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Large Number of Fraudulent Activities in Healthcare are Responsible for Driving the Global Healthcare Fraud Detection Market


The Report “Healthcare Fraud Detection Market by Type (Descriptive, Prescriptive), Application (Insurance Claim, Prepay, Post payment), Component (Service, Software), Delivery (On-premise, Cloud), End user (Insurance Payer, Private, Public) — Global Forecast to 2022.” The overall healthcare fraud detection market is expected to grow from 2,242.7 million by 2022 from USD 504.4 million in 2016, at a CAGR of 28.9% from 2017 to 2022. The base year considered for the study is 2016 and the forecast period is from 2017 to 2022.

Fraudulent healthcare claims increase the burden on the healthcare system of the society. As healthcare costs rise, the costs associated with these schemes also rises, thus making the consumers endure rising insurance premiums and out-of-pocket expenses.

In July 2017, federal authorities in the US announced charges against 412 physicians, nurses, pharmacists and other medical professionals who accounted for more than USD 1.3 billion in fraudulent transactions across more than 20 states in the US. Healthcare fraud is a problem that costs billions of dollars for taxpayers across the globe. 

The National Health Care Anti-fraud Association (US) estimated that 3% of the healthcare spending, around USD 60 billion is spent on healthcare fraud in the US. Along with this, identity theft is another major problem that has victimized around 1.5 million people in the US. The average cost incurred by a victim due to medical identity theft is around USD 20,000. Likewise fraud, corruption, and waste are a major threat to the sustainability of healthcare systems in Europe. According to the European countries’ National Report, the most common types of healthcare-related fraud in Europe include non-compliance with invoicing rules as well as the invoicing of irregular or unperformed health services. 

From 2014 to 2015, nearly 4,819 episodes of fraud (an average of 402 cases per month) were reported to the health system in the UK (Source: ENFCN). In Belgium, the government health inspection authority (MEID) identified 1,225,585 infringements in 2015. 

Additionally, health insurance is gradually growing in popularity in Asia, especially through private health insurers, making the payers in these regions susceptible to fraud. Considering these factors, the need for fraud detection and prevention tools is increasing in the healthcare industry, which acts as a significant opportunity for the players in this market. Read More 

The healthcare fraud detection market is highly competitive with the presence of various players. Some of the major players operating in the market include IBM (US), Optum (US), SAS (US), McKesson (US), SCIO (US), Verscend (US), Wipro (India), Conduent (US), Know more about key industry players

Posted by on 14. Juni 2019.


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