1 Introduction (Page No. - 16)

1.1 Objectives of the Study

1.2 Market Definition

1.3 Market Scope

1.3.1 Markets Covered

1.3.2 Years Considered for the Study

1.4 Currency

1.5 Limitations

1.6 Stakeholders

2 Research Methodology (Page No. - 20)

2.1 Research Approach

2.1.1 Secondary Sources

2.1.1.1 Key Data From Secondary Sources

2.1.2 Primary Sources

2.1.2.1 Key Data From Primary Sources

2.2 Market Size Estimation

2.3 Market Breakdown and Data Triangulation

2.4 Assumptions for the Study

3 Executive Summary (Page No. - 28)

4 Premium Insights (Page No. - 32)

4.1 Healthcare Fraud Analytics Market Overview

4.2 Asia Pacific: Market, By Solution Type and Application (2019)

4.3 Market: Geographic Growth Opportunities

4.4 Market: Regional Mix

4.5 Market: Developing vs Developed Regions

5 Market Overview (Page No. - 36)

5.1 Introduction

5.2 Market Dynamics

5.2.1 Drivers

5.2.1.1 Large Number of Fraudulent Activities in Healthcare

5.2.1.2 Increasing Number of Patients Seeking Health Insurance

5.2.1.3 Prepayment Review Model

5.2.1.4 High Returns on Investment

5.2.1.5 Rise in Pharmacy Claims-Related Fraud

5.2.2 Restraints

5.2.2.1 Limitations in the Data Capturing Process in Medicaid Services

5.2.3 Opportunities

5.2.3.1 Adoption of Healthcare Fraud Analytics in Developing Countries

5.2.3.2 Emergence of Social Media and Its Impact on the Healthcare Industry

5.2.3.3 Role of AI in Healthcare Fraud Detection

5.2.4 Challenges

5.2.4.1 Dearth of Skilled Personnel

5.2.4.2 Time-Consuming Deployment and the Need for Frequent Upgrades

6 Industry Insights (Page No. - 42)

6.1 Industry Trends

6.1.1 Shifting Focus From On-Premise Models to Cloud-Based On-Demand Models

6.1.2 Mergers and Acquisitions: the Most Adopted Strategy

6.1.3 Technological Advancements

6.1.4 New Use Case: Opioid Epidemic Crisis

6.1.5 End-User Trends: Adoption of Healthcare Fraud Analytics Solutions By Pharmacy Benefit Managers

7 Healthcare Fraud Analytics Market, By Solution Type (Page No. - 45)

7.1 Introduction

7.2 Descriptive Analytics

7.2.1 Descriptive Analytics Segment Accounted for the Largest Market Share

7.3 Predictive Analytics

7.3.1 Predictive Analytics Helps in Simulating Future Events & Trends That Can Enable Payers to Predict Preventable Events

7.4 Prescriptive Analytics

7.4.1 Prescriptive Models Offer Additional Advantages Relating to the Investigation of Suspicious Behavior to Generate Comprehensive Insights

8 Healthcare Fraud Analytics Market, By Delivery Model (Page No. - 52)

8.1 Introduction

8.2 On-Premise Delivery Models

8.2.1 On-Premise Models Account for the Largest Share of the Market

8.3 On-Demand Delivery Models

8.3.1 Cloud-Based Delivery Models Offer Organizations Increased Scalability and Speed

9 Healthcare Fraud Analytics Market, By Application (Page No. - 58)

9.1 Introduction

9.2 Insurance Claims Review

9.2.1 Postpayment Review

9.2.1.1 Postpayment Review Dominated the Healthcare Fraud Analytics Insurance Claims Review Market

9.2.2 Prepayment Review

9.2.2.1 The Majority of Prepayment Models Use Predictive Analytics to Detect Fraud and Stop Fraudulent Claims Payments

9.3 Pharmacy Billing Misuse

9.3.1 Fraud, Waste, and Abuse Cases in Pharmacy and Prescription Drug Areas are Driving the Demand for Analytics

9.4 Payment Integrity

9.4.1 Changes in Regulatory Guidelines have Aided the Adoption of Payment Integrity Software

9.5 Other Applications

10 Healthcare Fraud Analytics Market, By End User (Page No. - 69)

10.1 Introduction

10.2 Public & Government Agencies

10.2.1 Public & Government Agencies Dominate the Healthcare Fraud Analytics Market, By End User

10.3 Private Insurance Payers

10.3.1 Private Insurance Payers are Focused on Deploying Analytics to Combat Increasing Monetary Losses

10.4 Third-Party Service Providers

10.4.1 Adoption of Fraud Analytics Solutions By Public Insurers Puts Private Bodies at Risk, Driving Attention Toward Outsourcing

