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Industry Dynamics and Applications In Healthcare Fraud Analytics Market

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Healthcare Research Reports
Industry Dynamics and Applications In Healthcare Fraud Analytics Market

Healthcare Fraud Analytics Market growth can be attributed to a large number of fraudulent activities in healthcare, increasing number of patients seeking health insurance, high returns on investment, and the rising number of pharmacy claims-related frauds. However, the dearth of skilled personnel is expected to restrain the growth of this market. 

 

Fraud analytics is the efficient use of data analytics and related business insights developed through statistical, quantitative, predictive, comparative, cognitive, and other emerging applied analytical models for detecting and preventing healthcare fraud. 

 

The healthcare industry has been witnessing a number of cases of frauds, done by patients, doctors, physicians, and other medical specialists. Many healthcare providers and specialists have been observed to be engaged in fraudulent activities, for the sake of profit. 

 

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A couple of reasons contributing to the growth of the health insurance market include the rise in the aging population, growth in healthcare expenditure, and increased burden of diseases. In the US, the number of citizens without health insurance has significantly decreased, from 48 million in 2010 to 28.6 million in 2016. 

 

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As per the US Department of Health and Human Services findings of 2018, national Medicaid data has shortcomings that could hinder the process of fraud detection in the public sector. The OIG claims that Medicaid data is often incomplete and inaccurate; this affects the process of detecting fraudulent claims and results in the wastage of billions of dollars due to FWA. 

 

The healthcare industry is changing at an incredible rate, and one of the major contributors to this change is the increasing popularity of healthcare communication through social media. 

 


Key Market Players

The prominent players in healthcare fraud analytics market are IBM Corporation (US), Optum, Inc. (US), Cotiviti, Inc. (US), Change Healthcare (US), Fair Isaac Corporation (US), SAS Institute Inc. (US), EXLService Holdings, Inc. (US), Wipro Limited (India), Conduent, Incorporated (US), CGI Inc. (Canada), HCL Technologies Limited (India), Qlarant, Inc. (US), DXC Technology (US), Northrop Grumman Corporation (US), LexisNexis (US), Healthcare Fraud Shield (US)


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