Avner Ziv

DUBLIN–(BUSINESS WIRE)–The “United States Healthcare Fraud Detection Market – Progress, Developments, and Forecast (2019 – 2024)” report has been added to ResearchAndMarkets.com’s providing.

The US Healthcare Fraud Detection market studied was valued at USD 337.41 million in 2018, and is anticipated to succeed in USD 1,254.48 million by 2024, with an anticipated CAGR of 24.47%, through the forecast interval (2019-2024).

The main elements attributing to the expansion of the US healthcare fraud detection market are rising fraudulent actions within the US healthcare, rising stress to extend in operations effectivity and scale back healthcare spending, and prepayment evaluation mannequin.

As an example, as per the Nationwide Well being Care Anti-Fraud Affiliation said that medical insurance frauds in the USA value round USD 80 billion per yr to the shoppers. Criminals are trying ahead to revenue from the individuals throughout the nation. As most people within the nation are having medical insurance, free medical therapies or complimentary session affords are being stolen.

Such instances of frauds in medical insurance are inflicting damages to the medical historical past of individuals. A couple of years again, it was troublesome for the healthcare suppliers to determine the fraud, as criminals had been enjoying with all kinds of affected person identifications and insurance coverage info.

On account of such frauds, sufferers are compelled to pay larger premiums and their medical historical past is compromised. Subsequently, the US healthcare division is at the moment extra centered on the discount of such instances by implementing fraud detection know-how. Subsequently, it’s believed that as a result of rising fraudulent actions within the US healthcare division, the market studied might develop sooner or later.

Key Market Developments

Evaluate of Insurance coverage Claims is Anticipated to Maintain the Main Share

The healthcare fraud detection answer performs a significant position within the evaluation of insurance coverage claims, as many of the fraud instances happen whereas claiming the insurance coverage. As per the estimates of the Nationwide Well being Care Anti-Fraud Affiliation (NHCAA), well being care fraud prices the USA round USD 68 billion yearly. Medical health insurance fraud is a kind of fraud through which false or deceptive info is offered to a medical insurance firm in an try to have them pay unauthorized advantages to the coverage holder one other occasion or the entity offering providers. The offense could be dedicated by the insured particular person or the supplier of well being providers.

Most well being insurances embrace particular advantages and medical insurance fraud practices, comparable to overbilling for the kind of providers acquired, rob shoppers of those advantages. A central goal of the current US healthcare coverage reform, most notably the Reasonably priced Care Act’s (ACA) Well being Insurance coverage Market, has been to extend entry to steady, inexpensive medical insurance. Owing to the aforementioned elements, the evaluation of insurance coverage claims section is anticipated to develop exponentially within the US healthcare fraud detection market.

Aggressive Panorama

The healthcare fraud detection market is reasonably aggressive and consists of a number of main gamers. By way of market share, few of the key gamers at the moment dominate the market. With the rising adoption of Healthcare IT and the rising variety of fraud instances, few different smaller gamers are anticipated to enter into the market within the coming years.

A number of the main gamers of the market are Conduent, DXC Expertise Firm, EXL (Scio Well being Analytics), Worldwide Enterprise Machines Company (IBM), and Mckesson are amongst others.

Key Subjects Lined


1.1 Examine Deliverables

1.2 Examine Assumptions

1.Three Scope of the Examine




4.1 Market Overview

4.2 Market Drivers

4.2.1 Rising Fraudulent Actions within the US Healthcare

4.2.2 Rising Stress to Improve in Operations Effectivity & Cut back Healthcare Spending

4.2.Three Prepayment Evaluate Mannequin

4.Three Market Restraints

4.3.1 Lack of Expert Healthcare IT Labor within the Nation

4.Four Porter’s 5 Drive Evaluation

4.4.1 Risk of New Entrants

4.4.2 Bargaining Energy of Patrons/Shoppers

4.4.Three Bargaining Energy of Suppliers

4.4.Four Risk of Substitute Merchandise

4.4.5 Depth of Aggressive Rivalry


5.1 By Sort

5.1.1 Descriptive Analytics

5.1.2 Predictive Analytics

5.1.Three Prescriptive Analytics

5.2 By Utility

5.2.1 Evaluate of Insurance coverage Claims

5.2.2 Cost Integrity

5.Three By Finish-user

5.3.1 Personal Insurance coverage Payers

5.3.2 Authorities Businesses

5.3.Three Different Finish-users


6.1 Firm Profiles

6.1.1 Conduent Inc.

6.1.2 DXC Expertise Firm

6.1.Three EXL (Scio Well being Analytics)

6.1.Four Worldwide Enterprise Machines Company (IBM)

6.1.5 McKesson

6.1.6 Northrop Grumman

6.1.7 OSP Labs

6.1.eight SAS Institute

6.1.9 Relx Group PLC (LexisNexis)

6.1.10 United Well being Group Included (Optum Inc.)


For extra details about this report go to https://www.researchandmarkets.com/r/3sddo8