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市場調查報告書
商品編碼
1401979
到 2030 年的醫療詐欺分析市場預測:按解決方案類型、部署、應用程式、最終用戶和區域進行的全球分析Healthcare Fraud Analytics Market Forecasts to 2030 - Global Analysis By Solution Type (Predictive Analytics, Prescriptive Analytics, Descriptive Analytics and Other Solution Types), Deployment, Application, End User and By Geography |
根據 Stratistics MRC 的數據,2023 年全球醫療詐欺分析市場規模將達到 23 億美元,預計到 2030 年將達到 109 億美元,預測期內複合年成長率為 24.7%。
醫療保健詐欺分析市場代表了醫療保健業務的新興領域,它使用尖端技術和分析來檢測、預防和減少詐欺。隨著醫療保健實踐變得更加複雜,以及電子健康記錄、申請系統和索賠等多個資訊來源產生的資料量不斷增加,對強大的詐騙偵測程序的需求也隨之增加。
OIG 表示,醫療補助資料通常不完整且不準確,影響了詐欺申請檢測流程,並導致 FWA 浪費了數十億美元。
電子健康記錄普及
隨著醫療保健系統轉向數位平台並能夠存取大量患者資料,機會和挑戰並存。電子健康記錄(EHR) 的使用可以創建更廣泛、更集中的醫療記錄資料庫,這為詐欺提供了機會。此外,為了防止這種情況,醫療保健組織正在使用先進的分析工具來審查電子健康資料是否有詐欺以及可能表明詐欺的趨勢。
整合複雜度
將先進的詐欺分析系統整合到現有的醫療保健基礎設施中是一項常見的實施任務,既複雜又耗時。不同的資訊格式、醫療保健組織之間不一致的標準以及與遺留系統的兼容性問題加劇了這種複雜性。與擁有不同 IT 系統的醫療機構合作時,很難實現無縫整合,因為他們需要確保高效的資料流和即時分析。然而,習慣於傳統工作流程的員工可能會抵制醫療保健提供者並擾亂業務。
技術進步
分析工具、機器學習演算法和人工智慧的持續發展正在改變醫療保健部門防止詐欺的能力。這些技術進步使得更複雜、更有效的詐欺偵測技術能夠即時處理大量醫療資料。進階分析透過偵測複雜模式、異常和可疑方法來提高詐騙偵測的準確性和速度。此外,透過採用最尖端科技,醫療保健公司可以領先日益複雜的詐欺計劃,同時最大限度地減少財務損失並保持系統完整性。
資料安全和隱私問題
隨著越來越多的公司使用先進的分析來打擊詐欺,管理大量敏感患者資料所帶來的安全和隱私洩露問題越來越引起醫療保健公司的擔憂。這已成為一個問題。醫療產業受到嚴格監管,因此存在詐欺存取、資料外洩和網路攻擊的高風險。解決複雜問題需要以公正的方式從病患資料中收集關鍵見解,同時嚴格遵守 HIPAA(健康保險互通性與課責法案)等隱私法規。
由於世界各地的醫療保健系統需要有效地分配資源並防止詐欺,因此詐欺分析解決方案比以往任何時候都更加重要。同時,流行病擾亂了衛生系統,轉移了資源,並迅速將注意力集中在補救措施上。新醫療服務的快速推出以及與 COVID-19 相關的交易激增使詐欺偵測系統更具挑戰性。此外,大流行的經濟影響可能會進一步助長虛假申請。
預測分析產業預計在預測期內成長最大
預測分析細分市場預計將在預測期內成為最大的細分市場。預測分析使用先進的演算法和機器學習模型來分析歷史資訊、識別趨勢並預測未來的詐欺。透過採取積極主動的方法並領先於新的詐欺計劃,醫療保健提供者可以防止財務損失並保護醫療保健系統的完整性。此外,預測分析透過即時分析大型資料集並提高偵測可疑行為的準確性,同時減少詐騙偵測偵測的有效性。
藥房申請問題領域預計在預測期內複合年成長率最高。
預計藥品申請問題的複合年成長率最高。藥房申請問題,包括申請、分拆和詐欺處方箋申請,已成為醫療產業詐欺的主要手段。詐欺的增加推動了對專門分析解決方案的需求,這些解決方案旨在識別藥品申請資料中的異常和差異。預測模型和機器學習演算法等即時詐欺分析工具正用於調查藥房申請交易。
該地區的快速現代化和數位轉型使得許多國家採用了電子健康記錄(EHR)和其他數位醫療技術,其中亞太地區所佔佔有率最大。由於醫療保健成本不斷上升以及與詐欺相關的處罰不斷增加,亞太地區的醫療保健支付者和提供者正在投資先進的分析解決方案。亞太地區也明顯增加了旨在改善衛生系統課責和透明度的監管措施。
憑藉其複雜的醫療基礎設施和完善的報銷系統,北美地區處於有利地位,可以繼續盈利擴張。醫療保健詐欺帶來的財務成本不斷增加,促使監管機構在美國實施《虛假申報法》和《健康保險申請與責任法》(HIPAA) 等措施,以防止醫療產業的詐騙,並頒布了廣泛的立法。此外,這些監管措施也推動了進階分析解決方案的採用,這些措施需要更高的透明度、資料保護和詐騙偵測功能。
According to Stratistics MRC, the Global Healthcare Fraud Analytics Market is accounted for $2.3 billion in 2023 and is expected to reach $10.9 billion by 2030 growing at a CAGR of 24.7% during the forecast period. The term "Healthcare Fraud Analytics Market" describes the emerging segment of the healthcare business that uses cutting-edge technology and analytics to detect, prevent, and lessen fraudulent activity. Robust fraud detection procedures are becoming more and more necessary as the healthcare landscape grows more complicated and involves a growing amount of data generated from several sources, such as electronic health records, billing systems, and claims.
