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Becoming an AHFI

The Gold Standard of Professionalism in Health Care Fraud Investigation

AHFI Accreditation may be obtained by choosing one of two tracks: The Professional Credential Process for Senior Staff or The Examination-based Process.

General Criteria for all Applicants

1. Must be an employee of a Member Organization, Affiliate Member, Premier and Supporting Member, Individual Member or employees of an NHCAA Law Enforcement Liaison, or other federal, state or local law enforcement agency;
2. Meet a combined 100-point qualification total for Experience, Training and Education, including minimums required in each category, (see below);
3. Provide letters of reference from, and contact information for, three individuals who, in NHCAA's judgment, are qualified to attest firsthand to the applicant's specific professional skills and competency in health care fraud detection, investigation, or prosecution. Of the three individuals, one must be employed in a direct supervisory capacity over the applicant by the applicant's organization, and two must be employed outside the applicant's organization;
4. Professional Conduct: The purpose of the National Health Care Anti-Fraud Association's accreditation program is to designate qualifying individuals as highly trained and experienced professional investigators in the field of health care fraud. Accordingly, NHCAA expects that individuals who apply for and are granted the designation "Accredited Health Care Fraud Investigator" will carry out their responsibilities in a professional and ethical manner, and it reserves the right to deny or revoke accreditation of individuals who-in the sole judgment of the Accreditation Review Board-have demonstrably failed to do so.

Qualification Criteria for The Professional Credential Process

In addition to meeting the above general criteria, applicants must meet a combined 100-point qualification total for Experience, Training and Education, including the minimums required in each category.

I. Professional Experience
(40 points required, 60 points possible)

1. Minimum 8 years’ relevant professional experience in health care fraud detection, investigation and/or prosecution (40 points).
2. Additional 5 points for each additional year of full-time relevant, related professional experience.

II. Training
(40 points required; 55 points possible)

1. Minimum of 90 hours, in the 4 years preceding application, of health care anti-fraud training (either as participant or instructor), subject to approval by NHCAA, with supporting documentation.(40 points).
2. Additional 3 points for each NHCAA/NHCAA Institute training event counted in above total. (Does not apply to NHCAA Audio Conferences).

III. Education
(10 points required; 20 points possible)

1. Minimum of Secondary School Diploma or GED (10 points)
2. Additional 2 points for each year or accredited higher education

Qualification Criteria for The Examination-based Process

In addition to meeting the above general criteria, applicants must meet the following minimum standards for Experience, Training and Education, as well as successfully pass an examination.

I. Professional Experience
Minimum of 3 years’ relevant professional experience in health care fraud detection, investigation or prosecution

II. Training
Minimum of 75 hours, in the 4 years preceding application, of health care anti-fraud training (either as participants or instructor) subject to approval by NHCAA, with supporting documentation.

III. Education
Minimum of Secondary School Diploma or GED

IV. Examination
Passing score of an AHFI Examination. Exams are offered in both the Spring and Fall of each year.

For candidates selecting the Examination-based Process, the Examination for Accredited Health Care Fraud Investigator (AHFI) is designed as a fair test of knowledge and skills, both general and specific, that a person who specializes professionally in the detection and investigation and/or prosecution of health care fraud would reasonably be expected to have acquired in the course of meeting other AHFI Accreditation requirements in the areas of professional experience, continuing professional education, formal education, and professional conduct.