AHFI Application Criteria

QUALIFICATIONS FOR ACCREDITATION CHECKLIST
Do the following apply to you? If so, you can submit your AHFI® application.

  • Membership – Are you an Individual Member or an employee of an NHCAA Member Organization, Affiliate Member, Platinum, Premier and Supporting Member, or an NHCAA Law Enforcement Liaison? Membership criteria and applications can be found on the NHCAA website, or by emailing nhcaa@nhcaa.org.
  • Professional Experience - Do you have a minimum of three years' relevant professional experience in health care fraud detection, investigation or prosecution?
  • Training – Do you have a minimum of 75 hours, in the four years preceding application, of health care anti-fraud training (either as participants or instructor) subject to approval by NHCAA, with supporting documentation?
  • Formal Education – Do you have a minimum of Secondary School Diploma or GED?
  • References - Can you provide letters of reference from three individuals who, in NHCAA’s judgment, are qualified to attest firsthand to your specific professional skills and competency in health care fraud detection, investigation or prosecution? 

To request the AHFI® Application kit, please review the sections below and email us at AHFI@nhcaa.org with your complete contact information.

Employees of NHCAA member organizations, affiliate members, platinum, premier and supporting members are eligible to apply for the AHFI® program and exam. In addition, employees of NHCAA law enforcement liaison or other federal, state and local law enforcement agencies are eligible to apply. Individual members are also eligible for the AHFI® program. Membership must be verified by the NHCAA before applications will be considered.

At least 3 years of professional health care fraud investigative experience required. Professional experience in health care fraud detection, investigation or prosecution can be defined as any work-related experience related to the actual investigation of health care fraud, or engaging in detection activities where the intent is to uncover health care fraud, or the prosecuting of health care fraud cases. The developing of anti-fraud software and products to enhance the detection and prevention of health care fraud is also acceptable. Auditing activities, where the individual is examining claims for the purpose of uncovering of billing and claims errors is not considered an investigation or detection activity, unless when a potential fraud scheme is uncovered, the detection and investigation of the fraud happens in the audit department, and not referred to the SIU or another federal or state agency.

For candidates with less than 5 years of professional experience, attendance at NHCAA Health Care Fraud Investigator's Boot Camp, is strongly recommended. View more information on acceptable training, and how to calculate training hours on the AHFI® FAQ webpage.

Candidates must have participated in a minimum of 75 hours of continuing professional education—related specifically to health care fraud and subject to approval by NHCAA—in the 4 calendar years preceding the application. Qualifying training is not limited to NHCAA or NHCAA Institute-sponsored programs.

  • NHCAA will accept any training program whose learning objectives and educational goal would enhance the health care fraud investigation, detection or prosecution skills of the investigator.
  • Acceptable training not specific to health care fraud can include coding classes, software (anti-fraud or excel) classes, classes from other health care organizations designed to raise awareness of health care products or terminology.
  • Training can come from a number of sources, including other professional associations, user group meetings, software vendors, and internal training.
  • To receive credit for training activities attended, the applicant must submit (at the time of application) an agenda from the program indicating topics covered, time per topic and some type of evidence of course completion.
  • Other forms of verification may include letters from program sponsors confirming your attendance, and letters from supervisors verifying your internal training. In each case, you must supply contact information for the appropriate verifying individual. An email address is the most efficient manner for our verification process.
  • With respect to your participation in NHCAA or NHCAA Institute programs please submit a copy of your complete NHCAA transcripts. To view your NHCAA Training transcript, visit the Credit Tracking.
  • You also may count any hours you have spent as an instructor or presenter of such training toward your qualifying total.

Candidates must have earned a minimum of a secondary school (high school) diploma or its formal equivalent (GED). You must provide evidence of the highest degree achieved in the form of transcripts or a copy of your diploma and provide contact information for purposes of verification by NHCAA.

The three letters of reference that you provide must conform to the requirements described in Section I above and must be submitted on company letterhead with a formal signature. The letters must also include the three individuals’ complete contact information, including e-mail if available, for purposes of verification by NHCAA. Again, please keep in mind that the letters must address your professional skills and competency in detection, investigation or prosecution of health care fraud. Letters must be submitted with your application.