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醫療詐欺分析市場：2023 年至 2028 年預測
市場調查報告書
商品編碼
1410065

醫療詐欺分析市場：2023 年至 2028 年預測

Healthcare Fraud Analytics Market - Forecasts from 2023 to 2028
出版日期: | 出版商: Knowledge Sourcing Intelligence | 英文 149 Pages | 商品交期: 最快1-2個工作天內

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簡介目錄

醫療詐欺分析市場預計將從 2021 年的 16.26 億美元成長到 2028 年的 59.89 億美元，複合年成長率為 20.47%。

醫療保健詐欺分析市場規模正在擴大，重點是偵測和預防醫療保健業務中的詐欺。詐欺申請、身份盜竊和不必要的治療每年都會對醫療保健系統造成數十億美元的損失。醫療保健詐欺分析系統使用先進的資料分析技術和演算法來發現趨勢、異常和可疑活動，從而實現主動詐欺檢測和預防。醫療保健詐欺分析市場的成長在減少詐欺、保護醫療保健組織免受財務損失以及維護醫療保健行業的信任和誠信方面具有巨大潛力。就市場佔有率而言，眾多行業競爭對手正在努力佔領市場的很大一部分，包括專業分析解決方案提供者、技術公司和醫療保健組織本身。隨著醫療機構投資先進的分析工具和技術來檢測和防止詐欺，該市場預計將進一步擴大。

醫療詐欺分析市場對成本控制和財務損失預防的需求。

醫療詐欺分析產業的關鍵促進因素是成本控制和避免財務損失的需求。據 NHCAA 稱，醫療保健詐欺預計每年佔全球醫療保健支出的 3% 至 10%。這種經濟負擔凸顯了實施詐欺分析工具來偵測和預防詐欺的必要性。研究表明，採用此類解決方案可以顯著降低醫療機構的成本。對高階分析解決方案的市場需求是由對降低成本和避免財務損失的關注所推動的。

對詐欺預防的意識不斷提高和關注擴大了醫療詐欺分析市場規模

醫療詐欺分析行業對詐欺預防的認知和重視日益增強。在醫療保健詐欺分析產業，對詐欺預防的重視推動了市場的成長和創新。

政府打擊醫療詐欺分析市場中的醫療詐欺的措施和法規。

政府措施和法律規章在防止醫療保健詐欺方面發揮著至關重要的作用。世界各國政府正在製定更強力的措施來打擊詐欺並保護醫療保健系統的完整性。這些方法包括建立專門的詐欺團隊、增加詐欺偵測計劃的資金以及製定法律來阻止和懲罰詐欺。此外，政府正在與行業相關人員合作，制定最佳實踐、共用資訊並提高申請和索賠程序的透明度。打擊醫療保健詐欺有助於我們履行經濟責任、保護患者並促進更安全、更有效率的醫療保健系統。

北美是醫療保健詐欺分析市場的市場領導者。

北美在醫療保健詐欺分析市場佔有率方面處於行業領先地位。這是由於多種原因造成的，包括該地區嚴格的法律規範、高額醫療支出以及不斷上升的醫療詐騙。此外，北美擁有完善的醫療保健系統，強調詐欺預防和合規性。該地區對醫療保健詐欺預防的關注以及先進分析技術的採用，支撐了其作為該地區醫療保健詐欺分析市場領導的地位。

醫療詐欺分析市場擴大採用電子健康記錄(EHR) 和數位健康系統。

電子健康記錄(EHR) 和數位醫療系統的日益普及對醫療詐欺分析行業產生了重大影響。據美國衛生資訊技術協調員辦公室稱，到 2021 年，美國 96% 的非聯邦急診醫院將擁有經過認證的 EHR 系統。醫療保健資料的數位化提供了詐欺分析系統可以用來檢測和防止詐欺的大量資訊。 EHR 和數位醫療系統整合可實現即時監控、資料分析和模式識別，使醫療保健組織能夠即時發現詐欺申請、編碼錯誤和其他詐欺。

主要進展：

  • 2022 年 6 月 Change Healthcare 的產品線「病患參與」連結了整個病患體驗中的接觸點，增加了病患與醫師之間的接觸並改善了溝通。 Change Healthcare 的服務與 Luma Health 業界領先的結構相結合，使供應商能夠協調功能、臨床和財務旅行，進一步增強患者體驗。

