NHCAA

What NHCAA does

The National Health Care Anti-Fraud Association (NHCAA) is a private non-profit organization founded in 1985 and headquartered at 1220 L Street NW, Washington, DC, that operates as a private-public partnership focused exclusively on combating health care fraud in the United States. NHCAA serves nearly 90 private health insurers as member organizations and over 230 federal and state law enforcement and regulatory agencies as government liaisons, including the FBI and HHS-OIG. Its activities span detection, investigation, civil and criminal prosecution support, and prevention of health care fraud through information sharing, professional education, and collaborative initiatives.

NHCAA's core operating asset is SIRIS (Special Investigation Resource and Intelligence System), a searchable database hosted by LexisNexis Risk Solutions that aggregates three datasets: provider cases, health care fraud schemes, and Requests for Investigation Assistance (RIAs) from law enforcement partners. The RIA mechanism allows government agencies to reach multiple private insurers in a single step for collaborative fraud investigations. Education and training are delivered through the NHCAA Learn online platform, the Annual Training Conference (13 CPE hours), Boot Camp (24 CPE hours), AHFI Prep Course, Schemes program, and monthly on-demand trainings. The AHFI (Accredited Health Care Fraud Investigator) professional certification, registered with NASBA and aligned with AAPC standards, anchors the individual professional-development track. Supporting infrastructure includes the NHCAA CONNECT community platform (powered by Higher Logic) and a unified SSO-enabled member portal (IdentityServer4 / MOJO Identity).

NHCAA sustains operations through a diversified, member-funded revenue model. Recurring membership dues are collected across four categories — Member Organizations, Government Liaisons, Individual Members, and Supporting Members (Platinum, Premier, Standard tiers). Education and training programs generate one-time registration fees (ATC $1,295–$1,575, Boot Camp $995–$1,225, AHFI Prep $675, Schemes $775–$850) plus monthly on-demand training subscriptions at $50 per session. The NHCAA Institute for Health Care Fraud Prevention, established in 2000 as a separately incorporated, tax-exempt educational foundation, operates as an adjacent subsidiary delivering the professional-development mission. Publications (The Sentinel, Inside SIRIS, The Compass, In the Courts, Annual Fraud Trends Reports, Fraud Briefs, Gen AI Issue Brief) and an annual awards program further reinforce member engagement and industry positioning.

Name

NHCAA

Legal name

The National Health Care Anti-Fraud Association

Website

https://nhcaa.org

Company type

Private

Founded year

1985

Operating status

Operating

Headcount range

11–50 employees

Short description

NHCAA is a 1985-founded non-profit trade association that serves nearly 90 private health insurers and over 230 U.S. government agencies by providing anti-fraud training, AHFI certification, and the SIRIS intelligence database for collaborative health care fraud investigations.

Ownership category

akta.pro rank

Product category

Healthcare Anti-Fraud Education and Training Services

NAICS

Business Associations (813910)

SIC

Services-Membership Organizations (8600)

akta.pro primary industry

Fraud, Waste & Abuse (FWA) Detection & SIU Support (BPAAAFAH)

akta.pro secondary industry

Independent Practice Association (IPA) Model HMOs (HLAEAMAD)

Keywords

• Healthcare fraud prevention
• Anti-fraud training programs
• Fraud investigation database
• Professional certification programs
• Membership association services

Headquarters

HQ city

Washington

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Marketing or Sales, Technology or R&D, Infrastructure, Others

Revenue model

1. Membership Dues: NHCAA generates revenue through various membership categories including Member Organizations (private health insurers), Government Liaisons, Individual Members, and Supporting Members (Platinum, Premier, Standard). Members receive access to training programs, information-sharing resources, and networking opportunities.
2. Annual Training Conference Registration: Revenue from registration fees for the Annual Training Conference, with tiered pricing for members ($1,295-$1,375), government ($1,295), and non-members ($1,475-$1,575). The 2026 ATC offers 13 CPE hours.
3. Education and Training Programs: Revenue from specialized training programs including Boot Camp ($995-$1,225), AHFI Prep Course ($675), and Schemes program ($775-$850). Programs offer Continuing Professional Education (CPE) credits applicable to AHFI designation.
4. Monthly On-Demand Trainings: Monthly on-demand training sessions with complimentary registration for Member Organizations and Government Liaisons during the first month, and $50 fee thereafter. Offers 1 CPE hour per session.

