세계의 의료 부정 적발 시장 리포트(2023년)

“Healthcare Fraud Detection Global Market Report 2023 ” from The Business Research Company provides strategists, marketers and senior management with the critical information they need to assess the market.

This report focuses on healthcare fraud detection market which is experiencing strong growth. The report gives a guide to the trends which will be shaping the market over the next ten years and beyond.

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Where is the largest and fastest growing market for healthcare fraud detection? How does the market relate to the overall economy, demography and other similar markets? What forces will shape the market going forward? “The healthcare fraud detection market global report ” from The Business Research Company answers all these questions and many more.

The report covers market characteristics, size and growth, segmentation, regional and country breakdowns, competitive landscape, market shares, trends and strategies for this market. It traces the market's historic and forecast market growth by geography.

• The market characteristics section of the report defines and explains the market.
• The market size section gives the market size ($b) covering both the historic growth of the market, and forecasting its development.
• The forecasts are made after considering the major factors currently impacting the market. These include:

The impact of sanctions, supply chain disruptions, and altered demand for goods and services due to the Russian Ukraine war, impacting various macro-economic factors and parameters in the Eastern European region and its subsequent effect on global markets.

The impact of higher inflation in many countries and the resulting spike in interest rates.

The continued but declining impact of COVID-19 on supply chains and consumption patterns.

• Market segmentations break down the market into sub markets.
• The regional and country breakdowns section gives an analysis of the market in each geography and the size of the market by geography and compares their historic and forecast growth. It covers the growth trajectory of COVID-19 for all regions, key developed countries and major emerging markets.
• The competitive landscape chapter gives a description of the competitive nature of the market, market shares, and a description of the leading companies. Key financial deals which have shaped the market in recent years are identified.
• The trends and strategies section analyses the shape of the market as it emerges from the crisis and suggests how companies can grow as the market recovers.

Scope

Markets Covered:

• 1) By Type: Descriptive Analytics; Predictive Analytics; Prescriptive Analytics

• 2) By Model: On-premise Delivery; On-demand Delivery

• 3) By Component: Services; Software

• 4) By Application: Insurance Claims Review; Payment Integrity

• 5) By End User: Healthcare Payers; Government Agencies; Other end-users

• Companies Mentioned: International Business Machines Corporation; Cotiviti Inc; Fair Isaac and Company; SAS Institute; CGI Inc

• Countries: Australia; Brazil; China; France; Germany; India; Indonesia; Japan; Russia; South Korea; UK; USA

• Regions: Asia-Pacific; Western Europe; Eastern Europe; North America; South America; Middle East; Africa

• Time series: Five years historic and ten years forecast.

• Data: Ratios of market size and growth to related markets, GDP proportions, expenditure per capita,

• Data segmentations: country and regional historic and forecast data, market share of competitors, market segments.

• Sourcing and Referencing: Data and analysis throughout the report is sourced using end notes.

• Delivery format: PDF, Word and Excel Data Dashboard.

Executive Summary

Major players in the healthcare fraud detection market are: International Business Machines Corporation, Cotiviti Inc., Fair Isaac and Company, SAS Institute, CGI Inc., DXC Technology, RELX Group plc, EXL Service Holdings Inc., HCL Technologies, UnitedHealth Group Incorporated, Optum Inc., Conduent Inc., Change Healthcare, OSP Labs, and Codoxo.

The global healthcare fraud detection market is expected to grow from $2.16 billion in 2022 to $2.80 billion in 2023 at a compound annual growth rate (CAGR) of 29.5%. The Russia-Ukraine war disrupted the chances of global economic recovery from the COVID-19 pandemic, at least in the short term. The war between these two countries has led to economic sanctions on multiple countries, a surge in commodity prices, and supply chain disruptions, causing inflation across goods and services and affecting many markets across the globe. The healthcare fraud detection market is expected to reach $7.74 billion in 2027 at a CAGR of 28.9%.

The health fraud detection market includes revenues earned by entities by tracking secondary data, providing technology specialist. The market value includes the value of related goods sold by the service provider or included within the service offering. Only goods and services traded between entities or sold to end consumers are included.