公司產品

  • 詐欺偵測系統： IBM 提供先進的分析工具，利用機器學習和人工智慧來偵測可能顯示詐欺活動的趨勢和異常情況。這些系統分析大量的醫療保健資料，例如申請、申請記錄和患者資訊，以檢測異常行為和潛在的詐欺。
  • 即時監控和警報： Optum 提供即時監控系統，持續監控醫療保健交易和資料流。這些系統採用基於規則的演算法來偵測並通知您潛在的詐欺活動，從而實現快速介入和預防。
  • 身分驗證： LexisNexis Risk Solutions 提供身分驗證技術，協助醫療保健組織驗證病患、醫療保健提供者和其他營業單位的身分。為了避免身份盜竊和詐欺，這些解決方案利用強大的身份驗證演算法和資料庫。
  • 提供者網路分析： Optum 的詐欺分析解決方案使用網路分析技術來揭示醫療保健提供者、患者和其他組織之間的聯繫和互動。這項調查有助於揭露涉及協作、詐欺申請行為或有組織網路的詐欺計劃。

目錄

第1章簡介

  • 市場概況
  • 市場定義
  • 調查範圍
  • 市場區隔
  • 貨幣
  • 先決條件
  • 基準年和預測年時間表

第2章調查方法

  • 調查資料
  • 資訊來源
  • 研究設計

第3章執行摘要

  • 研究亮點

第4章市場動態

  • 市場促進因素
  • 市場抑制因素
  • 波特五力分析
    • 供應商的議價能力
    • 買方議價能力
    • 新進入者的威脅
    • 替代品的威脅
    • 業內競爭對手之間的對抗關係
  • 產業價值鏈分析

第5章醫療詐欺分析市場：按組成部分

  • 介紹
  • 軟體
  • 服務

第6章醫療詐欺分析市場：依發展分類

  • 介紹
  • 本地
  • 雲端基礎

第7章醫療詐欺分析市場：依應用分類

  • 介紹
  • 保險申請審核
  • 付款誠信
  • 身分和存取管理
  • 其他

第8章醫療詐欺分析市場：依最終用戶分類

  • 介紹
  • 醫療保健付款人
  • 醫療服務提供方
  • 政府機關
  • 其他

第9章醫療詐欺分析市場：按地區

  • 介紹
  • 北美洲
    • 美國
    • 加拿大
    • 墨西哥
  • 南美洲
    • 巴西
    • 阿根廷
    • 其他
  • 歐洲
    • 英國
    • 德國
    • 法國
    • 義大利
    • 西班牙
    • 其他
  • 中東/非洲
    • 沙烏地阿拉伯
    • 阿拉伯聯合大公國
    • 其他
  • 亞太地區
    • 日本
    • 中國
    • 印度
    • 韓國
    • 印尼
    • 台灣
    • 其他

第10章競爭環境及分析

  • 主要企業及策略分析
  • 新興企業和市場盈利
  • 合併、收購、協議和合作
  • 供應商競爭力矩陣

第11章 公司簡介

  • IBM Corporation
  • SAS Institute Inc.
  • Optum（a part of UnitedHealth Group）
  • FairWarning（acquired by Imprivata）
  • EXL Service Holdings, Inc.
  • Pondera Solutions（acquired by Thomson Reuters）
  • Cotiviti Holdings, Inc.
  • Change Healthcare
  • Wipro Limited
  • FICO（Fair Isaac Corporation）
簡介目錄
Product Code: KSI061615735

The healthcare fraud analytics market is expected to grow at a CAGR of 20.47% from US$1.626 billion in 2021 to US$5.989 billion in 2028.

The healthcare fraud analytics market size is growing and focuses on detecting and preventing fraudulent actions in the healthcare business. Billing fraud, identity theft, and needless treatments all cost the healthcare system billions of dollars each year. Advanced data analytics techniques and algorithms are used in healthcare fraud analytics systems to uncover trends, abnormalities, and suspicious activity, allowing for proactive fraud detection and prevention. The healthcare fraud analytics market growth has enormous potential to reduce fraudulent activities, safeguard healthcare organizations from financial losses, and maintain the healthcare industry's confidence and integrity. In terms of market share, numerous industry competitors, such as specialized analytics solution providers, technology firms, and healthcare organizations themselves, are striving to grab a substantial chunk of the market. The market is likely to expand further as healthcare organizations invest in sophisticated analytics tools and technology to detect and prevent fraud in the sector.

