US Healthcare Fraud Analytics Market to 2027 - Country Analysis and Forecasts by Solution (Predictive Analytics, Descriptive Analytics, Prescriptive Analytics); Mode of Delivery (On-Premise Delivery Models, Cloud-Based Delivery Models); Application (Insurance Claims Review, Pharmacy Billing Misuse, Payment Integrity, Medical Identity Theft, Other Applications); End User (Government Agencies, Private Insurance Payers, Third-party Service Providers, Employers)

Abstract
The US Healthcare Fraud Analytics Market is expected to reach US$ 3,483.12 Mn in 2027 from US$ 517.28 Mn in 2019. The market is estimated to grow with a CAGR of 27.4% from 2020-2027.

The growth of the healthcare fraud analytics market is primarily attributed to the increasing number of healthcare fraudulent cases in the US and growing health insurance industry in the US. However, concerns regarding healthcare fraud analytics may hinder the growth of the market during the forecast period. The hospital industry is growing at a faster pace in the US. The hospital industry in the US is growing. Though the average hospital stay for a single person has been slightly decreased from 7 days to 5-6 days over the last couple of decades in the US, but, the total number of hospital admissions increased to 36.5 million in 2017. An increase in the elder population is a major reason for driving the hospital market in the US.

For instance, as per the National Health Care Anti-Fraud Association (NHCAA) estimated that every year, losses due to healthcare frauds are in the tens of billions of dollars. Some government and law enforcement agencies also estimated that healthcare frauds cost around 10% of the total annual health expenditure, which could be around US$ 300 billion. Thus, an increasing number of fraudulent healthcare cases is likely to demand healthcare fraud analytics solutions

In 2019, the predictive analytics segment held the largest market share of the healthcare fraud analytics market, by solution. This segment is also anticipated to dominate the market in 2027 owing to its analytics detection and identification patterns. Also, the segment is anticipated to witness growth at a significant rate during the forecast period, 2020 to 2027.

The US healthcare fraud analytics market by mode of delivery is segmented into on-premise delivery models, cloud-based delivery models. The US healthcare fraud analytics market is dominated by on-premise delivery models segment in 2019 with a considerable market share by mode of delivery. This segment is also predicted to dominate the market in 2027. However, cloud-based delivery models segment is anticipated to witness growth at a significant rate during the forecast period, 2020 to 2027, because it is an extremely manageable alternative which helps in the accessing real-time information.

In 2019, the insurance claims review held a largest market share of the healthcare fraud analytics market, by the application. This segment is also predicted to dominate the market in 2027 because it is very common and costly to the healthcare insurance system when fraud is detected and the number of health insurance frauds are increasing every year. Also, the insurance claims segment is anticipated to witness growth at a significant rate during the forecast period, 2020 to 2027.

In 2019, the government agencies segment held the largest market share of the healthcare fraud analytics market, by end user. This segment is also anticipated to dominate the market in 2027 as data analytics allows the government agencies to observe the billing patterns and then spot the unusual and suspicious cases. Also, the segment is anticipated to witness growth at a significant rate during the forecast period, 2020 to 2027.

Some of the major primary and secondary sources for healthcare fraud analytics included in the report are Medicare & Medicaid Services, World Health Organization, Health Maintenance Organization, U.S. Department of Justice, and others.

