The North America Healthcare Fraud Analytics Market is expected to witness market growth of 22.5% CAGR during the forecast period (2022-2028).
A simple numerical study of a surgeon's costs, for instance, may reveal that surgeons are charging far more than his peers, implying that the patient is committing fraud. A more thorough examination, however, may discover that surgeon is qualified to undertake resource- and labor-intensive neuro-surgeries that nobody else in the state can. Many hours of work go into training massive data to avoid false positives. Healthcare and billing processes are always evolving, and historical data that was relevant a few months ago may become obsolete if a specialty undergoes significant changes. Experts in healthcare fraud data analytics, on the other hand, are more than capable of meeting the difficulties of this ever-changing industry.
Computer data analytics programs have advanced tremendously, and fraud detection software is used in a variety of financial sectors. Insurance companies must utilize every instrument at their disposal to enhance profit margins and stay competitive. As part of a wider digital transformation for the twenty-first century, health insurance firms can collaborate with data analytics companies that specialize in healthcare to build cloud computing solutions.
There is a rising healthcare spending, increased implementation of healthcare IT, and an increase in the number of fraud instances. According to the website Consumer Information section of the National Health Care Anti-Fraud Association (NHCAA) updated in 2021, the United States spent multiple trillions on health care each year. According to the NHCAA, health care fraud costs the US economy multiple billions each year, with another multiple billion being deceived and stolen. The actions, as well as the loss of income as a result of fraud and illicit operations, make healthcare fraud the country's most serious problem.
The US market dominated the North America Predictive Analytics Market by Country in 2021, and is expected to continue to be a dominant market till 2028; thereby, achieving a market value of $507.7 million by 2028. The Canada market is experiencing a CAGR of 25.4% during (2022 - 2028). Additionally, The Mexico market is expected to witness a CAGR of 24.3% during (2022 - 2028).
Based on Delivery Model, the market is segmented into On-premise and Cloud. Based on Application, the market is segmented into Insurance Claim Review, Pharmacy billing Issue, Payment Integrity, and Others. Based on End User, the market is segmented into Public & Government Agencies, Private Insurance Payers, Third-party Service Providers, and Employers. Based on Solution Type, the market is segmented into Descriptive Analytics, Predictive Analytics, and Prescriptive Analytics. Based on countries, the market is segmented into U.S., Mexico, Canada, and Rest of North America.
The market research report covers the analysis of key stake holders of the market. Key companies profiled in the report include Wipro Limited, IBM Corporation, DXC Technology Company, SAS Institute, Inc., Conduent, Incorporated, HCL Technologies Ltd., UnitedHealth Group, Inc. (Optum, Inc.), OSP Labs, Cotiviti, Inc., and ExlService Holdings, Inc.
A simple numerical study of a surgeon's costs, for instance, may reveal that surgeons are charging far more than his peers, implying that the patient is committing fraud. A more thorough examination, however, may discover that surgeon is qualified to undertake resource- and labor-intensive neuro-surgeries that nobody else in the state can. Many hours of work go into training massive data to avoid false positives. Healthcare and billing processes are always evolving, and historical data that was relevant a few months ago may become obsolete if a specialty undergoes significant changes. Experts in healthcare fraud data analytics, on the other hand, are more than capable of meeting the difficulties of this ever-changing industry.
Computer data analytics programs have advanced tremendously, and fraud detection software is used in a variety of financial sectors. Insurance companies must utilize every instrument at their disposal to enhance profit margins and stay competitive. As part of a wider digital transformation for the twenty-first century, health insurance firms can collaborate with data analytics companies that specialize in healthcare to build cloud computing solutions.
There is a rising healthcare spending, increased implementation of healthcare IT, and an increase in the number of fraud instances. According to the website Consumer Information section of the National Health Care Anti-Fraud Association (NHCAA) updated in 2021, the United States spent multiple trillions on health care each year. According to the NHCAA, health care fraud costs the US economy multiple billions each year, with another multiple billion being deceived and stolen. The actions, as well as the loss of income as a result of fraud and illicit operations, make healthcare fraud the country's most serious problem.
The US market dominated the North America Predictive Analytics Market by Country in 2021, and is expected to continue to be a dominant market till 2028; thereby, achieving a market value of $507.7 million by 2028. The Canada market is experiencing a CAGR of 25.4% during (2022 - 2028). Additionally, The Mexico market is expected to witness a CAGR of 24.3% during (2022 - 2028).
Based on Delivery Model, the market is segmented into On-premise and Cloud. Based on Application, the market is segmented into Insurance Claim Review, Pharmacy billing Issue, Payment Integrity, and Others. Based on End User, the market is segmented into Public & Government Agencies, Private Insurance Payers, Third-party Service Providers, and Employers. Based on Solution Type, the market is segmented into Descriptive Analytics, Predictive Analytics, and Prescriptive Analytics. Based on countries, the market is segmented into U.S., Mexico, Canada, and Rest of North America.
The market research report covers the analysis of key stake holders of the market. Key companies profiled in the report include Wipro Limited, IBM Corporation, DXC Technology Company, SAS Institute, Inc., Conduent, Incorporated, HCL Technologies Ltd., UnitedHealth Group, Inc. (Optum, Inc.), OSP Labs, Cotiviti, Inc., and ExlService Holdings, Inc.
Scope of the Study
Market Segments Covered in the Report:
By Delivery Model
- On-premise
- Cloud
By Application
- Insurance Claim Review
- Pharmacy billing Issue
- Payment Integrity
- Others
By End User
- Public & Government Agencies
- Private Insurance Payers
- Third-party Service Providers
- Employers
By Solution Type
- Descriptive Analytics
- Predictive Analytics
- Prescriptive Analytics
By Country
- US
- Canada
- Mexico
- Rest of North America
Key Market Players
List of Companies Profiled in the Report:
- Wipro Limited
- IBM Corporation
- DXC Technology Company
- SAS Institute, Inc.
- Conduent, Incorporated
- HCL Technologies Ltd.
- UnitedHealth Group, Inc. (Optum, Inc.)
- OSP Labs
- Cotiviti, Inc.
- ExlService Holdings, Inc.
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Table of Contents
Chapter 1. Market Scope & Methodology
Chapter 2. Market Overview
Chapter 3. Competition Analysis - Global
Chapter 4. North America Healthcare Fraud Analytics Market by Delivery Model
Chapter 5. North America Healthcare Fraud Analytics Market by Application
Chapter 6. North America Healthcare Fraud Analytics Market by End User
Chapter 7. North America Healthcare Fraud Analytics Market by Solution Type
Chapter 8. North America Healthcare Fraud Analytics Market by Country
Chapter 9. Company Profiles
Companies Mentioned
- Wipro Limited
- IBM Corporation
- DXC Technology Company
- SAS Institute, Inc.
- Conduent, Incorporated
- HCL Technologies Ltd.
- UnitedHealth Group, Inc. (Optum, Inc.)
- OSP Labs
- Cotiviti, Inc.
- ExlService Holdings, Inc.
Methodology
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