Healthcare fraud detection refers to a group of actions performed to stop someone from obtaining patient data or property under false pretences and involves account auditing and detective investigation. It is used to promote transparency and accountability, risk assessment by identifying data usage, detection, prevention, and management of suspicious fraud, waste, and abuse, and reduce leakage of sensitive information such as patient medical records and other credentials.

North America was the largest region in the healthcare fraud detection market in 2022. The regions covered in the healthcare fraud detection report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East and Africa.

The main type of healthcare fraud detection include descriptive analytics, predictive analytics and prescriptive analytics. The descriptive analytics are used to help with predictive and prescriptive analytics to manage medical imaging scans, clinical and outcomes data. Descriptive analytics refers to the method of finding patterns and relationships by combining historical and present data to identify suspicious activities. The models includes on-premise delivery and on-demand delivery, which uses components such as services and software. The application includes insurance claims review and payment integrity and are used by healthcare payers, government agencies and others.

The rise in fraudulent events in the healthcare industry is expected to propel the healthcare fraud detection market going forward. Fraudulent events in healthcare refer to the deliberate misrepresentation of patient data and insurance information in order to obtain an unfair or illegal gain or to deprive a user of a legal right. For instance, in 2021, the Department of Justice (DOJ) opened 831 new criminal health care fraud investigations. Moreover, in 2021, DOJ opned 805 new civil health care fraud investigations. According to data published by the United States Sentencing Commission, a US-based agency that articulates sentencing guidelines, in August 2022, 336 health care fraud offenders were identified in fiscal year 2021, making up 8.0% of total theft, property damage, and fraud charges. Therefore, the rise in fraudulent events in the healthcare industry is expected to drive the healthcare fraud detection market.

Adoption of advanced analytics tools is a key trend gaining popularity in the healthcare fraud detection market. Major players are concentrating their efforts on creating innovative technologies to sustain their position in the healthcare fraud detection market. For instance, in January 2022, Premier, Inc., a US-based healthcare technology company, launched "INSights" based on PINC AITM technology. Insights is a vendor-neutral analytics platform that has access to the risk-adjusted, standardised, and cleaned healthcare data from PINC AITM. Insights is designed for healthcare providers to lower the workload associated with data preparation and analytics development for quick gains in clinical, quality, and financial outcomes.

In 2021, Equifax, a global data, analytics and technology company acquired Appriss Insights for $1.825 billion. With the acquisition Equifax will expand its largest and fastest growing business-workforce solutions. Appriss Insights is a UK based provider of proprietary data and analytics solutions to address safety, fraud, risk and compliance issues effectively and efficiently for government and commercial enterprises including healthcare.

The countries covered in the healthcare fraud detection market report are: Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA.

The market value is defined as the revenues that enterprises gain from the sale of goods and/or services within the specified market and geography through sales, grants, or donations in terms of the currency (in USD, unless otherwise specified).

The revenues for a specified geography are consumption values that are revenues generated by organizations in the specified geography within the market, irrespective of where they are produced. It does not include revenues from resales along the supply chain, either further along the supply chain or as part of other products.

The healthcare fraud detection market research report is one of a series of new reports from The Business Research Company that provides healthcare fraud detection market statistics, including healthcare fraud detection industry global market size, regional shares, competitors with an healthcare fraud detection market share, detailed healthcare fraud detection market segments, market trends and opportunities, and any further data you may need to thrive in the healthcare fraud detection industry. This healthcare fraud detection market research report delivers a complete perspective of everything you need, with an in-depth analysis of the current and future scenario of the industry.

Table of Contents

1. Executive Summary

2. Healthcare Fraud Detection Market Characteristics

3. Healthcare Fraud Detection Market Trends And Strategies

4. Healthcare Fraud Detection Market - Macro Economic Scenario

• 4.1. COVID-19 Impact On Healthcare Fraud Detection Market
• 4.2. Ukraine-Russia War Impact On Healthcare Fraud Detection Market
• 4.3. Impact Of High Inflation On Healthcare Fraud Detection Market

5. Healthcare Fraud Detection Market Size And Growth

• 5.1. Global Healthcare Fraud Detection Historic Market, 2017-2022, $ Billion
  • 5.1.1. Drivers Of The Market
  • 5.1.2. Restraints On The Market
• 5.2. Global Healthcare Fraud Detection Forecast Market, 2022-2027F, 2032F, $ Billion
  • 5.2.1. Drivers Of The Market
  • 5.2.2. Restraints On the Market

