醫療保健詐欺分析市場、機會、成長動力、產業趨勢分析與預測，2024-2032 年

2023 年，全球醫療保健詐欺分析市場估值為23 億美元，預測顯示出強勁的成長軌跡，預計2024 年至2032 年複合年成長率為24.1%。上升、醫療保健支出不斷增加、醫療保健系統日益複雜以及數位醫療解決方案的廣泛採用。

隨著醫療保健組織努力減輕詐欺活動的影響，對即時詐欺偵測的需求不斷增加。透過即時分析，組織可以快速找出並解決可疑活動，從而減少詐騙的可能性。資料處理技術的進步以及在預防詐欺方面加快決策的迫切需求增強了對即時檢測的日益重視。

醫療保健詐欺分析產業分為解決方案類型、部署模式、應用程式、最終用途和區域。

市場將其解決方案分為描述性分析、規範性分析和預測性分析。 2023 年，描述性分析領域在營收排行榜上名列前茅，達到 12 億美元。描述性分析使醫療保健實體能夠審查歷史詐欺活動，同時辨別詐欺者採用的模式、行為和策略。透過深入研究過去的資料，組織可以找出普遍存在的詐欺計劃，利用這種洞察力來增強其檢測系統。這種對從歷史詐欺事件中學習的重視極大地推動了對描述性分析的需求。

市場將其部署模式分為本地解決方案和基於雲端的解決方案。 2023 年，本地解決方案領域佔據了 58% 的市場。鑑於醫療保健實體管理從病史到財務詳細資訊等敏感患者資料，這些數據成為網路威脅的主要目標。本地解決方案增強了對資料安全的控制，使組織能夠在其基礎設施內實施自己的保護措施。對資料安全和隱私的高度重視推動了對本地詐欺分析解決方案的偏好。

2023 年，北美以 8.838 億美元的收入引領醫療詐欺分析市場。預測顯示，從 2024 年到 2032 年，成長率將資料23.8%。這些先進技術透過篩選大量資料來發現潛在的詐欺模式，從而促進卓越的詐欺偵測。因此，該地區獲得最先進技術的機會加速了複雜的詐欺分析解決方案的採用。

目錄

第 1 章：方法與範圍

第 2 章：執行摘要

第 3 章：產業洞察

• 產業生態系統分析
• 產業影響力
  • 成長動力
    • 醫療詐欺發生率上升
    • 提高對預防詐欺的認知和關注
    • 技術進步
  • 產業陷阱與挑戰
    • 實施成本高
    • 缺乏熟練的專業人員
• 成長潛力分析
• 監管環境
• 報銷場景
• 波特的分析
• PESTEL分析
• 政策展望
• 差距分析
• 未來市場趨勢

第 4 章：競爭格局

• 介紹
• 公司矩陣分析
• 主要市場參與者的競爭分析
• 競爭定位矩陣
• 戰略儀表板

第 5 章：市場估計與預測：按解決方案類型，2021 - 2032 年

• 主要趨勢
• 描述性分析
• 規範性分析
• 預測分析

第 6 章：市場估計與預測：按部署模式，2021 - 2032 年

• 主要趨勢
• 本地
• 基於雲端

第 7 章：市場估計與預測：按應用分類，2021 - 2032

• 主要趨勢
• 保險理賠審查
  • 付款後審核
  • 預付款審核
• 藥局帳單問題
• 付款誠信
• 其他應用

第 8 章：市場估計與預測：按最終用途，2021 - 2032 年

• 主要趨勢
• 醫療保健提供者
• 保險公司
• 政府機構
• 其他最終用戶

第 9 章：市場估計與預測：按地區，2021 - 2032

• 主要趨勢
• 北美洲
  • 美國
  • 加拿大
• 歐洲
  • 德國
  • 英國
  • 法國
  • 西班牙
  • 義大利
  • 荷蘭
  • 歐洲其他地區
• 亞太地區
  • 中國
  • 日本
  • 印度
  • 澳洲
  • 韓國
  • 亞太地區其他地區
• 拉丁美洲
  • 巴西
  • 墨西哥
  • 阿根廷
  • 拉丁美洲其他地區
• 中東和非洲
  • 南非
  • 沙烏地阿拉伯
  • 阿拉伯聯合大公國
  • 中東和非洲其他地區

第 10 章：公司簡介

• CGI Inc.
• Change Healthcare
• Conduent Incorporated
• Cotiviti, Inc.
• DXC Technology Company
• EPIC
• ExlService Holdings, Inc.
• Fair Isaac Corporation
• HCL Technologies Limited
• IBM Corporation
• LexisNexis Risk Solutions.
• Optum Inc.
• Qlarant Commercial Solutions, Inc.
• SAS Institute Inc.
• WIPRO LIMITED

The Global Healthcare Fraud Analytics Market was valued at USD 2.3 billion in 2023 and projections indicate a robust growth trajectory, with an anticipated CAGR of 24.1% from 2024 to 2032. This surge is primarily driven by the escalating incidence of healthcare fraud, rising healthcare expenditures, the increasing complexity of healthcare systems, and the widespread adoption of digital health solutions.

As healthcare organizations strive to mitigate the repercussions of fraudulent activities, the demand for real-time fraud detection is intensifying. With real-time analytics, organizations can swiftly pinpoint and address suspicious activities, thereby curtailing the potential for fraud. This growing emphasis on real-time detection is bolstered by advancements in data processing technologies and the pressing need for expedited decision-making in fraud prevention.

The healthcare fraud analytics industry is bifurcated into solution type, deployment mode, application, end-use, and region.