According to the OIG, Medicaid data is frequently incomplete and inaccurate, affecting the process of detecting fraudulent claims and resulting in the waste of billions of dollars due to FWA.
Increasing adoption of electronic health records
There are both potential and challenges when healthcare systems move to digital platforms and make enormous volumes of patient data available. The use of electronic health records (EHRs) makes it possible to create a more extensive and centralized database of medical records, which offers an opportunity for fraud. Additionally, in order to prevent this, healthcare institutions are using advanced analytics tools to closely examine electronic health data in order to search for irregularities and trends that may indicate fraud.
Complexity of integration
The integration of advanced fraud analytics systems into pre-existing healthcare infrastructures is a common implementation task that can be complex and time-consuming. The complexity is increased by different information formats, inconsistent standards among healthcare institutions, and compatibility problems with outdated systems. It is difficult to achieve seamless integration when dealing with institutions that have diverse IT systems, as it is necessary to ensure efficient data flow and real-time analysis. However, staff members used to traditional workflows may oppose healthcare providers and cause operational interruptions.
Advancements in technology
The healthcare sector's ability to prevent fraud has been transformed by the ongoing development of analytical tools, machine learning algorithms, and artificial intelligence. These technological advancements process enormous volumes of healthcare data in real time, enabling more complex and effective fraud detection techniques. Advanced analytics improve the accuracy and speed of fraud detection by detecting complex patterns, anomalies, and suspicious measures. Moreover, by incorporating cutting-edge technologies, healthcare companies may minimize financial losses and maintain the integrity of their systems while staying ahead of ever more sophisticated fraud schemes.
Data security and privacy concerns
Concerns regarding security breaches and privacy violations are raised by the management of enormous amounts of sensitive patient data, which is a concern for healthcare companies as they use advanced analytics to combat fraud in increasing numbers. Because the healthcare industry is heavily regulated, there is a significant risk of unauthorized access, data leaks, or cyberattacks. Achieving a complicated problem requires strict compliance with privacy rules such as HIPAA (Health Insurance Portability and Accountability Act) while also collecting important insights from patient data in an equitable manner.
Fraud analytics solutions are more important than ever because of the growing pressure on healthcare systems throughout the world to allocate resources efficiently and prevent fraud. On the other hand, the epidemic has also caused disruptions in the healthcare system, diverting resources and rapid attention to remedies. The quick adoption of new healthcare services and the surge in transactions associated with COVID-19 have made fraud detection systems more challenging. Furthermore, the pandemic's economic effects could promote further false claims.
The predictive analytics segment is expected to be the largest during the forecast period
Predictive analytics segment is expected to be the largest during the forecast period. Predictive analytics analyzes prior information, identifies trends, and projects future fraudulent activity using sophisticated algorithms and machine learning models. Healthcare businesses can prevent financial losses and safeguard the integrity of healthcare systems by adopting a proactive approach and staying ahead of emerging fraud schemes. Furthermore, predictive analytics improves the effectiveness of fraud detection by analyzing large datasets in real time and increasing the accuracy of spotting suspicious behavior while reducing false positives.
The pharmacy billing issue segment is expected to have the highest CAGR during the forecast period
Pharmacy billing issue segment is expected to have the highest CAGR. Pharmacy billing problems, like overbilling, unbundling, or charging for fraudulent prescriptions, have emerged as major avenues for fraud in the healthcare industry. The need for specialist analytics solutions designed to identify anomalies and discrepancies in pharmacy billing data has increased due to the rise in these fraudulent activities. Real-time fraud analytics tools such as predictive modeling and machine learning algorithms are being used to examine pharmacy billing transactions.
Due to the region's rapid modernization and digital transformation, many of its nations have adopted electronic health records (EHRs) and other digital health technologies, the Asia-Pacific area accounted for the largest percentage. Healthcare payers and providers in Asia Pacific are investing in advanced analytics solutions as a result of rising healthcare costs and growing penalties associated with fraud. In addition, there is an apparent rise in regulatory actions in the Asia-Pacific area that are intended to improve accountability and transparency in healthcare systems.
Because of the complex healthcare infrastructure and sophisticated reimbursement system, the North American region is better positioned to continue profitable expansion. Because of the growing financial damage that healthcare fraud causes, regulatory agencies have enacted extensive laws, such as the False Claims Act and the Health Insurance Portability and Accountability Act (HIPAA) in the United States, to prevent fraud in the healthcare industry. Moreover, the adoption of advanced analytics solutions is urged by these regulatory measures, which need more transparency, data protection, and fraud detection capabilities.
Some of the key players in Healthcare Fraud Analytics market include Conduent Inc, Cotiviti Inc, DXC Technology, EXL Service Holdings Inc, HCL Technologies Limited, IBM, Optum Inc., OSP Labs, SAS Institute Inc and Wipro Limited.
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