6. Healthcare Fraud Detection Market Segmentation

• 6.1. Global Healthcare Fraud Detection Market, Segmentation By Type, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• Descriptive Analytics
• Predictive Analytics
• Prescriptive Analytics
• 6.2. Global Healthcare Fraud Detection Market, Segmentation By Model, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• On-premise Delivery
• On-demand Delivery
• 6.3. Global Healthcare Fraud Detection Market, Segmentation By Component, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• Services
• Software
• 6.4. Global Healthcare Fraud Detection Market, Segmentation By Application, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• Insurance Claims Review
• Payment Integrity
• 6.5. Global Healthcare Fraud Detection Market, Segmentation By End User, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• Healthcare Payers
• Government Agencies
• Other end-users

7. Healthcare Fraud Detection Market Regional And Country Analysis

• 7.1. Global Healthcare Fraud Detection Market, Split By Region, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• 7.2. Global Healthcare Fraud Detection Market, Split By Country, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion

8. Asia-Pacific Healthcare Fraud Detection Market

• 8.1. Asia-Pacific Healthcare Fraud Detection Market Overview
• Region Information, Impact Of COVID-19, Market Information, Background Information, Government Initiatives, Regulations, Regulatory Bodies, Major Associations, Taxes Levied, Corporate Tax Structure, Investments, Major Companies
• 8.2. Asia-Pacific Healthcare Fraud Detection Market, Segmentation By Type, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• 8.3. Asia-Pacific Healthcare Fraud Detection Market, Segmentation By End User, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion

9. China Healthcare Fraud Detection Market

• 9.1. China Healthcare Fraud Detection Market Overview
• 9.2. China Healthcare Fraud Detection Market, Segmentation By Type, Historic and Forecast, 2017-2022, 2022-2027F, 2032F,$ Billion
• 9.3. China Healthcare Fraud Detection Market, Segmentation By End User, Historic and Forecast, 2017-2022, 2022-2027F, 2032F,$ Billion

10. India Healthcare Fraud Detection Market

• 10.1. India Healthcare Fraud Detection Market, Segmentation By Type, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• 10.2. India Healthcare Fraud Detection Market, Segmentation By End User, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion

11. Japan Healthcare Fraud Detection Market

• 11.1. Japan Healthcare Fraud Detection Market, Segmentation By Type, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• 11.2. Japan Healthcare Fraud Detection Market, Segmentation By End User, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion

12. Australia Healthcare Fraud Detection Market

• 12.1. Australia Healthcare Fraud Detection Market, Segmentation By Type, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• 12.2. Australia Healthcare Fraud Detection Market, Segmentation By End User, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion

13. Indonesia Healthcare Fraud Detection Market

• 13.1. Indonesia Healthcare Fraud Detection Market, Segmentation By Type, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• 13.2. Indonesia Healthcare Fraud Detection Market, Segmentation By End User, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion

14. South Korea Healthcare Fraud Detection Market

• 14.1. South Korea Healthcare Fraud Detection Market, Segmentation By Type, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• 14.2. South Korea Healthcare Fraud Detection Market, Segmentation By End User, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion

15. Western Europe Healthcare Fraud Detection Market

• 15.1. Western Europe Healthcare Fraud Detection Market Overview
• 15.2. Western Europe Healthcare Fraud Detection Market, Segmentation By Type, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• 15.3. Western Europe Healthcare Fraud Detection Market, Segmentation By End User, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion

16. UK Healthcare Fraud Detection Market

• 16.1. UK Healthcare Fraud Detection Market, Segmentation By Type, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• 16.2. UK Healthcare Fraud Detection Market, Segmentation By End User, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion

17. Germany Healthcare Fraud Detection Market

• 17.1. Germany Healthcare Fraud Detection Market, Segmentation By Type, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• 17.2. Germany Healthcare Fraud Detection Market, Segmentation By End User, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion

