- What is the AHFI®?
- Do I have to be an NHCAA Member to be eligible to apply for an AHFI®?
- How many training hours do I need to apply for the AHFI®?
- What types of training and education experience will count towards my AHFI® credits?
- How do I calculate training hours?
- What is professional experience in health care fraud detection, investigation or prosecution?
- I have been an investigator for a public-sector agency for 15 years but none of the investigations I have conducted relates to health care fraud. Is that experience creditable?
- Who determines if experience is creditable towards the AHFI® designation?
- How do I report training hours?
- What is the format of the AHFI® Examination?
- What is a passing Examination score?
- What topics does the AHFI® Examination cover?
- How long is the AHFI® Examination and where is it administered?
- Is there a study guide for the Examination?
- What are the Application and Examination fees?
- When will I receive the glossary, Handbook and other material to help me prepare for the AHFI® examination?
AHFI® is a unique professional designation granted by the National Health Care Anti-Fraud Association to individuals who meet certain qualifications related to professional experience, specialized training, formal education and demonstrated knowledge in the detection, investigation and/or prosecution of health care fraud.
All AHFI® applicants must be employed by an NHCAA Member Organization, employed by a federal, state or local law enforcement agency, or be an NHCAA Individual Member.
You must have a minimum of 75 hours of health care anti-fraud training in the 4 years preceding the submission of the application.
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, or at the time of AHFI® renewal, an agenda from the program indicating topics covered, time per topic and some type of evidence of course completion, like a certificate of attendance, or receipt of payment.
If attending NHCAA in-person trainings, a certificate of completion stating the number of Continuing Professional Education unites (CPEs) earned will be available at the close of the conference. The NHCAA Website lists the number of CPEs awarded for all other online learning, like the Online NETS and NHCAA Audio Conferences. These credits are earned by attending the event, and then completing and submitting an attestation of completion form. NHCAA keeps records of all NHCAA issued training program attendance. Hours for non-NHCAA training will be determined by the NHCAA staff, based on the submission of the necessary documentation. A transcript of NHCAA training is available by using the transcript calculator located on the NHCAA website in the Education Center, found under the Education & Training Tab.
Professional experience in health care fraud detection, investigation or prosecution can be defined as any work experience related to the 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 billing and claims errors is not considered an investigation or detection activity, and when a potential fraud scheme is uncovered, the detection and investigation of the fraud happens in the audit department, instead of being referred to the SIU or another federal or state agency.
Because the Accredited Health Care Fraud Investigator designation is so unique, in order to meet the qualification in the Work Experience criterion, the work has to relate to health care fraud.
The Accreditation Review Board, a three-person board comprised of current AHFIs, reviews applications and determines if the candidate is indeed eligible to sit for the AHFI exam.
For applicants, training hours and supporting documentation needs to be submitted with the AHFI® application. For AHFI® renewals, any outside training hours and supporting documentation should be submitted with the AHFI® renewal financial payment.
When taken during the Fall and Spring testing windows at one of the many testing center locations, the AHFI® Examination is a 200 question computer-based test. If taking the exam at one of NHCAA's conferences, the exam administered is a paper and pencil exam comprised of 200 multiple-choice questions.
To pass the Examination, a candidate must achieve a score of at least 70 percent or answer 140 questions of the 200 correctly.
The Examination deals with the Nature and Scope of the US Health Care System; Medical/Health Insurance Terminology; Types of Fraud and Fraud Indicators; Detection/Investigation Skills and Knowledge; and Legal/Statutory/Regulatory Aspects of Health Care Fraud.
The testing time for the Examination is 4 hours and is administered at testing centers around the country as well as at the Annual Training Conference. The test is administered on behalf of NHCAA by Professional Testing Corporation, New York.
There is no study guide offered per se. The NHCAA Accreditation Committee, the governing body that sets the criteria for applying for Accreditation, believes that those individuals who are routinely involved in health care fraud detection, investigation and/or prosecution, should be able to pass the Examination based on their professional experience, training and education. Therefore, the Committee has decided not to offer a formalized study guide, but offer a Glossary of Terms to be used for study, a detailed outline of health care laws and regulations, fraud schemes by specialty and sample questions, an AHFI® Prep Course that draws from the specific sections of the exam, and the NHCAA Fraud Fighter's Handbook, a useful tool to study best practices in fraud investigation.
The Application & Examination Fees are $950 for NHCAA Members and $695 for employees of public sector entities, and include the first 3 year AHFI® renewal fee.
Once your application has been accepted and payment made, The Handbook, AHFI® Glossary and other prep information will be sent to you via email and US mail. Anyone can register for the AHFI® Preparation Course.
To request the AHFI® Application for Accreditation kit, please email us at firstname.lastname@example.org with your complete contact information.