Becoming a Certified Healthcare Fraud Investigator (CrHFI)
What is the CrHFI?
CrHFI is a unique professional designation granted by the Association of Certified Forensic Practitioners (ACFP) 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.
General Criteria for all Applicants
- Must be an employee of a Member Organization, Affiliate Member, Premier and Supporting Member, Individual Member or employees of an Law Enforcement Liaison, or other law enforcement agency;
- Meet the qualifications, detailed below, for Experience, Training and Education.
- Provide letters of reference from, and contact information for, three individuals who, in ACFP’s judgment, are qualified to attest firsthand to the applicant’s specific professional skills and competency in health care fraud detection, investigation, or prosecution. Of the three individuals, one must be employed in a direct supervisory capacity over the applicant by the applicant’s organization, and at least one must be employed outside the applicant’s organization;
- Certified Healthcare Fraud Investigator (CrHFI) is to designate qualifying individuals as highly trained and experienced professional investigators in the field of health care fraud. Accordingly, ACFP expects that individuals who apply for and are granted the designation “Certified Healthcare Fraud Investigator (CrHFI)” will carry out their responsibilities in a professional and ethical manner, and it reserves the right to deny or revoke accreditation of individuals who-in the sole judgment of the Accreditation Review Board-have demonstrably failed to do so.
In addition to meeting the above general criteria, applicants must meet the following minimum standards for Professional Experience, Training and Education, as well as successfully pass an examination.
I. Professional Experience
Minimum of three years’ relevant professional experience in health care fraud detection, investigation or prosecution.
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 ACFP, with supporting documentation. For candidates with less than 5 years of professional experience, attendances at ACFP Health Care Fraud Investigator’s Boot Camp, is strongly recommended.
Minimum of Secondary School Diploma or GED
Passing score of an ACFP Examination.
The Examination for the Certified Healthcare Fraud Investigator (CrHFI) is designed as a fair test of knowledge and skills, both general and specific, that a person who specializes professionally in the detection and investigation and/or prosecution of health care fraud would reasonably be expected to have acquired in the course of meeting other CrHFI Accreditation requirements in the areas of professional experience, continuing professional education, formal education, and professional conduct.
Info about CrHFI
The types of training and education experience that will count towards CrHFI
ACFP 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 ACFP 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.
Professional experience in health care fraud detection, investigation or prosecution
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.
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 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.
There is no study guide offered per se. The ACFP 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.