10.5 Employers

10.5.1 Employers are Considering Fraud Analytics Solutions as A Step Toward Better Cost Management

11 Healthcare Fraud Analytics Market, By Region (Page No. - 76)

11.1 Introduction

11.2 North America

11.2.1 US

11.2.1.1 US Dominates the Global Healthcare Fraud Analytics Market

11.2.2 Canada

11.2.2.1 Growing Adoption of Data-Crunching Technologies Like Predictive Analytics to Drive Market Growth

11.3 Europe

11.3.1 Germany

11.3.1.1 Germany is the Fastest-Growing Market for Healthcare Fraud Analytics Solutions in Europe

11.3.2 UK

11.3.2.1 Launch of Initiatives Such as Nhscfa Will Support the Market for Fraud Analytics Solutions in the UK

11.3.3 France

11.3.3.1 Increasing Adoption of Information Technology for the Detection of Healthcare Fraud�A Key Factor Driving Market Growth

11.3.4 Rest of Europe

11.4 Asia Pacific

11.4.1 APAC Market to Witness the Highest Growth in the Healthcare Fraud Analytics Market During the Forecast Period

11.5 Latin America

11.5.1 Volume of Claims Processing is Expected to Increase in Latin American Countries Owing to the Increasing Penetration of Health Insurance

11.6 Middle East & Africa

11.6.1 Healthcare Fraud is One of the Leading Crimes in South Africa

12 Competitive Landscape (Page No. - 105)

12.1 Introduction

12.2 Competitive Situation and Trends

12.2.1 Mergers, Acquisitions, and Joint Ventures

12.2.2 Collaborations, Partnerships, and Agreements

12.2.3 Expansions

12.3 Competitive Leadership Mapping

12.3.1 Visionary Leaders

12.3.2 Innovators

12.3.3 Dynamic Differentiators

12.3.4 Emerging Companies

13 Company Profiles (Page No. - 110)

(Business Overview, Products Offered, Recent Developments, MnM View)*

13.1 IBM

13.2 Optum (A Part of Unitedhealth Group)

13.3 Cotiviti Holdings, Inc.

13.4 Fair Isaac Corporation

13.5 SAS Institute

13.6 Change Healthcare

13.7 EXL Service Holdings, Inc.

13.8 Wipro

13.9 Conduent, Inc.

13.10 HCL Technologies

13.11 CGI Group

13.12 DXC Technology Company

13.13 Northrop Grumman Corporation

13.14 LexisNexis (A Part of Relx Group)

13.15 Pondera Solutions

13.16 Other Players Operating in the Healthcare Fraud Analytics Market

13.16.1 WhiteHatAI

13.16.2 Healthcare Fraud Shield

13.16.3 FraudLens, Inc.

13.16.4 HMS

13.16.5 FraudScope, Inc.

*Business Overview, Products Offered, Recent Developments, MnM View Might Not Be Captured in Case of Unlisted Companies.

14 Appendix (Page No. - 137)

14.1 Discussion Guide

14.2 Knowledge Store: Marketsandmarkets� Subscription Portal

14.3 Available Customizations

14.4 Related Reports

14.5 Author Details



List of Tables (105 Tables)

Table 1 List of Stakeholders Interviewed for the Study

Table 2 Companies Offering Innovative Fraud Analytics Solutions

Table 3 Healthcare Fraud Analytics Market, By Solution Type, 2018�2025 (USD Million)

Table 4 Descriptive Analytics Solutions for Healthcare Fraud Detection

Table 5 Descriptive Analytics Market, By Region, 2018�2025 (USD Million)

Table 6 Descriptive Analytics Market, By Country, 2018�2025 (USD Million)

Table 7 Predictive Analytics Solutions for Healthcare Fraud Detection

Table 8 Predictive Analytics Market, By Region, 2018�2025 (USD Million)

Table 9 Predictive Analytics Market, By Country, 2018�2025 (USD Million)

Table 10 Prescriptive Analytics Solutions for Healthcare Fraud Detection

Table 11 Prescriptive Analytics Market, By Region, 2018�2025 (USD Million)

Table 12 Prescriptive Analytics Market, By Country, 2018�2025 (USD Million)

Table 13 Healthcare Fraud Analytics Market, By Delivery Model, 2018�2025 (USD Million)

Table 14 Key Vendors Offering On-Premise Solutions in the Market

Table 15 Market for On-Premise Delivery Models, By Region, 2018�2025 (USD Million)

Table 16 Market for On-Premise Delivery Models, By Country, 2018�2025 (USD Million)

Table 17 Key Vendors Providing On-Demand Solutions

Table 18 Market for On-Demand Delivery Models, By Region, 2018�2025 (USD Million)

Table 19 Market for On-Demand Delivery Models, By Country, 2018�2025 (USD Million)

Table 20 Market, By Application, 2018�2025 (USD Million)

