Healthcare fraud is hard to trace and sometimes goes unnoticed; as a result, detecting such false statements is critical, as they add to society's burden. The use of a fraud identification solution allows healthcare organisations to use predictive data methodologies in accounting and auditing. Account auditing will expose suspicious providers and policyholders, as well as identify possible fraud cases before they happen. Leading life sciences organisations are currently using a range of data mining tools to address these fraudulent activities. Data mining techniques include scouring databases for new information, such as health-care insurance data, fraud techniques, and health-care information systems, among other items. According to the Coalition Against Insurance Fraud in the United States, the health-care and pharmaceutical companies steal tens of billions of dollars per year by fraudulent means. Health care fraud is difficult to detect in many situations, and it can go unnoticed.
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Key Driving Factors: Growing the number of patients who want health insurance to help the market:
Some of the top growth boosters in the global market are a growing consumer pool opting for health care insurance, an unprecedented increase in suspicious events in the healthcare sector, and increasing pressure to monitor violence and fraud in healthcare. The number of healthcare BPOs, the implementation of cutting-edge fraud identity management tools, the increasing acceptance of cloud-based analytical solutions, and social media's major impact on the healthcare industry are all encouraging factors. Artificial intelligence (AI) integration is becoming more prevalent in healthcare technologies and services, which could benefit the global healthcare fraud detection market.
This report offers the major market player’s profiles, such as WhiteHatAI, Healthcare Fraud Shield, FraudLens, Inc, HMS, FraudScope, Inc, IBM, Optum (A Part of UnitedHealth Group), Cotiviti Holdings, Inc, Fair Isaac Corporation, SAS Institute, Change Healthcare, EXL Service Holdings, Inc, Wipro, Conduent, Inc, CL Technologies, CGI Group, DXC Technology Company, and Northrop Grumman Corporation
Opportunities: Developing Countries to Offer Attractive Prospects:
Government-led initiatives to boost the healthcare IT industry could present a lucrative opportunity for healthcare fraud detection companies in the coming years. During the evaluation phase, the boom in funding for the introduction of many IT platforms in the healthcare industry would open up a slew of new growth opportunities for the leading vendors.
The market is divided into insurance claims analysis, pharmacy billing abuse, payment integrity, and other applications based on application. The healthcare fraud analytics market was dominated by the insurance claims review segment. In the coming years, the increasing number of patients seeking health insurance, the rising number of false claims, and the the acceptance of the prepayment evaluation model are expected to propel this segment forward.
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Published Date : April-2021