 (USD Million)
Table 35 North America: Healthcare Fraud Detection Market for Private Insurance Payers, By Country, 2015–2022 (USD Million)
Table 36 Healthcare Fraud Detection Market for Public/Government Agencies, By Region, 2015–2022 (USD Million)
Table 37 North America: Healthcare Fraud Detection Market for Public/Government Agencies, By Country, 2015–2022 (USD Million)
Table 38 Healthcare Fraud Detection Market for Third-Party Service Providers, By Region, 2015–2022 (USD Million)
Table 39 North America: Healthcare Fraud Detection Market for Third-Party Service Providers, By Country, 2015–2022 (USD Million)
Table 40 Healthcare Fraud Detection Market for Employers, By Region, 2015–2022 (USD Million)
Table 41 North America: Healthcare Fraud Detection Market for Employers, By Country, 2015–2022 (USD Million)
Table 42 Healthcare Fraud Detection Market, By Region, 2015–2022 (USD Million)
Table 43 North America: Healthcare Fraud Detection Market, By Country, 2015–2022 (USD Million)
Table 44 North America: Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 45 North America: Healthcare Fraud Detection Software Market, By Delivery Model, 2015–2022 (USD Million)
Table 46 North America: Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 47 North America: Healthcare Fraud Detection Market, By Application, 2015–2022 (USD Million)
Table 48 North America: Insurance Claims Review Market, By Type, 2015–2022 (USD Million)
Table 49 North America: Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 50 US: Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 51 US: Healthcare Fraud Detection Software Market, By Delivery Model, 2015–2022 (USD Million)
Table 52 US: Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 53 US: Healthcare Fraud Detection Market, By Application, 2015–2022 (USD Million)
Table 54 US: Insurance Claims Review Market, By Type, 2015–2022 (USD Million)
Table 55 US: Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 56 Canada: Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 57 Canada: Healthcare Fraud Detection Software Market, By Delivery Model, 2015–2022 (USD Million)
Table 58 Canada: Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 59 Canada: Healthcare Fraud Detection Market, By Application, 2015–2022 (USD Million)
Table 60 Canada: Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 61 Europe: Healthcare Fraud Detection Market, By Country, 2015–2022 (USD Million)
Table 62 Europe: Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 63 Europe: Healthcare Fraud Detection Software Market, By Delivery Model, 2015–2022 (USD Million)
Table 64 Europe: Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 65 Europe: Healthcare Fraud Detection Market, By Application, 2015–2022 (USD Million)
Table 66 Europe: Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 67 Germany: Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 68 Germany: Healthcare Fraud Detection Software Market, By Delivery Model, 2015–2022 (USD Million)
Table 69 Germany: Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 70 Germany: Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 71 UK: Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 72 UK: Healthcare Fraud Detection Software Market, By Delivery Model, 2015–2022 (USD Million)
Table 73 UK: Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 74 UK: Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 75 France: Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 76 France: Healthcare Fraud Detection Software Market, By Delivery Model, 2015–2022 (USD Million)
Table 77 France: Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 78 France: Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 79 RoE: Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 80 RoE: Healthcare Fraud Detection Software Market, By Delivery Model, 2015–2022 (USD Million)
Table 81 RoE: Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 82 RoE: Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 83 Asia: Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 84 Asia: Healthcare Fraud Detection Software Market, By Delivery Model, 2015–2022 (USD Million)
Table 85 Asia: Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 86 Asia: Healthcare Fraud Detection Market, By Application, 2015–2022 (USD Million)
Table 87 Asia: Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 88 RoW: Healthcare Fraud Detection Market, By Component, 2015–2022 (USD Million)
Table 89 RoW: Healthcare Fraud Detection Software Market, By Delivery Model, 2015–2022 (USD Million)
Table 90 RoW: Healthcare Fraud Detection Market, By Type, 2015–2022 (USD Million)
Table 91 RoW: Healthcare Fraud Detection Market, By End User, 2015–2022 (USD Million)
Table 92 Healthcare Fraud Detection Ranking Analysis, By Key Player, 2016

List of Figures

Figure 1 Healthcare Fraud Detection Market
Figure 2 Research Design
Figure 3 Breakdown of Primary Interviews: By Company Type, Designation, and Region
Figure 4 Data Triangulation
Figure 5 Descriptive Analytics Segment to Dominate the Market, By Type, During the Forecast Period
Figure 6 Services Segment to Dominate the Market in 2017
Figure 7 On-Demand Delivery Models to Grow at the Highest Rate During the Forecast Period
Figure 8 Private Insurance Payers Segment to Hold the Largest Market Share in 2017
Figure 9 North America to Hold the Largest Share of the Global Market During 2017 to 2022
Figure 10 Large Number of Fraudulent Activities in Healthcare to Drive the Growth of the Market
Figure 11 Services Segment to Grow at the Highest CAGR Over the Forecast Period (2017 -2022)
Figure 12 Prescriptive Analytics to Witness High Growth Rate From 2017 to 2022
Figure 13 On-Premise Models to Account for the Largest Share of the Healthcare Fraud Detection in 2017
Figure 14 Healthcare Fraud Detection Market: Drivers, Restraints, Opportunities, and Challenges
Figure 15 Healthcare Spending as A Percentage of the GDP, By Country, 2015
Figure 16 Services Segment to Dominate the Healthcare Fraud Detection Market in 2017
Figure 17 On-Demand Segment to Register Highest Growth Rate During the Forecast Period (2017–2022)
Figure 18 North America to Dominate the Global Healthcare Fraud Detection Market for On-Premise Delivery Models (2017–2022)
Figure 19 Prescriptive Analytics to Witness Highest Growth During the Forecast Period
Figure 20 North America is Expected to Dominate the Global Descriptive Analytics Market (2017–2022)
Figure 21 Insurance Claims Review Segment to Dominate the Healthcare Fraud Detection Market in 2017
Figure 22 Payers to Dominate the Healthcare Fraud Detection Market During the Forecast Period
Figure 23 North America to Witness the Highest Growth in the Healthcare Fraud Detection Market During the Forecast Period
Figure 24 North America: Healthcare Fraud Detection Market Snapshot
Figure 25 Europe: Healthcare Fraud Detection Market Snapshot
Figure 26 Asia: Healthcare Fraud Detection Market Snapshot
Figure 27 RoW: Healthcare Fraud Detection Market Snapshot
Figure 28 Market Evolution Framework
Figure 29 IBM: Company Snapshot
Figure 30 Mckesson: Company Snapshot
Figure 31 Fico: Company Snapshot
Figure 32 SAS Institute: Company Snapshot
Figure 33 Wipro: Company Snapshot
Figure 34 Conduent: Company Snapshot
Figure 35 HCL: Company Snapshot
Figure 36 CGI Group: Company Snapshot
Figure 37 DXC Technology: Company Snapshot
Figure 38 Northrop Grumman: Company Snapshot
Figure 39 Relx Group: Company Snapshot

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