The market segments its solutions into descriptive, prescriptive, and predictive analytics. In 2023, the descriptive analytics segment led the revenue chart, amassing USD 1.2 billion. Descriptive analytics empowers healthcare entities to scrutinize historical fraudulent activities while discerning the patterns, behaviors, and tactics employed by fraudsters. By delving into past data, organizations can pinpoint prevalent fraud schemes, leveraging this insight to bolster their detection systems. This emphasis on learning from historical fraud incidents significantly propels the demand for descriptive analytics.

The market classifies its deployment modes into on-premises and cloud-based solutions. In 2023, the on-premises solutions segment commanded a dominant 58% market share. Given that healthcare entities manage sensitive patient data ranging from medical histories to financial details, these become prime targets for cyber threats. On-premises solutions provide enhanced control over data security, allowing organizations to enforce their own protective measures within their infrastructure. This heightened emphasis on data security and privacy propels the preference for on-premises fraud analytics solutions.

In 2023, North America led the healthcare fraud analytics market with a revenue of USD 883.8 million. Forecasts suggest a growth rate of 23.8% from 2024 to 2032. North America's leadership in technological innovation, especially in data analytics, AI, and machine learning, plays a pivotal role. These advanced technologies facilitate superior fraud detection by sifting through vast data volumes to spot potential fraudulent patterns. Consequently, the region's access to state-of-the-art technology accelerates the adoption of sophisticated fraud analytics solutions.

Table of Contents

Chapter 1 Methodology and Scope

• 1.1 Market scope and definitions
• 1.2 Research design
  • 1.2.1 Research approach
  • 1.2.2 Data collection methods
• 1.3 Base estimates and calculations
  • 1.3.1 Base year calculation
  • 1.3.2 Key trends for market estimation
• 1.4 Forecast model
• 1.5 Primary research and validation
  • 1.5.1 Primary sources
  • 1.5.2 Data mining sources

Chapter 2 Executive Summary

• 2.1 Industry 360° synopsis

Chapter 3 Industry Insights

• 3.1 Industry ecosystem analysis
• 3.2 Industry impact forces
  • 3.2.1 Growth drivers
    • 3.2.1.1 Rising incidence of healthcare fraud
    • 3.2.1.2 Growing awareness and focus on fraud prevention
    • 3.2.1.3 Technological advancements
  • 3.2.2 Industry pitfalls and challenges
    • 3.2.2.1 High implementation costs
    • 3.2.2.2 Lack of skilled professionals
• 3.3 Growth potential analysis
• 3.4 Regulatory landscape
• 3.5 Reimbursement scenario
• 3.6 Porter's analysis
• 3.7 PESTEL analysis
• 3.8 Policy outlook
• 3.9 Gap analysis
• 3.10 Future market trends

Chapter 4 Competitive Landscape, 2023

• 4.1 Introduction
• 4.2 Company matrix analysis
• 4.3 Competitive analysis of major market players
• 4.4 Competitive positioning matrix
• 4.5 Strategy dashboard

Chapter 5 Market Estimates and Forecast, By Solution Type, 2021 - 2032 ($ Mn)

• 5.1 Key trends
• 5.2 Descriptive analytics
• 5.3 Prescriptive analytics
• 5.4 Predictive analytics

Chapter 6 Market Estimates and Forecast, By Deployment Mode, 2021 - 2032 ($ Mn)

• 6.1 Key trends
• 6.2 On-premises
• 6.3 Cloud-based

Chapter 7 Market Estimates and Forecast, By Application, 2021 - 2032 ($ Mn)

• 7.1 Key trends
• 7.2 Insurance claims review
  • 7.2.1 Postpayment review
  • 7.2.2 Prepayment review
• 7.3 Pharmacy billing issue
• 7.4 Payment integrity
• 7.5 Other applications

Chapter 8 Market Estimates and Forecast, By End-Use, 2021 - 2032 ($ Mn)

• 8.1 Key trends
• 8.2 Healthcare providers
• 8.3 Insurance companies
• 8.4 Government organizations
• 8.5 Other end-users

Chapter 9 Market Estimates and Forecast, By Region, 2021 - 2032 ($ Mn)

• 9.1 Key trends
• 9.2 North America
  • 9.2.1 U.S.
  • 9.2.2 Canada
• 9.3 Europe
  • 9.3.1 Germany
  • 9.3.2 UK
  • 9.3.3 France
  • 9.3.4 Spain
  • 9.3.5 Italy
  • 9.3.6 Netherlands
  • 9.3.7 Rest of Europe
• 9.4 Asia Pacific
  • 9.4.1 China
  • 9.4.2 Japan
  • 9.4.3 India
  • 9.4.4 Australia
  • 9.4.5 South Korea
  • 9.4.6 Rest of Asia Pacific
• 9.5 Latin America
  • 9.5.1 Brazil
  • 9.5.2 Mexico
  • 9.5.3 Argentina
  • 9.5.4 Rest of Latin America
• 9.6 Middle East and Africa
  • 9.6.1 South Africa
  • 9.6.2 Saudi Arabia
  • 9.6.3 UAE
  • 9.6.4 Rest of Middle East and Africa

Chapter 10 Company Profiles

• 10.1 CGI Inc.
• 10.2 Change Healthcare
• 10.3 Conduent Incorporated
• 10.4 Cotiviti, Inc.
• 10.5 DXC Technology Company
• 10.6 EPIC
• 10.7 ExlService Holdings, Inc.
• 10.8 Fair Isaac Corporation
• 10.9 HCL Technologies Limited
• 10.10 IBM Corporation
• 10.11 LexisNexis Risk Solutions.
• 10.12 Optum Inc.
• 10.13 Qlarant Commercial Solutions, Inc.
• 10.14 SAS Institute Inc.
• 10.15 WIPRO LIMITED