Table 21 Deployment of Prepayment vs Postpayment Analytics Systems

Table 22 Market for Insurance Claims Review, By Type, 2018�2025 (USD Million)

Table 23 Market for Insurance Claims Review, By Region, 2018�2025 (USD Million)

Table 24 Market for Insurance Claims Review, By Country, 2018�2025 (USD Million)

Table 25 Market for Postpayment Claims Review, By Region, 2018�2025 (USD Million)

Table 26 Market for Postpayment Claims Review, By Country, 2018�2025 (USD Million)

Table 27 Market for Prepayment Claims Review, By Region, 2018�2025 (USD Million)

Table 28 Market for Prepayment Claims Review, By Country, 2018�2025 (USD Million)

Table 29 Market for Pharmacy Billing Misuse Applications, By Region, 2018�2025 (USD Million)

Table 30 Market for Pharmacy Billing Misuse Applications, By Country, 2018�2025 (USD Million)

Table 31 Market for Payment Integrity Applications, By Region, 2018�2025 (USD Million)

Table 32 Market for Payment Integrity Applications, By Country, 2018�2025 (USD Million)

Table 33 Healthcare Fraud Analytics Market for Other Applications, By Region, 2018�2025 (USD Million)

Table 34 Market for Other Applications, By Country, 2018�2025 (USD Million)

Table 35 Market, By End User, 2018�2025 (USD Million)

Table 36 Market for Public & Government Agencies, By Region, 2018�2025 (USD Million)

Table 37 Market for Public & Government Agencies, By Country, 2018�2025 (USD Million)

Table 38 Market for Private Insurance Payers, By Region, 2018�2025 (USD Million)

Table 39 Market for Private Insurance Payers, By Country, 2018�2025 (USD Million)

Table 40 Market for Third-Party Service Providers, By Region, 2018�2025 (USD Million)

Table 41 Healthcare Fraud Analytics Market for Third-Party Service Providers, By Country, 2018�2025 (USD Million)

Table 42 Market for Employers, By Region, 2018�2025 (USD Million)

Table 43 Market for Employers, By Country, 2018�2025 (USD Million)

Table 44 Market, By Region, 2018�2025 (USD Million)

Table 45 North America: Market, By Country, 2018�2025 (USD Million)

Table 46 North America: Market, By Delivery Model, 2018�2025 (USD Million)

Table 47 North America: Market, By Solution Type, 2018�2025 (USD Million)

Table 48 North America: Market, By Application, 2018�2025 (USD Million)

Table 49 North America: Market for Insurance Claims Review, By Type, 2018�2025 (USD Million)

Table 50 North America: Market, By End User, 2018�2025 (USD Million)

Table 51 US: Healthcare Fraud Analytics Market, By Delivery Model, 2018�2025 (USD Million)

Table 52 US: Market, By Solution Type, 2018�2025 (USD Million)

Table 53 US: Market, By Application, 2018�2025 (USD Million)

Table 54 US: Market for Insurance Claims Review, By Type, 2018�2025 (USD Million)

Table 55 US: Market, By End User, 2018�2025 (USD Million)

Table 56 Canada: Market, By Delivery Model, 2018�2025 (USD Million)

Table 57 Canada: Market, By Solution Type, 2018�2025 (USD Million)

Table 58 Canada: Market, By Application, 2018�2025 (USD Million)

Table 59 Canada: Market for Insurance Claims Review, By Type, 2018�2025 (USD Million)

Table 60 Canada: Market, By End User, 2018�2025 (USD Million)

Table 61 List of Some of the Ehfcn Member Organization Across Europe

Table 62 Europe: Market, By Country, 2018�2025 (USD Million)

Table 63 Europe: Healthcare Fraud Analytics Market, By Delivery Model, 2018�2025 (USD Million)

Table 64 Europe: Market, By Solution Type, 2018�2025 (USD Million)

Table 65 Europe: Market, By Application, 2018�2025 (USD Million)

Table 66 Europe: Market for Insurance Claims Review, By Type, 2018�2025 (USD Million)

Table 67 Europe: Market, By End User, 2018�2025 (USD Million)

Table 68 Germany: Market, By Delivery Model, 2018�2025 (USD Million)

Table 69 Germany: Market, By Solution Type, 2018�2025 (USD Million)

Table 70 Germany: Market, By Application, 2018�2025 (USD Million)

Table 71 Germany: Market for Insurance Claims Review, By Type, 2018�2025 (USD Million)

Table 72 Germany: Market, By End User, 2018�2025 (USD Million)

Table 73 UK: Market, By Delivery Model, 2018�2025 (USD Million)

Table 74 UK: Market, By Solution Type, 2018�2025 (USD Million)

Table 75 UK: Market, By Application, 2018�2025 (USD Million)

