World News: 14:12 GMT Wednesday 11th September 2019. [Orbis Research via Globe Newswire via SPi World News]
Dallas, Texas, Sept. 11, 2019 (GLOBE NEWSWIRE) -- The term healthcare fraud detection refers to solutions that are helpful in earlier detection of errors in claim submissions, duplication of claims, etc., to minimize the healthcare spending and improve efficiency.
Growing healthcare expenditure, rising patient awareness about health insurance, increasing pressure to reduce healthcare spending and improve the efficiency, and growing fraudulent activities across healthcare sector globally are some of the major factors responsible for the growth of global healthcare fraud detection market. However, the healthcare sector has been witnessing a huge number of fraud cases, done by doctors, physicians, patients, as well as medical specialists.
In the healthcare industry, several fraudulent cases done by patients may comprise the fraudulent procurement of prescription fraud, sickness certificate, and avoidance of medical charges. However, many times medical specialists are also involved in several fraudulent activities such as frauds related to prescriptions, payments of medical tests, consultations, as well as facility services.
The expenditure on the healthcare sector is growing across the world, especially in the low as well as middle-income regions. According to the 2016 WHO report, the growth in healthcare expenditure in such regions was around 6% per year and about 4% in the high-income regions. In addition to this, emerging and innovative technologies in healthcare fraud detection are likely to contribute to the global healthcare fraud detection market growth.
The Global Healthcare Fraud Detection market studied was valued at USD 679.18 million in 2018, and is expected to reach USD 2540.29 million by 2024, with an anticipated CAGR of 24.59%, during the forecast period (2019-2024).
The major factors attributing to the growth of the healthcare fraud detection market are rising healthcare expenditure, rise in the number of patients opting for health insurance, growing pressure to increase operations efficiency and reduce healthcare spending, and increasing fraudulent activities in healthcare. The healthcare industry is witnessing a number of cases of frauds, which can be done by patients, doctors, physicians, and other medical specialists. Many healthcare providers and specialists are caught doing the frauds, for the sake of profit.
Fraudulent cases in healthcare that are done by patients include fraudulent provision of sickness certificates, prescription fraud, and evasion of medical charges. Medical professionals are also involved in the frauds, which contain prescription fraud by pharmacists, fraud and error concerning payments for medical tests, facility services, and consultations.
And even the healthcare expenditure is rising for instance currently, low and middle-income countries across the world are witnessing growth in healthcare expenditure. As per the 2016 report, the World Health Organization stated that this growth is approximately 6% per annum, as compared to 4% in high-income countries.
A report from WHO on global healthcare expenditure (2016) states that governments spend USD 60 per person on health, in lower-middle-income countries, and around USD 270 per person in upper-middle-income countries. For the upper-income countries, healthcare expenditure is equally distributed, which reflects in the overall development of the healthcare system. On the contrary, people in the low- and middle-income countries have to pay from their own pockets, due to less contribution of the governments toward health spending in these countries. Most of the insurance companies are adopting fraud detection software, due to the rising availability of the same in developed regions. This growth in the availability of the software is due to the rising healthcare expenditure, which is inspiring the companies to come up with a service or product to meet the market demand.
The healthcare fraud detection solution plays a major role in the review of insurance claims, as most of the fraud cases occur while claiming the insurance. As per the estimates of the National Health Care Anti-Fraud Association (NHCAA), health care fraud costs the United States around USD 68 billion annually. In healthcare insurance fraud, the false information is provided to a health insurance company in an attempt to have them pay unauthorized benefits to the policy holder‚ another party‚ or the service provider.
Machine learning techniques help in improving predictive accuracy, enabling loss control units to achieve higher coverage with low false-positive rates. Moreover, the quality and quantity of available data have a huge impact on predictive accuracy than the quality of the algorithm. There are various organizations across the world that aims to reduce the healthcare insurance fraud, such as Insurance Fraud Bureau of Australia (IFBA), Canadian Life and Health Insurance Association (CLHIA), NHS Counter Fraud Authority (NHSCFA), and European Healthcare Fraud & Corruption Network (EHFCN), among others. Presence of such type of organizations is expected to create more awareness among the users, thereby leading to high demand for healthcare fraud detection solutions.
North America is expected to dominate the overall market, throughout the forecast period. This is due to the increasing healthcare spending, increasing healthcare IT adoption, a growing number of fraud cases. In the North America region, the United States holds the largest market share. The Middle East & African region is anticipated to have the lowest market size, in the coming future. In terms of growth rate, Asia-Pacific is expected to be the fastest-growing region.
The healthcare fraud detection market is moderately competitive and consists of several major players. In terms of market share, few of the major players currently dominate the market. With the rising adoption of Healthcare IT and the increasing number of fraud cases, few other smaller players are expected to enter into the market in the coming years. Some of the major players of the market are CGI Inc., DXC Technology Company, EXL (Scio Health Analytics), International Business Machines Corporation (IBM), and Mckesson are among others.
2 RESEARCH METHODOLOGY
3 EXECUTIVE SUMMARY
4 MARKET DYNAMICS4.1 Market Overview4.2 Market Drivers4.2.1 Rising Healthcare Expenditure4.2.2 Rise in the Number of Patients Opting for Health Insurance4.2.3 Growing Pressure to Increase Operations Efficiency and Reduce Healthcare Spending4.2.4 Increasing Fraudulent Activities in Healthcare4.3 Market Restraints4.3.1 Unwillingness to Adopt Healthcare Fraud Analytics4.4 Porter's Five Force Analysis4.4.1 Threat of New Entrants4.4.2 Bargaining Power of Buyers/Consumers4.4.3 Bargaining Power of Suppliers4.4.4 Threat of Substitute Products4.4.5 Intensity of Competitive RivalryContinued…
Globe Newswire: 14:12 GMT Wednesday 11th September 2019
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