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医疗诈欺分析市场：2023 年至 2028 年预测
市场调查报告书
商品编码
1410065

医疗诈欺分析市场：2023 年至 2028 年预测

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个工作天内

价格
简介目录

医疗诈欺分析市场预计将从 2021 年的 16.26 亿美元成长到 2028 年的 59.89 亿美元，复合年增长率为 20.47%。

医疗保健诈欺分析市场规模正在扩大，重点是侦测和预防医疗保健业务中的诈欺。诈欺申请、身份盗窃和不必要的治疗每年都会对医疗保健系统造成数十亿美元的损失。医疗保健诈欺分析系统使用先进的资料分析技术和演算法来发现趋势、异常和可疑活动，从而实现主动诈欺检测和预防。医疗保健诈欺分析市场的成长在减少诈欺、保护医疗保健组织免受财务损失以及维护医疗保健行业的信任和诚信方面具有巨大潜力。就市场占有率而言，众多行业竞争对手正在努力占领市场的很大一部分，包括专业分析解决方案提供者、技术公司和医疗保健组织本身。随着医疗机构投资先进的分析工具和技术来检测和防止诈欺，该市场预计将进一步扩大。

医疗诈欺分析市场对成本控制和财务损失预防的需求。

医疗诈欺分析产业的关键驱动因素是成本控制和避免财务损失的需求。据 NHCAA 称，医疗保健诈欺预计每年占全球医疗保健支出的 3% 至 10%。这种经济负担凸显了实施诈欺分析工具来侦测和预防诈欺的必要性。研究表明，采用此类解决方案可以显着降低医疗机构的成本。对高阶分析解决方案的市场需求是由对降低成本和避免财务损失的关注所推动的。

对诈欺预防的意识不断提高和关注扩大了医疗诈欺分析市场规模

医疗诈欺分析行业对诈欺预防的认识和重视日益增强。在医疗保健诈欺分析产业，对诈欺预防的重视推动了市场的成长和创新。

政府打击医疗诈欺分析市场中的医疗诈欺的措施和法规。

政府措施和法律规章在防止医疗保健诈欺方面发挥着至关重要的作用。世界各国政府正在製定更强有力的措施来打击诈欺并保护医疗保健系统的完整性。这些方法包括建立专门的诈欺团队、增加诈欺侦测计划的资金以及製定法律来阻止和惩罚诈欺。此外，政府正在与行业相关人员合作，制定最佳实践、共用资讯并提高申请和索赔程序的透明度。打击医疗保健诈欺有助于我们履行经济责任、保护患者并促进更安全、更有效率的医疗保健系统。

北美是医疗保健诈欺分析市场的市场领导者。

北美在医疗保健诈欺分析市场份额方面处于行业领先地位。这是由于多种原因造成的，包括该地区严格的法律规范、高额医疗支出以及不断上升的医疗诈骗。此外，北美拥有完善的医疗保健系统，强调诈欺预防和合规性。该地区对医疗保健诈欺预防的关注以及先进分析技术的采用，支撑了其作为该地区医疗保健诈欺分析市场领导的地位。

医疗诈欺分析市场越来越多地采用电子健康记录(EHR) 和数位健康系统。

电子健康记录(EHR) 和数位医疗系统的日益普及对医疗诈欺分析行业产生了重大影响。据美国卫生资讯技术协调员办公室称，到 2021 年，美国 96% 的非联邦急诊医院将拥有经过认证的 EHR 系统。医疗保健资料的数位化提供了诈欺分析系统可以用来检测和防止诈欺的大量资讯。 EHR 和数位医疗系统整合可实现即时监控、资料分析和模式识别，使医疗保健组织能够即时发现诈欺申请、编码错误和其他诈欺。

主要进展：

  • 2022 年 6 月 Change Healthcare 的产品线「病患参与」连结了整个病患体验中的接触点，增加了病患与医师之间的接触并改善了沟通。 Change Healthcare 的服务与 Luma Health 业界领先的结构相结合，使供应商能够协调功能、临床和财务旅行，进一步增强患者体验。

公司产品

  • 诈欺侦测系统： IBM 提供先进的分析工具，利用机器学习和人工智慧来侦测可能显示诈欺活动的趋势和异常情况。这些系统分析大量的医疗保健资料，例如申请、申请记录和患者资讯，以检测异常行为和潜在的诈欺。
  • 即时监控和警报： Optum 提供即时监控系统，持续监控医疗保健交易和资料流。这些系统采用基于规则的演算法来侦测并通知您潜在的诈欺活动，从而实现快速介入和预防。
  • 身分验证： LexisNexis Risk Solutions 提供身分验证技术，协助医疗保健组织验证病患、医疗保健提供者和其他营业单位的身分。为了避免身份盗窃和诈欺，这些解决方案利用强大的身份验证演算法和资料库。
  • 提供者网路分析： Optum 的诈欺分析解决方案使用网路分析技术来揭示医疗保健提供者、患者和其他组织之间的联繫和互动。这项调查有助于揭露涉及协作、诈欺申请行为或有组织网路的诈欺计划。

目录

第一章简介

  • 市场概况
  • 市场定义
  • 调查范围
  • 市场区隔
  • 货币
  • 先决条件
  • 基准年和预测年时间表

第二章调查方法

  • 调查资料
  • 资讯来源
  • 研究设计

第三章执行摘要

  • 研究亮点

第四章市场动态

  • 市场驱动因素
  • 市场抑制因素
  • 波特五力分析
    • 供应商的议价能力
    • 买方议价能力
    • 新进入者的威胁
    • 替代品的威胁
    • 业内竞争对手之间的对抗关係
  • 产业价值链分析

第五章医疗诈欺分析市场：按组成部分

  • 介绍
  • 软体
  • 服务

第六章医疗诈欺分析市场：依发展划分

  • 介绍
  • 本地
  • 云端基础

第七章医疗诈欺分析市场：依应用分类

  • 介绍
  • 保险申请审核
  • 付款诚信
  • 身分和存取管理
  • 其他的

第八章医疗诈欺分析市场：依最终用户分类

  • 介绍
  • 医疗保健付款人
  • 医疗服务提供方
  • 政府机关
  • 其他的

第九章医疗诈欺分析市场：按地区

  • 介绍
  • 北美洲
    • 美国
    • 加拿大
    • 墨西哥
  • 南美洲
    • 巴西
    • 阿根廷
    • 其他的
  • 欧洲
    • 英国
    • 德国
    • 法国
    • 义大利
    • 西班牙
    • 其他的
  • 中东/非洲
    • 沙乌地阿拉伯
    • 阿拉伯聯合大公国
    • 其他的
  • 亚太地区
    • 日本
    • 中国
    • 印度
    • 韩国
    • 印尼
    • 台湾
    • 其他的

第十章竞争环境及分析

  • 主要企业及策略分析
  • 新兴企业和市场盈利
  • 合併、收购、协议和合作
  • 供应商竞争力矩阵

第十一章 公司简介

  • 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）
简介目录
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)