AHFI® Application & Exam Requirements
The AHFI® Exam is based on the following areas as established by the comprehensive analysis conducted in 2018. Additional information, including a detailed outline of study topics, 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
The Exam is based on your experience as an investigator in a SIU and not memorization of key facts.
- All applicants must be members of NHCAA either through corporate membership or individual membership.
- Are you a member? Check your NHCAA Member Profile.
- Want to become an individual member? Download the Individual Membership application.
- 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 minimum 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. (Your transcript must be up to date. NHCAA will not back-date your participation in webinar programs.) 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.
Candidates are required to submit the following 2 references:
- One (1) reference letter from a colleague, internal or external to your organization, who works with you and can speak to your professional experience investigating health care fraud.
- 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.
Applications are reviewed by the Accreditation Committee. This process will take approximately three (3) weeks. There may be a delay in processing during especially busy times, i.e. the lead up to ATC.
Accepted/ Not Accepted – applicants will receive an email from NHCAA informing them of acceptance status.
Applications will not be reviewed from December 10, 2021 – January 3, 2022.