Content
TABLE OF CONTENTS
1. Introduction
1.1 Scope of the Study
1.2 The Insight Partners Research Report Guidance
1.3 Market Segmentation
1.3.1 US Healthcare Fraud Analytics Market – By Solution
1.3.2 US Healthcare Fraud Analytics Market – By Mode of Delivery
1.3.3 US Healthcare Fraud Analytics Market – By Application
1.3.4 US Healthcare Fraud Analytics Market – By End User
2. Healthcare Fraud Analytics Market – Key Takeaways
3. Research Methodology
3.1 Coverage
3.2 Secondary Research
3.3 Primary Research
4. Healthcare Fraud Analytics– Market Landscape
4.1 Overview
4.2 Pest Analysis
4.2.1 Healthcare Fraud Analytics Market in US: PEST Analysis
4.3 Expert Opinion
5. Healthcare Fraud Analytics Market – Key Dynamics
5.1 Drivers
5.1.1 Increasing Number of Healthcare Fraudulent Cases in the US
5.1.2 Growing Health Insurance Industry in the US
5.2 Restraints
5.2.1 Concerns Regarding Healthcare Fraud Analytics
5.3 Opportunities
5.3.1 Growing Hospital Industry
5.4 Future Trends
5.4.1 AI in Healthcare Fraud Detection
5.5 Impact Analysis
6. Healthcare Fraud Analytics Market – US Analysis
6.1 US Healthcare Fraud Analytics Market Revenue Forecast And Analysis
6.2 Positioning of Key Players
6.2.1 Fair, Isaac and Company (FICO)
6.2.2 Conduent Inc.
7. Healthcare Fraud Analytics Market Analysis and Forecast to 2027 – Solution
7.1 Overview
7.2 Healthcare Fraud Analytics Market, By Solution, 2019 & 2027 (%)
7.3 US Healthcare Fraud Analytics Market, Revenue and Forecast to 2027, By Solution (US$ Mn)
7.4 Predictive Analytics
7.4.1 Overview
7.4.2 Predictive Analytics Market Revenue and Forecast to 2027 (US$ Mn)
7.5 Descriptive Analytics
7.5.1 Overview
7.5.2 Descriptive Analytics Market Revenue and Forecast to 2027 (US$ Mn)
7.6 Prescriptive Analytics
7.6.1 Overview
7.6.2 Prescriptive Analytics Market Revenue and Forecast to 2027 (US$ Mn)
8. Healthcare Fraud Analytics Market Analysis and Forecast to 2027 – Mode of Delivery
8.1 Overview
8.2 Healthcare Fraud Analytics Market, By Mode of Delivery, 2019 & 2027 (%)
8.3 US Healthcare Fraud Analytics Market, Revenue and Forecast to 2027, By Mode Of Delivery (US$ Mn)
8.4 On-Premise Delivery Models
8.4.1 Overview
8.4.2 On-Premise Delivery Models Market Revenue and Forecast to 2027 (US$ Mn)
8.5 Cloud-Based Delivery Mode
8.5.1 Overview
8.5.2 Cloud-Based Delivery Mode Market Revenue and Forecast to 2027 (US$ Mn)
9. Healthcare Fraud Analytics Market Analysis and Forecast to 2027 –Application
9.1 Overview
9.2 Healthcare Fraud Analytics Market, By Application, 2019 & 2027 (%)
9.3 US Healthcare Fraud Analytics Market, Revenue and Forecast to 2027, By Application (US$ Mn)
9.4 Insurance Claims Review
9.4.1 Overview
9.4.2 Insurance Claims Review Market Revenue and Forecast to 2027 (US$ Mn)
9.5 Pharmacy Billing Misuse
9.5.1 Overview
9.5.2 Pharmacy Billing Misuse Market Revenue and Forecast to 2027 (US$ Mn)
9.6 Payment Integrity
9.6.1 Overview
9.6.2 Payment Integrity Market Revenue and Forecast to 2027 (US$ Mn)
9.7 Medical Identity Theft
9.7.1 Overview
9.7.2 Medical Identity Theft Market Revenue and Forecast to 2027 (US$ Mn)
9.8 Other Applications
9.8.1 Overview
9.8.2 Other Applications Market Revenue and Forecast to 2027 (US$ Mn)
10. Healthcare Fraud Analytics Market Analysis and Forecast to 2027 –End User
10.1 Overview
10.2 Healthcare Fraud Analytics Market, By End User, 2019 & 2027 (%)
10.3 US Healthcare Fraud Analytics Market, Revenue and Forecast to 2027, End User (US$ Mn)
10.4 Government Agencies
10.4.1 Overview
10.4.2 Government Agencies Review Market Revenue and Forecast to 2027 (US$ Mn)
10.5 Private Insurance Payers
10.5.1 Overview
10.5.2 Private Insurance Payers Market Revenue and Forecast to 2027 (US$ Mn)
10.6 Third-party Service Providers
10.6.1 Overview
10.6.2 Third-party Service Providers Market Revenue and Forecast to 2027 (US$ Mn)
10.7 Employers
10.7.1 Overview
10.7.2 Employers Market Revenue and Forecast to 2027 (US$ Mn)
11. Healthcare Fraud Analytics Market to 2027– Industry Landscape
11.1 Overview
11.2 Growth Strategies Done By The Companies In The Market, (%)
11.3 Organic Developments Done By The Companies In The Market
11.4 Inorganic Developments Done By The Companies In The Market
12. Healthcare Fraud Analytics Market – Key Company Profiles
12.1 Conduent, Inc.
12.1.1 Key Facts
12.1.2 Business Description
12.1.3 Products and Services
12.1.4 Financial Overview
12.1.5 SWOT Analysis
12.1.6 Key Developments
12.2 DXC Technology Company
12.2.1 Key Facts
12.2.2 Business Description
12.2.3 Products and Services
12.2.4 Financial Overview
12.2.5 SWOT Analysis
12.2.6 Key Developments
12.3 SCIOInspire, Corp. (EXL Service Holdings, Inc.)
12.3.1 Key Facts
12.3.2 Business Description
12.3.3 Products and Services
12.3.4 Financial Overview
12.3.5 SWOT Analysis
12.3.6 Key Developments
12.4 OPTUM, INC (UnitedHealth Group)
12.4.1 Key Facts
12.4.2 Business Description
12.4.3 Products and Services
12.4.4 Financial Overview
12.4.5 SWOT Analysis
12.4.6 Key Developments
12.5 SAS Institute
12.5.1 Key Facts
12.5.2 Business Description
12.5.3 Products and Services
12.5.4 Financial Overview
12.5.5 SWOT Analysis
12.5.6 Key Developments
12.6 Pondera Solutions
12.6.1 Key Facts
12.6.2 Business Description
12.6.3 Products and Services
12.6.4 Financial Overview
12.6.5 SWOT Analysis
12.6.6 Key Developments
12.7 LexisNexis Risk Solutions (RELX plc)
12.7.1 Key Facts
12.7.2 Business Description
12.7.3 Products and Services
12.7.4 Financial Overview
12.7.5 SWOT Analysis
12.7.6 Key Developments
12.8 Fair, Isaac and Company (FICO)
12.8.1 Key Facts
12.8.2 Business Description
12.8.3 Financial Overview
12.8.4 Product Portfolio
12.8.5 SWOT Analysis
12.8.6 Key Developments
12.9 Cotiviti, Inc. (Verscend Technologies, Inc.)
12.9.1 Key Facts
12.9.2 Business Description
12.9.3 Financial Overview
12.9.4 Product Portfolio
12.9.5 SWOT Analysis
12.9.6 Key Developments
12.10 WhiteHatAI
12.10.1 Key Facts
12.10.2 Business Description
12.10.3 Financial Overview
12.10.4 Product Portfolio
12.10.5 SWOT Analysis
12.10.6 Key Developments
13. Appendix
13.1 About The Insight Partners
13.2 Glossary Of Terms

