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

NHCAA recently 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 Exam is based on your experience as an investigator in a SIU and not memorization of key facts. The Prep Course, outline, and study guide will help you study and prepare for the Exam, they do not provide answers.  

*Click the corresponding tab to view detailed information.

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 

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 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.

Reference Letters

Candidates are required to submit the following 2 references:

  1. 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.
  2. 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.

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 26 – November 21, 2020 (Expect longer delays in the review process as we prepare for the ATC)
  • December 14, 2020 - January 1, 2021

Due to the evolving situation with COVID, NHCAA has created an online version of our AHFI Prep Course. We will host an in-person program again when the time is appropriate and its once again safe to meet in large groups.

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” for more seasoned investigators. You do not need to be accepted to take the AHFI® Exam in order to participate in the Prep Course.

Visit AHFI Prep Course to register today!

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

Accepted applicants are able to take the exam beginning on June 3, 2019. NHCAA's testing partner is Kryterion Inc. Testing will be available throughout the year at remote locations . Testing is also available online but you must have a camera and administrator rights to your computer to install the testing program. For more information on remote testing please email ahfi@nhcaa.org. No exams will be administered in-person at any NHCAA educational events.

Details

  • The test is 150 questions.
  • Test takers must take the exam within three (3) months of being accepted.
  • Test takers will have three (3) 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.
  • Any subsequent retest will require a six (6) month waiting period.
  • Additional fees apply.
  • The subsequent rest must occur within twelve (12) months of previous retest.

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®?

NHCAA will email an invoice to you three months prior to your renewal date. If you do not receive that email you can also download the invoice here.

Be sure to check your transcript on a regular basis to make sure your eligibility requirements will be met. NHCAA will not back-date your participation in webinar programs.

Download the Invoice

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 sixty (60) credits must come from NHCAA trainings
  • The cost to renew is $325
  • Renewal is due every three (3) years

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
  • Renewal is due every three (3) years

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 reinstatement fee of $325 is required.
  • The new renewal date will begin upon reinstatement of the AHFI®.

Are you an individual member?

As an individual member your membership renewal is due each year. Your AHFI certification is not covered under your individual membership. Your AHFI certification will need to be renewed every three years. Often these two renewal dates will not occur in the same month.

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.