Healthcare fraud analytics is the application of analytical techniques to identify potential fraudulent activity in healthcare claims data. These techniques can include pattern recognition, predictive modeling, and data mining. By identifying potential fraud, waste, and abuse, healthcare fraud analytics can help payers and providers improve the efficiency and effectiveness of their fraud detection and prevention efforts.
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Key Trends
There are several key trends in healthcare fraud analytics technology. One is the increasing use of data mining and machine learning techniques to detect fraud. This is being driven by the need for more sophisticated methods to deal with the increasing volume and complexity of data. Another trend is the use of cloud-based systems to store and analyze data. This allows for more flexibility and scalability in terms of data processing and analysis. Finally, there is a trend toward the use of more sophisticated visualization techniques to help analysts understand and communicate the results of their fraud analytics.
Key Drivers
There are a number of key drivers of the healthcare fraud analytics market. One of the key drivers is the increasing need for fraud detection and prevention in the healthcare industry. With the increasing costs of healthcare and the number of fraudulent claims being made, there is a great need for analytics tools that can help identify and prevent fraud. Another key driver is the increasing adoption of data analytics by healthcare organizations. Data analytics is becoming increasingly important in the healthcare industry as it helps organizations to make better decisions, improve operations, and reduce costs. Additionally, the increasing use of electronic health records (EHRs) is also driving the need for healthcare fraud analytics. EHRs contain a wealth of information that can be used to identify fraud and abuse.
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Key Market Segments
The healthcare fraud analytics market report is bifurcated on the basis of solution type, deployment mode, application, end-user, and region. On the basis of solution type, it is segmented into descriptive analytics, predictive analytics, and prescriptive analytics. Based on deployment mode, it is analyzed across on-premises and on-demand. By application it is categorized into pharmacy billing misuse, payment integrity, and others. By end-user it is divided into public & government agencies, private insurance payers, employers, and others. Region-wise, it is studied across North America, Europe, Asia-Pacific, and rest of the World.
Key Market Players
The healthcare fraud analytics market report includes players such as Conduent Inc., CGI Group Inc., Fair Isaac Corporation, HCL Technologies Ltd., IBM , Mckesson Corporation, SAS Institute, Inc., SCIO Insprise, Corp., Wipro Limited., and Optum, Inc.
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