The global market is facing a plethora of challenges. Travel bans and quarantines, halt of indoor/outdoor activities, temporary shutdown of business operations, supply demand fluctuations, stock market volatility, falling business assurance, and many uncertainties are somehow exerting a partial negative impact on the business dynamics.
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. In the healthcare sector, fraudulent activities done by patients include the fraudulent procurement of sickness certificates, prescription fraud, and evasion of medical charges.
Over the years, the number of people benefitting from various healthcare schemes has grown considerably. 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.
Download PDF Brochure @ https://www.marketsandmarkets.com/pdfdownloadNew.asp?id=221837663
In the US, the number of citizens without health insurance has significantly decreased, from 48 million in 2010 to 28.6 million in 2016. In 2017, 12.2 million people signed up for or renewed their health insurance during the 2017 open enrollment period (Source: National Center for Health Statistics).
Emerging markets such as Asia promise significant growth in health insurance coverage, mainly due to increasing government initiatives, rising government and private investments for promoting medical insurance, and growing income levels. This growth is aided by the increasing affordability of health insurance for the middle class in this region and the rising awareness regarding the benefits of health insurance.
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. Not only has social media become a place where people seek health information, but social media channels also allow for two-way public communication between patients, providers, and other third parties. This helps create a large forum for health discussions globally.
This vast network of healthcare influencers, leaders, patients, providers, organizations, and governmental entities creates a massive amount of healthcare data on a regular basis. This data, if segregated, segmented, and analyzed in a meaningful way, can offer incredible value for improving treatment efficiencies and health outcomes.
The deployment of fraud analytics solutions is a time-consuming process. The process involves creating user interfaces, new databases, and predictive models; evaluating and deploying models, and monitoring their effectiveness. In this process, data analysts continuously run algorithms until they get the most effective predictive model.
At times, analysts may not find the appropriate predictive model for expected outcomes, which results in time wastage. This means they must start the same process again with new data. Thus, if data analysts fail at one stage, the whole process is disturbed. Furthermore, the software requires frequent upgrades, as fraudsters constantly change tactics. This adds to the total cost of fraud analytics solutions.
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), Sharecare, Inc. (US), FraudLens, Inc. (US), HMS Holding Corp. (US), Codoxo (US), H20.ai (US), Pondera Solutions, Inc. (US), FRISS (The Netherlands), Multiplan (US), FraudScope (US), and OSP Labs (US).