LIST OF TABLES
Table 1. Number of Hospitals in the US
Table 2. US Healthcare Fraud Analytics Market, Revenue and Forecast to 2027, By Solution (US$ Mn)
Table 3. US Healthcare Fraud Analytics Market, Revenue and Forecast to 2027, By Mode Of Delivery (US$ Mn)
Table 4. US Healthcare Fraud Analytics Market, Revenue and Forecast to 2027, By Application (US$ Mn)
Table 5. US Healthcare Fraud Analytics Market, Revenue and Forecast to 2027, By End User (US$ Mn)
Table 6. Organic Developments Done by the Companies
Table 7. Inorganic Developments Done by the Companies
Table 8. Glossary of Terms, Healthcare Fraud Analytics Market

LIST OF FIGURES
Figure 1. Healthcare Fraud Analytics Market Segmentation
Figure 2. US Healthcare Fraud Analytics Market Overview
Figure 3. Predictive Analytics Segment Held Largest Share Of Solution Segment In Healthcare Fraud Analytics Market
Figure 4. US Healthcare Fraud Analytics Market, Industry Landscape
Figure 5. Healthcare Fraud Analytics Market in US: PEST Analysis
Figure 6. Healthcare Fraud Analytics Market Impact Analysis of Drivers and Restraints
Figure 7. US Healthcare Fraud Analytics Market – Revenue Forecast And Analysis – 2019- 2027
Figure 8. Market Positioning Of Key Player In Healthcare Fraud Analytics Market
Figure 9. Healthcare Fraud Analytics Market, by Solution, 2019 & 2027 (%)
Figure 10. Predictive Analytics Market Revenue and Forecast to 2027 (US$ Mn)
Figure 11. Descriptive Analytics Market Revenue and Forecast to 2027 (US$ Mn)
Figure 12. Surgical Lamp Market Revenue and Forecast to 2027 (US$ Mn)
Figure 13. Healthcare Fraud Analytics Market, by Mode of Delivery, 2019 & 2027 (%)
Figure 14. On-Premise Delivery Models Market Revenue and Forecasts to 2027 (US$ Mn)
Figure 15. Cloud-Based Delivery Mode Market Revenue and Forecast to 2027 (US$ Mn)
Figure 16. Healthcare Fraud Analytics Market, by Application, 2019 & 2027 (%)
Figure 17. Insurance Claims Review Market Revenue and Forecasts to 2027 (US$ Mn)
Figure 18. Pharmacy Billing Misuse Market Revenue and Forecasts to 2027 (US$ Mn)
Figure 19. Payment Integrity Market Revenue and Forecasts to 2027 (US$ Mn)
Figure 20. Medical Identity Theft Market Revenue and Forecasts to 2027 (US$ Mn)
Figure 21. Other Applications Market Revenue and Forecasts to 2027 (US$ Mn)
Figure 22. Healthcare Fraud Analytics Market, by End User, 2019 & 2027 (%)
Figure 23. Government Agencies Review Market Revenue and Forecasts to 2027 (US$ Mn)
Figure 24. Private Insurance Payers Market Revenue and Forecasts to 2027 (US$ Mn)
Figure 25. Third-party Service Providers Market Revenue and Forecasts to 2027 (US$ Mn)
Figure 26. Medical Identity Theft Market Revenue and Forecasts to 2027 (US$ Mn)
Figure 27. Growth Strategies Done By the Companies in the Market, (%)