18. France Healthcare Fraud Detection Market

• 18.1. France Healthcare Fraud Detection Market, Segmentation By Type, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• 18.2. France Healthcare Fraud Detection Market, Segmentation By End User, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion

19. Eastern Europe Healthcare Fraud Detection Market

• 19.1. Eastern Europe Healthcare Fraud Detection Market Overview
• 19.2. Eastern Europe Healthcare Fraud Detection Market, Segmentation By Type, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• 19.3. Eastern Europe Healthcare Fraud Detection Market, Segmentation By End User, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion

20. Russia Healthcare Fraud Detection Market

• 20.1. Russia Healthcare Fraud Detection Market, Segmentation By Type, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• 20.2. Russia Healthcare Fraud Detection Market, Segmentation By End User, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion

21. North America Healthcare Fraud Detection Market

• 21.1. North America Healthcare Fraud Detection Market Overview
• 21.2. North America Healthcare Fraud Detection Market, Segmentation By Type, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• 21.3. North America Healthcare Fraud Detection Market, Segmentation By End User, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion

22. USA Healthcare Fraud Detection Market

• 22.1. USA Healthcare Fraud Detection Market Overview
• 22.2. USA Healthcare Fraud Detection Market, Segmentation By Type, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• 22.3. USA Healthcare Fraud Detection Market, Segmentation By End User, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion

23. South America Healthcare Fraud Detection Market

• 23.1. South America Healthcare Fraud Detection Market Overview
• 23.2. South America Healthcare Fraud Detection Market, Segmentation By Type, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• 23.3. South America Healthcare Fraud Detection Market, Segmentation By End User, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion

24. Brazil Healthcare Fraud Detection Market

• 24.1. Brazil Healthcare Fraud Detection Market, Segmentation By Type, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• 24.2. Brazil Healthcare Fraud Detection Market, Segmentation By End User, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion

25. Middle East Healthcare Fraud Detection Market

• 25.1. Middle East Healthcare Fraud Detection Market Overview
• 25.2. Middle East Healthcare Fraud Detection Market, Segmentation By Type, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• 25.3. Middle East Healthcare Fraud Detection Market, Segmentation By End User, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion

26. Africa Healthcare Fraud Detection Market

• 26.1. Africa Healthcare Fraud Detection Market Overview
• 26.2. Africa Healthcare Fraud Detection Market, Segmentation By Type, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion
• 26.3. Africa Healthcare Fraud Detection Market, Segmentation By End User, Historic and Forecast, 2017-2022, 2022-2027F, 2032F, $ Billion

27. Healthcare Fraud Detection Market Competitive Landscape And Company Profiles

• 27.1. Healthcare Fraud Detection Market Competitive Landscape
• 27.2. Healthcare Fraud Detection Market Company Profiles
  • 27.2.1. International Business Machines Corporation
    • 27.2.1.1. Overview
    • 27.2.1.2. Products and Services
    • 27.2.1.3. Strategy
    • 27.2.1.4. Financial Performance
  • 27.2.2. Cotiviti Inc
    • 27.2.2.1. Overview
    • 27.2.2.2. Products and Services
    • 27.2.2.3. Strategy
    • 27.2.2.4. Financial Performance
  • 27.2.3. Fair Isaac and Company
    • 27.2.3.1. Overview
    • 27.2.3.2. Products and Services
    • 27.2.3.3. Strategy
    • 27.2.3.4. Financial Performance
  • 27.2.4. SAS Institute
    • 27.2.4.1. Overview
    • 27.2.4.2. Products and Services
    • 27.2.4.3. Strategy
    • 27.2.4.4. Financial Performance
  • 27.2.5. CGI Inc
    • 27.2.5.1. Overview
    • 27.2.5.2. Products and Services
    • 27.2.5.3. Strategy
    • 27.2.5.4. Financial Performance

28. Key Mergers And Acquisitions In The Healthcare Fraud Detection Market

29. Healthcare Fraud Detection Market Future Outlook and Potential Analysis

30. Appendix

• 30.1. Abbreviations
• 30.2. Currencies
• 30.3. Historic And Forecast Inflation Rates
• 30.4. Research Inquiries
• 30.5. The Business Research Company
• 30.6. Copyright And Disclaimer