Healthcare fraud detection is a software that utilizes the detection technology in real-time to spot the fraudulent who commit/ follow unauthentic billing patterns and trends that can cost heavily to the organizations. Thus, the software helps saving potential waste, preventing a scam from actually taking place. Altogether, healthcare frauds involve drug frauds, medical insurance frauds, and medicine frauds. Generally, Fraud damages are compensated as per the ‘False Claims Act.’ —
The global healthcare fraud detection market is growing pervasively over the past few years, mainly due to the increasing number of fraudulent scams that are happening in the healthcare sector which is increasing, worldwide. This software, integrating with eHealth, mHealth, and HER has been able to decrease communication breach between patients and caregivers. As a result, the healthcare fraud detection software perceives a high uptake across the globe.
Acknowledging the increasing demand and growth, the market is witnessing currently, Market Research Future (MRFR) in its recently published analysis asserts that the global healthcare fraud detection market will garner a significant growth by 2023, registering a CAGR of 26.7% over the assessment period (2018-2023).
Additional factors that are contributing to the growth of the market include increasing population that is dictating the dire need for quality healthcare, rapid urbanization, and improving economic situations in the countries across the globe. Moreover, exploitation of medical funds and more patients seeking medical insurance also steer the market growth.
On the other hand, factors such as constant improvisations, complexities, and technological incompetency are expected to impede the growth of the market. Nevertheless, the augmenting demand for controlling the medical expenses across suppliers & hospitals is expected to propel the market growth to an extent.
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Key players leading the global healthcare fraud detection market include Septodont, Henry Schein, 3M, Straumann, KERR Corporation, GC orthodontics, Patterson Dental, EnvisionTEC, American Orthodontics, Dentsply Sirona, Planmeca OY, and Nobel Biocare (Part of Danaher Corporation) among others.
Global Healthcare Fraud Detection Market – Segmentations
For enhanced understanding, the market has been segmented into five key dynamics;
By Components: Services and Software.
By Types: Predictive Analytics, Descriptive Analytics, and Prescriptive Analytics among others.
By End-users: Employers, Regulatory or Public Agencies, Private Insurance Payers, Insurance Claim Reviews, Third Party Services, Payment Integrity, and Identity & Case Management among others.
By Application: Insurance Claims Review and Payment Integrity among others.
By Regions: North America, Asia Pacific, Europe, and the Rest-of-the-World.
Global Healthcare Fraud Detection Market – Geographical Analysis
North America heading with its one of the world's best medical facilities, dominates the global healthcare fraud detection market. The US, led by the huge technological advancements and high per capita healthcare expenditures accounts for the leading market for healthcare fraud detection in the region.
Some of the factors such as the availability of advanced technologies, the presence of well-established infrastructure, and skilled professionals that are required for the development of advent technology are positively impacting the growth in the regional market.
The healthcare fraud detection market in the European region accounts for the second-largest market, globally. Factors such as the resurging economy that is availing the best possible healthcare, increasing healthcare expenditures, substantially, and the government support that encourages vendors to develop new and better technology are propelling the growth of the regional market.
The Asia Pacific healthcare fraud detection market is emerging as a profitable market mainly due to the rapidly improving healthcare infrastructure. Moreover, factors positively impacting the growth in the regional market include the rapidly increasing cases of fraudulence in the healthcare that is dictating the demand for advent technology to prevent them, continually and the spreading awareness towards the availability and benefits of this technology.
Rapidly developing economies are providing immense opportunities in the healthcare fraud detection market in the region. Besides, the increasing adoption of technologies is impacting market growth in the region, positively. Furthermore, growing healthcare concerns are increasing the market size of the healthcare fraud detection market.
Global Healthcare Fraud Detection Market – Competitive Landscape
Fiercely competitive, the healthcare fraud detection market appears to be fragmented, characterized by the presence of numerous small & large players. The key strategies traced from the analysis of recent developments of the key players include agreement & partnership, product launch, acquisition, and expansion. These Players invest substantially in the R&D to develop a technology with unrivaled features and design that are on a different level entirely compared to their competition.
January 25, 2018 --- The US - Department of Veterans Affairs (VA), HHS, and CMS announced their partnership for healthcare fraud prevention that leverages data sharing to identify fraud and abuse within healthcare programs which are collectively overseen.
According to the agreement the VA plans will be leveraging CMS improvements in data analytics to enhance fraud detection and prevention efforts. CMS previously demonstrated success in fraud prevention analytics based on the results of the federal agency’s Center of Program Integrity which was implemented in 2010.
The VA-HHS alliance indicates the latest example of VA’s commitment to finding partners to assist with identifying innovative ways to seek out fraud, waste, and abuse, ensuring every tax dollar given to VA supports Veterans.
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