About AHFI

What is AHFI®?

Established in 2002, "Accredited Health Care Fraud Investigator" is a unique professional designation granted by the National Health Care Anti-Fraud Association to individuals who meet specific qualifications related to professional experience, specialized training and demonstrated knowledge in the detection, investigation and/or prosecution of health care fraud.

The AHFI® designation is available to qualified individuals who are employees of NHCAA Member Organizations, Individual Members or employees of an NHCAA Law Enforcement Liaison.

IMPORTANT UPDATES FOR AHFI® CANDIDATES

Over the past year, NHCAA conducted a comprehensive analysis of the AHFI® Program to with the goal of ensuring that the Exam accurately measures the core responsibilities and tasks of today's health care fraud investigator. As a result of this process, the AHFI® Exam and the Prep Course have been modified to ensure alignment with the industry’s current practices.

The new AHFI® Prep course will be offered in May and October 2019 and the Exam will be offered starting in June 2019.

The application process is a rolling process and therefore completed applications will be accepted throughout the year. Please review the new criteria established by the NHCAA Board of Directors.

Download the Application

CRITERIA

NHCAA Membership 

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Professional Experience

  • A minimum of five (5) years working in health care fraud detection and investigation as an employee of an organization eligible for NHCAA membership or a government agency; OR
  • A minimun of three (3) years working in health care fraud detection and investigation as an employee of an organization eligible for NHCAA membership or a government agency PLUS a minimum of three (3) years of non-health care fraud investigative experience; OR
  • A minimum of two (2) years working in health care fraud detection and investigation as an employee of an organization eligible for NHCAA membership or a government agency PLUS a minimum of five (5) years of non-health care fraud investigative experience.

Continuing Educational Credits

  • A minimum of sixty (60) hours of anti-fraud continuing education in the last five (5) years, subject to NHCAA approval.
  • At least twenty-four (24) of those credits must be NHCAA Continuing Professional Education (CPE) credits.

Acceptable training not specific to health care fraud can include clinical coding classes, NHCAA approved software (e.g., Tableau, STARS, Excel) classes, and training by other health care organizations designed to improve your investigative skills.

Trainings NOT ACCEPTED as continuing education credits include college courses and general mandatory training, task force meetings and staff meetings.

Reference Letters

Candidates are required to submit the following:

  • If currently employed in a SIU, approval via the referral form (in AHFI® application) from the head of the SIU.
    • If not currently employed in a SIU, one (1) reference letter from a supervisor
  • One (1) reference from a colleague, internal or external to your organization, who works with you and can speak to your professional experience investigating health care fraud.

APPLICATION TIMELINE

Applications are reviewed by the Accreditation Committee. This process will take approximately three (3) weeks to review.

Accepted/ Not Accepted – applicants will receive an email from NHCAA informing them of acceptance status.

  • If accepted – applicants information will be set up in the testing system and they will receive an email from Kryterion, Inc. (NHCAA’s chosen testing partner) to complete the registration and set up a time and location to take the test.
  • If not accepted – applicants will be provided information on why the application was not accepted.

Applications will not be accepted during these time frames:

  • October 4-25, 2019
  • December 15, 2019 - January 3, 2020

The NHCAA AHFI® Prep Course is a one-day intensive program designed to highlight key content areas of the AHFI® Exam. Experienced faculty provide instruction on the key areas addressed in the AHFI® Exam enabling candidates to feel better prepared. This course should serve as a “refresher” on information that a seasoned investigator should already know.

The new AHFI® Prep Course is held twice a year and is designed to prepare applicants for the exam. In 2019, the Prep Course which will be held on the following dates.

May 7, 2019 in Scottsdale, Arizona (8:30 am – 5:30 pm)
October 15, 2019 in Nashville, Tennessee (8:30 am – 5:30 pm)

The AHFI® Prep Course has been developed based on the following areas. These represent the categories of expertise that emerged from the comprehensive analysis conducted in 2018.

  • The Nature and Scope of The U.S. Health Care System
  • The Business and Operations of the Health Care Insurance System
  • Prevention, Identification and Detection of FWA
  • Investigative, Resolution and Reporting Process

Additional information including a study guide will be provided the week prior to the course.

The AHFI® Prep Course costs $425.
The application for the AHFI® Exam is an additional cost and process.

For registration, visit AHFI® Prep Course

The AHFI® Exam is based on the following areas as established by the comprehensive analysis conducted in 2018. Additional information including a comprehensive outline about the areas of study are available once applications are accepted.

  • The Nature and Scope of The U.S. Health Care System
  • The Business and Operations of the Health Care Insurance System
  • Prevention, Identification and Detection of FWA
  • Investigative, Resolution and Reporting Process
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Accepted applicants are able to take the exam beginning on June 3, 2019. NHCAA's new testing partner is Kryterion Inc. Testing will now be available throughout the year at remote locations only. No in-person exams will be administered.

Details

  • The test is 150 questions.
  • Test takers must take the exam within three (3) months of being accepted.
  • Test takers will have four (4) hours to take the exam.

Retesting

  • If needing to retest, a one (1) month waiting period is required
  • Additional fees apply.
  • The retest must occur within six (6) months from the original test.

Find your nearest testing center.

Pricing

Application: $975
Retest:        $225

Moving forward all AHFI® accredited individuals will be required to meet the new maintenance criteria.

Need to renew your AHFI®?

Current requirements for anyone who tested before June 2019, the renewal criteria include:

  • A minimum of sixty (60)Continuing Education Credits
  • A minimum of thirty-six (36) of the 60 credits must come from NHCAA trainings

Anyone passing starting June 2019 or renewing beginning June 2022, the new criteria include:

  • A minimum of forty-eight (48) Continuing Education Credits
  • A minimum of twenty-four (24) of the forty-eight (48) credits must come from NHCAA trainings
  • AHFI® accredited individuals are required to complete a log listing those credits with the invoice

The cost to renew is $325

Leaving the Industry or changing jobs?

If an AHFI® accredited individual is leaving the industry or changing jobs, the AHFI® can be put on hold. Please notify NHCAA at ahfi@nhcaa.org.

  • An AHFI® can be reinstated by notifying NHCAA. At that time, the maintenance criteria will reactivate and the the reinstatement fee of $325 is required.
  • The new renewal date will begin upon reinstatement of the AHFI®.

Are you retiring?

Please contact NHCAA at ahfi@nhcaa.org so that your status can be updated accordingly.

Below is an itemization of pricing related to AHFI®

AHFI® Prep Course $425
Application & Exam Fee $975
Renewal (every 3 years) $325
Retest $225

Individual Members

Annual individual membership is separate from any AHFI® related fees.