Healthcare Fraud Detection Market Opportunities - SWOT Analysis of Major Industry Segments

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.

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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.

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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

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