Pricing tiers

Go-to-market motion2 records

Distribution channels5 records

Marketing channels6 records

Core offering

NHCAA is a private-public partnership membership organization that educates, trains, and connects healthcare anti-fraud professionals. It provides access to the SIRIS investigative database hosted by LexisNexis, the AHFI professional certification program, in-person and virtual training programs (Annual Training Conference, Boot Camp, AHFI Prep Course, Schemes), publications, and an online community platform for information sharing between private health insurers and government law enforcement agencies.

Product overview

NHCAA is a private-public partnership against health care fraud offering a comprehensive suite of anti-fraud tools, education programs, and professional certification. The core offerings include SIRIS (a fraud investigation database hosted by LexisNexis), the AHFI professional certification program, various training programs (Boot Camp, AHFI Prep Course, Annual Training Conference, Schemes), and publications (The Sentinel, Inside SIRIS, The Compass, In the Courts, Annual Fraud Trends Reports, Fraud Briefs). Access to member resources is provided through the NHCAA Learn platform, NHCAA Connect community, and Member Center with SSO via IdentityServer4.

Differentiator

Problem solved

Functional benefit

Brands

• The NHCAA Institute for Health Care Fraud Prevention: Separately incorporated, tax-exempt educational foundation that provides education and training to private- and public-sector health care anti-fraud personnel.
• AHFI (Accredited Health Care Fraud Investigator)
• SIRIS (Special Investigation Resource and Intelligence System)
• NHCAA Learn
• NHCAA Connect

Products and services

• SIRIS (Special Investigation Resource and Intelligence System) A searchable database comprising three datasets: provider cases, health care fraud schemes, and Requests for Investigation Assistance (RIAs) from law enforcement partners, accessible to Member Organizations and Government Liaisons for fraud investigation support.
• AHFI (Accredited Health Care Fraud Investigator) Certification Professional certification program recognizing and advancing specialization in the detection, investigation, and prosecution of health care fraud for anti-fraud professionals.
• Annual Training Conference (ATC) Annual 3-day national conference providing education and training for health care fraud investigators, featuring sessions offering Continuing Professional Education (CPE) credits.
• Boot Camp for the Health Care Fraud Investigator A three-day in-person training program (24 CPE hours) designed for new entrants to health care fraud investigation, including prior approval of AAPC for 6.0 CEUs.
• AHFI Prep Course A one-month virtual on-demand course providing content areas for the AHFI exam, offering 7 CPE hours, designed to prepare candidates for AHFI certification.
• Enhancing Your Skills: Managing and Navigating Complex Investigations A three-day virtual program (10 CPE hours) focused on building skills necessary for middle managers and investigators handling complex health care fraud investigations.
• Schemes for Health Care Fraud Investigators & Analysts An annual virtual program (14 CPE hours and 6.0 AAPC CEUs) dissecting fraud schemes from across the health care industry, including data mining and analytics techniques.
• Monthly On-Demand Trainings Monthly on-demand training sessions (1 CPE hour per session) covering topics related to health care fraud detection and investigation for member anti-fraud professionals.
• NHCAA Membership Membership organization providing access to SIRIS, training programs, publications, networking, and information-sharing resources across four categories: Member Organizations, Government Liaisons, Individual Members, and Supporting Members.
• Member Center (SSO Portal) An SSO-enabled member portal providing access to the member center, educational credits tracking, event registration, and member-only resources for NHCAA members.
• NHCAA Connect (Community Platform) Online community platform powered by Higher Logic, providing member networking, job board, member discussions, and information sharing for the health care anti-fraud community.
• NHCAA Learn (Learning Management Platform) An online learning management platform providing access to on-demand training sessions, speaker information, presentation handouts, and supplemental educational materials for members.
• Information Sharing & Case Discussion Virtual monthly and in-person twice-yearly events enabling Member Organizations and Government Liaisons to share case information and discuss fraud schemes.