Need for Cost Containment and Financial Loss Prevention in Healthcare Fraud Analytics Market.

A primary driver in the Healthcare Fraud Analytics industry is the requirement for cost conservation and financial loss avoidance. Healthcare fraud is projected to account for 3% to 10% of worldwide healthcare spending each year, according to NHCAA. This financial burden emphasizes the need to implement fraud analytics tools to detect and prevent fraudulent actions. According to research, employing such solutions can result in considerable cost reductions for healthcare organizations. The market's demand for advanced analytics solutions is being driven by a focus on cost conservation and financial loss avoidance.

Growing Awareness and Focus on Fraud Prevention Enhances the Healthcare Fraud Analytics Market Size.

In the Healthcare Fraud Analytics industry, there is a rising awareness of and emphasis on fraud prevention. In the Healthcare Fraud Analytics industry, the emphasis on fraud prevention drives market growth and innovation.

Government Initiatives and Regulations to Combat Healthcare Fraud in Healthcare Fraud Analytics Market.

The role of government actions and legislation in preventing healthcare fraud is crucial. Governments throughout the world are enacting stronger measures to combat fraud and defend the integrity of healthcare systems. These approaches include the creation of specialized anti-fraud teams, greater financing for fraud detection programs, and the passage of legislation to discourage and penalize fraudulent behaviour. Furthermore, governments work with industry players to create best practices, share information, and increase transparency in billing and claims procedures. Combating healthcare fraud provides financial responsibility, protects patients, and promotes a safer and more efficient healthcare system.

North America is a Market Leader in the Healthcare Fraud Analytics Market.

North America is the industry leader in healthcare fraud analytics market share. This can be linked to a variety of causes, including the region's rigorous regulatory framework, high healthcare spending, and rising occurrences of healthcare fraud. Furthermore, North America has a well-established healthcare system that places a premium on fraud prevention and compliance. The region's emphasis on preventing healthcare fraud, along with the deployment of advanced analytics technology, underpins its market leadership in Healthcare Fraud Analytics.

Rising Adoption of Electronic Health Records (EHRs) and Digital Health Systems in Healthcare Fraud Analytics Market.

The growing use of Electronic Health Records (EHRs) and digital health systems is having a significant influence on the Healthcare Fraud Analytics industry. By 2021, 96% of non-federal acute care hospitals in the United States have adopted certified EHR systems, according to the Office of the National Coordinator for Health Information Technology. This digitization of healthcare data gives a lot of information that fraud analytics systems may use to detect and prevent fraudulent activity. The integration of EHRs with digital health systems enables real-time monitoring, data analysis, and pattern identification, allowing healthcare organizations to discover fraudulent billing, coding errors, and other fraudulent practices in real time.

Key Developments:

  • In June 2022, Patient Engagement is a line of products from Change Healthcare that connects touchpoints throughout the patient experience, increasing access and improving communication between patients and physicians. Change Healthcare services laid out income cycle the board capacities, joined with Luma Health's industry-driving arrangements, empower suppliers to coordinate functional, clinical, and monetary excursions, bringing about a more improved understanding experience.

Company Products:

  • Fraud Detection Systems: IBM provides sophisticated analytics tools that leverage machine learning and artificial intelligence to detect trends and anomalies that may indicate fraudulent activity. Large amounts of healthcare data, such as claims, billing records, and patient information, are analyzed by these systems to detect unusual behavior and probable fraud.
  • Real-time Monitoring and Alerting: Optum offers real-time monitoring systems that continually monitor healthcare transactions and data streams. These systems employ rule-based algorithms to detect and notify of potentially fraudulent activity, allowing for quick intervention and prevention.
  • Identity Verification: LexisNexis Risk Solutions offers identity verification technologies to assist healthcare organizations in validating the identities of their patients, providers, and other entities. To avoid identity theft and fraudulent actions, these solutions make use of powerful identity verification algorithms and databases.
  • Provider Network Analysis: Optum's fraud analytics solutions use network analysis techniques to uncover linkages and interconnections among healthcare providers, patients, and other organizations. This study aids in the detection of fraudulent schemes involving cooperation, incorrect billing practices, or organized networks.

