医疗保健诈欺分析市场、机会、成长动力、产业趋势分析与预测，2024-2032 年

2023 年，全球医疗保健诈欺分析市场估值为23 亿美元，预测显示出强劲的成长轨迹，预计2024 年至2032 年复合年增长率为24.1%。上升、医疗保健支出不断增加、医疗保健系统日益复杂以及数位医疗解决方案的广泛采用。

随着医疗保健组织努力减轻诈欺活动的影响，对即时诈欺侦测的需求不断增加。透过即时分析，组织可以快速找出并解决可疑活动，从而减少诈骗的可能性。资料处理技术的进步以及在预防诈欺方面加快决策的迫切需求增强了对即时检测的日益重视。

医疗保健诈欺分析产业分为解决方案类型、部署模式、应用程式、最终用途和区域。

市场将其解决方案分为描述性分析、规范性分析和预测性分析。 2023 年，描述性分析领域在营收排行榜上名列前茅，达到 12 亿美元。描述性分析使医疗保健实体能够审查历史诈欺活动，同时辨别诈欺者采用的模式、行为和策略。透过深入研究过去的资料，组织可以找出普遍存在的诈欺计划，利用这种洞察力来增强其检测系统。这种对从历史诈欺事件中学习的重视极大地推动了对描述性分析的需求。

市场将其部署模式分为本地解决方案和基于云端的解决方案。 2023 年，本地解决方案领域占据了 58% 的市场。鑑于医疗保健实体管理从病史到财务详细资讯等敏感患者资料，这些数据成为网路威胁的主要目标。本地解决方案增强了对资料安全的控制，使组织能够在其基础设施内实施自己的保护措施。对资料安全和隐私的高度重视推动了对本地诈欺分析解决方案的偏好。

2023 年，北美以 8.838 亿美元的收入引领医疗诈欺分析市场。预测显示，从 2024 年到 2032 年，成长率将资料23.8%。这些先进技术透过筛选大量资料来发现潜在的诈欺模式，从而促进卓越的诈欺侦测。因此，该地区获得最先进技术的机会加速了复杂的诈欺分析解决方案的采用。

目录

第 1 章：方法与范围

第 2 章：执行摘要

第 3 章：产业洞察

• 产业生态系统分析
• 产业影响力
  • 成长动力
    • 医疗诈欺发生率上升
    • 提高对预防诈欺的认识和关注
    • 技术进步
  • 产业陷阱与挑战
    • 实施成本高
    • 缺乏熟练的专业人员
• 成长潜力分析
• 监管环境
• 报销场景
• 波特的分析
• PESTEL分析
• 政策展望
• 差距分析
• 未来市场趋势

第 4 章：竞争格局

• 介绍
• 公司矩阵分析
• 主要市场参与者的竞争分析
• 竞争定位矩阵
• 战略仪表板

第 5 章：市场估计与预测：按解决方案类型，2021 - 2032 年

• 主要趋势
• 描述性分析
• 规范性分析
• 预测分析

第 6 章：市场估计与预测：按部署模式，2021 - 2032 年

• 主要趋势
• 本地
• 基于云端

第 7 章：市场估计与预测：按应用分类，2021 - 2032

• 主要趋势
• 保险理赔审查
  • 付款后审核
  • 预付款审核
• 药局帐单问题
• 付款诚信
• 其他应用

第 8 章：市场估计与预测：按最终用途，2021 - 2032 年

• 主要趋势
• 医疗保健提供者
• 保险公司
• 政府机构
• 其他最终用户

第 9 章：市场估计与预测：按地区，2021 - 2032

• 主要趋势
• 北美洲
  • 我们
  • 加拿大
• 欧洲
  • 德国
  • 英国
  • 法国
  • 西班牙
  • 义大利
  • 荷兰
  • 欧洲其他地区
• 亚太地区
  • 中国
  • 日本
  • 印度
  • 澳洲
  • 韩国
  • 亚太地区其他地区
• 拉丁美洲
  • 巴西
  • 墨西哥
  • 阿根廷
  • 拉丁美洲其他地区
• 中东和非洲
  • 南非
  • 沙乌地阿拉伯
  • 阿联酋
  • 中东和非洲其他地区

第 10 章：公司简介

• 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