Table 76 UK: Market for Insurance Claims Review, By Type, 2018�2025 (USD Million)

Table 77 UK: Market, By End User, 2018�2025 (USD Million)

Table 78 France: Market, By Delivery Model, 2018�2025 (USD Million)

Table 79 France: Market, By Solution Type, 2018�2025 (USD Million)

Table 80 France: Healthcare Fraud Analytics Market, By Application, 2018�2025 (USD Million)

Table 81 France: Market for Insurance Claims Review, By Type, 2018�2025 (USD Million)

Table 82 France: Market, By End User, 2018�2025 (USD Million)

Table 83 RoE: Market, By Delivery Model, 2018�2025 (USD Million)

Table 84 RoE: Market, By Solution Type, 2018�2025 (USD Million)

Table 85 RoE: Market, By Application, 2018�2025 (USD Million)

Table 86 RoE: Market for Insurance Claims Review, By Type, 2018�2025 (USD Million)

Table 87 RoE: Market, By End User, 2018�2025 (USD Million)

Table 88 Asia Pacific: Market, By Delivery Model, 2018�2025 (USD Million)

Table 89 Asia Pacific: Market, By Solution Type, 2018�2025 (USD Million)

Table 90 Asia Pacific: Market, By Application, 2018�2025 (USD Million)

Table 91 Asia Pacific: Market for Insurance Claims Review, By Type, 2018�2025 (USD Million)

Table 92 Asia Pacific: Market, By End User, 2018�2025 (USD Million)

Table 93 Latin America: Healthcare Fraud Analytics Market, By Delivery Model, 2018�2025 (USD Million)

Table 94 Latin America: Market, By Solution Type, 2018�2025 (USD Million)

Table 95 Latin America: Market, By Application, 2018�2025 (USD Million)

Table 96 Latin America: Market for Insurance Claims Review, By Type, 2018�2025 (USD Million)

Table 97 Latin America: Market, By End User, 2018�2025 (USD Million)

Table 98 MEA: Market, By Delivery Model, 2018�2025 (USD Million)

Table 99 MEA: Market, By Solution Type, 2018�2025 (USD Million)

Table 100 MEA: Market, By Application, 2018�2025 (USD Million)

Table 101 MEA: Market for Insurance Claims Review, By Type, 2018�2025 (USD Million)

Table 102 MEA: Healthcare Fraud Analytics Market, By End User, 2018�2025 (USD Million)

Table 103 Mergers, Acquisitions, and Joint Ventures: January 2017�December 2019

Table 104 Collaborations, Partnerships, and Agreements: January 2017�December 2019

Table 105 Expansions: January 2017�December 2019



List of Figures (32 Figures)

Figure 1 Research Design

Figure 2 Breakdown of Primary Interviews: By Company Type, Designation, and Region

Figure 3 Data Triangulation Methodology

Figure 4 Healthcare Fraud Analytics Market, By Solution Type, 2020 vs 2025 (USD Million)

Figure 5 Market, By Delivery Model, 2020 vs 2025 (USD Million)

Figure 6 Market, By Application, 2020 vs 2025 (USD Million)

Figure 7 Market, By End User, 2020 vs 2025 (USD Million)

Figure 8 Geographical Snapshot of the Market

Figure 9 Large Number of Fraudulent Activities in Healthcare to Drive Market Growth

Figure 10 Descriptive Analytics Segment Accounted for the Largest Share of the APAC Market in 2019

Figure 11 APAC Market to Register the Highest Growth During the Forecast Period

Figure 12 North America Will Continue to Dominate the Market in 2025

Figure 13 Developing Regions to Register Higher Growth During the Forecast Period

Figure 14 Market: Drivers, Restraints, Opportunities, and Challenges

Figure 15 US National Healthcare Fraud and Opioid Takedown Trends

Figure 16 Incidence of Fraudulent Claims�Global Scenario (2017)

Figure 17 Major Mergers and Acquisitions in the Healthcare Fraud Analytics Market

Figure 18 North America: Market Snapshot

Figure 19 Europe: Market Snapshot

Figure 20 Asia Pacific: Market Snapshot

Figure 21 Key Developments in the Analytics Market Between January 2017 and December 2019

Figure 22 Market: Competitive Leadership Mapping, 2019

Figure 23 Company Snapshot: IBM

Figure 24 Company Snapshot: Fair Isaac Corporation

Figure 25 Company Snapshot: EXL Service Holdings, Inc.

Figure 26 Company Snapshot: Wipro Limited

Figure 27 Company Snapshot: Conduent, Inc.

Figure 28 Company Snapshot: HCL Technologies

Figure 29 Company Snapshot: CGI Group

Figure 30 Company Snapshot: DXC Technology Company

Figure 31 Company Snapshot: Northrop Grumman Corporation

Figure 32 Company Snapshot: Relx Group