Segmentation

By Component

  • Software
  • Services

By Deployment

  • On-Premises
  • Cloud-Based

By Application

  • Insurance Claims Review
  • Payment Integrity
  • Identity & Access Management
  • Others

By End-User

  • Healthcare Payers
  • Healthcare Providers
  • Government Agencies
  • Others

By Geography

  • North America
  • United States
  • Canada
  • Mexico
  • South America
  • Brazil
  • Argentina
  • Others
  • Europe
  • United Kingdom
  • Germany
  • France
  • Italy
  • Spain
  • Others
  • Middle East and Africa
  • Saudi Arabia
  • UAE
  • Others
  • Asia Pacific
  • Japan
  • China
  • India
  • South Korea
  • Indonesia
  • Taiwan
  • Others

TABLE OF CONTENTS

1. INTRODUCTION

  • 1.1. Market Overview
  • 1.2. Market Definition
  • 1.3. Scope of the Study
  • 1.4. Market Segmentation
  • 1.5. Currency
  • 1.6. Assumptions
  • 1.7. Base, and Forecast Years Timeline

2. RESEARCH METHODOLOGY

  • 2.1. Research Data
  • 2.2. Sources
  • 2.3. Research Design

3. EXECUTIVE SUMMARY

  • 3.1. Research Highlights

4. MARKET DYNAMICS

  • 4.1. Market Drivers
  • 4.2. Market Restraints
  • 4.3. Porters Five Forces Analysis
    • 4.3.1. Bargaining Power of Suppliers
    • 4.3.2. Bargaining Power of Buyers
    • 4.3.3. Threat of New Entrants
    • 4.3.4. Threat of Substitutes
    • 4.3.5. Competitive Rivalry in the Industry
  • 4.4. Industry Value Chain Analysis

5. HEALTHCARE FRAUD ANALYTICS MARKET, BY COMPONENT

  • 5.1. Introduction
  • 5.2. Software
  • 5.3. Services

6. HEALTHCARE FRAUD ANALYTICS MARKET, BY DEPLOYMENT

  • 6.1. Introduction
  • 6.2. On-Premises
  • 6.3. Cloud-based

7. HEALTHCARE FRAUD ANALYTICS MARKET, BY APPLICATION

  • 7.1. Introduction
  • 7.2. Insurance Claims Review
  • 7.3. Payment Integrity
  • 7.4. Identity & Access Management
  • 7.5. Others

8. HEALTHCARE FRAUD ANALYTICS MARKET, BY END-USER

  • 8.1. Introduction
  • 8.2. Healthcare Payers
  • 8.3. Healthcare Providers
  • 8.4. Government Agencies
  • 8.5. Others

9. HEALTHCARE FRAUD ANALYTICS MARKET, BY GEOGRAPHY

  • 9.1. Introduction
  • 9.2. North America
    • 9.2.1. United States
    • 9.2.2. Canada
    • 9.2.3. Mexico
  • 9.3. South America
    • 9.3.1. Brazil
    • 9.3.2. Argentina
    • 9.3.3. Others
  • 9.4. Europe
    • 9.4.1. United Kingdom
    • 9.4.2. Germany
    • 9.4.3. France
    • 9.4.4. Italy
    • 9.4.5. Spain
    • 9.4.6. Others
  • 9.5. Middle East and Africa
    • 9.5.1. Saudi Arabia
    • 9.5.2. UAE
    • 9.5.3. Others
  • 9.6. Asia Pacific
    • 9.6.1. Japan
    • 9.6.2. China
    • 9.6.3. India
    • 9.6.4. South Korea
    • 9.6.5. Indonesia
    • 9.6.6. Taiwan
    • 9.6.7. Others

10. COMPETITIVE ENVIRONMENT AND ANALYSIS

  • 10.1. Major Players and Strategy Analysis
  • 10.2. Emerging Players and Market Lucrativeness
  • 10.3. Mergers, Acquisitions, Agreements, and Collaborations
  • 10.4. Vendor Competitiveness Matrix

11. COMPANY PROFILES

  • 11.1. IBM Corporation
  • 11.2. SAS Institute Inc.
  • 11.3. Optum (a part of UnitedHealth Group)
  • 11.4. FairWarning (acquired by Imprivata)
  • 11.5. EXL Service Holdings, Inc.
  • 11.6. Pondera Solutions (acquired by Thomson Reuters)
  • 11.7. Cotiviti Holdings, Inc.
  • 11.8. Change Healthcare
  • 11.9. Wipro Limited
  • 11.10. FICO (Fair Isaac Corporation)