Health fraud is an intentional deception or misrepresentation of fact that can result in unauthorized benefit or payment.

The growth of the medical payment fraud detection market is due to the unpredicted surge of healthcare scams and fraud during the COVID 19 outbreak, a rising number of patients opting for health insurance, and rising healthcare expenditure.

Furthermore, a large number of false or fake activities, increasing pressure of fraud and abuse on healthcare spending, and growing pressure to increase operational efficiency and reduce healthcare spending, are also expected to fuel the market during the forecast period.

However, the lack of skilled professionals and unwillingness to adopt the fraud analytics system in developing countries are expected to restrain the growth of the medical payment fraud detection market.

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Several market players such as SAS Institute, LexisNexis Risk Solutions, and Optuminsight, among others currently dominate the global medical payment fraud detection market.

Regional Analysis

The market has been divided, by region, into the Americas, Europe, Asia-Pacific, and the Middle East & Africa. The Americas region held the largest market in 2020, owing to the increasing number of patients opting for health insurances. For Instance, according to the Centers for Disease Detection and Prevention, in 2018 report, 25.5% people under age of 65 opted for public health insurance in the United States. The medical payment fraud detection market in the Americas has further been branched into North America and Latin America, with the North American market divided into the US and Canada. The European medical payment fraud detection market has been categorized as Western Europe and Eastern Europe. The Western European market has further been classified as Germany, France, Italy, Spain, the UK and the rest of Western Europe. The medical payment fraud detection market in Asia-Pacific has been segmented into Japan, China, India, Australia, South Korea, and the rest of Asia-Pacific. Due to large number of fraudulent activities, the market in Asia-Pacific is expected to be the fastest-growing. The medical payment fraud detection market in the Middle East & Africa has been divided into the Middle East and Africa.


Segmentation

Global Medical Payment Fraud Detection Market has been segmented based on the Type, Component, Delivery Model, Source of Services, and End User.

Based on Type, the global medical payment fraud detection market has been segmented into descriptive analytics, predictive analytics, and prescriptive analytics. Descriptive analytics forms the base for the effective application of predictive and prescriptive analytics.

On the basis of components, the market has been segmented into services and software. Software fraud detection is expected to hold a major market share.

Based on the delivery model, the market has been segmented into on-premise and cloud-based. The cloud-based fraud detection market is expected to gain traction during the forecast period.

On the basis of the source of service, the market has been segmented into in-house and outsourced.

The market based on end-user has been segmented into private insurance payers, public/ government agencies, and third-party service providers.

Key Players

Some of the key players in the global medical payment fraud detection market are LexisNexis Risk Solutions (US), International Business Machines Corporation (US), Optuminsight (US), OSP Labs (India), DXC Technology Company (US), UnitedHealth Group (US), SAS Institute (US), Fair Issac Corporation (US), EXL Service Holdings, Inc. (US), CGI GROUP (Canada).

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