Quantifiable outcome

• Over $54 billion stolen annually in health care fraud schemes
• +1 more outcomes

Named customers13 records

Segments4 records

Ideal customer profiles4 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration4 records

Feature3 records

Partnerships

Twelve partnerships are on record, tiered core and supporting.

• LexisNexis Risk SolutionscoreTechnology or IntegrationLexisNexis hosts SIRIS (Special Investigation Resource and Intelligence System), NHCAA's proprietary searchable database comprising provider cases, health care fraud schemes, and Requests for Investigation Assistance. This partnership enables the core investigative intelligence platform for member organizations and government liaisons.
• NHCAA Institute for Health Care Fraud PreventioncoreStrategic or Co-development PartnerEstablished in 2000 as a separately incorporated, tax-exempt educational foundation providing education and training to private- and public-sector health care anti-fraud personnel. The Institute is the primary vehicle for delivering NHCAA's professional development mission.
• Federal Law Enforcement and Regulatory AgenciescoreStrategic or Co-development PartnerNHCAA maintains over 230 government liaison partnerships with federal and state agencies having jurisdiction over health care fraud. Includes FBI, HHS-OIG, state Medicaid Fraud Control Units, and state insurance fraud bureaus. These partnerships enable information sharing and coordinated anti-fraud efforts.
• Private Health Insurers (Member Organizations)coreStrategic or Co-development PartnerNearly 90 private health insurers including Aetna, Anthem, Blue Cross Blue Shield plans, CIGNA, UnitedHealthcare, and Humana participate as member organizations. Members collaborate on fraud detection, share investigative intelligence via SIRIS, and participate in joint training programs.
• CotivitisupportingGTM or Marketing PartnerPlatinum Supporting Member sponsoring NHCAA webinars. Cotiviti provides behavioral health and FWA expertise for educational content including the 'Waste and Abuse in Behavioral Health' webinar featuring senior experts from the company.
• CodoxosupportingGTM or Marketing PartnerPartner webinar sponsor providing AI-powered health care integrity solutions content. Codoxo CEO Musheer Ahmed hosts deepfake detection discussions for payer SIU and payment integrity teams.
• Higher LogicsupportingTechnology or IntegrationPowers NHCAA CONNECT community platform for member networking, discussions, job board, and resource libraries. Uses OpenID Connect authentication integrated with NHCAA's SSO.
• AdobesupportingTechnology or IntegrationAdobe Connect platform used for live virtual training sessions and webinars. Participants require computer with speaker and internet connection; audio provided through the platform.
• 501Works (MOJO Identity)supportingTechnology or IntegrationProvides MOJO Identity authentication platform for NHCAA's member portal and SSO infrastructure, enabling secure access to member-only resources and training platforms.
• NASBA (National Association of State Boards of Accountancy)supportingStrategic or Co-development PartnerNHCAA Institute is registered with NASBA as a sponsor of continuing professional education on the National Registry of CPE Sponsors. Training programs offer CPE hours applicable to professional certifications.
• AAPC (American Academy of Professional Coders)supportingStrategic or Co-development PartnerPrograms including Boot Camp and Schemes have received prior approval from AAPC for continuing education hours. AHFI Prep Course content reviewed against AAPC certification standards.
• HHS-OIG (Office of Inspector General)coreStrategic or Co-development PartnerKey government liaison partner providing COVID-19 anti-fraud resources, compliance training, and Provider Compliance Training. Maintains most wanted fugitives list and fraud reporting portal integrated with NHCAA resources.

Scale indicators5 records

Recent moves7 records

Expansion highlights5 records

Direct peers

• National Insurance Crime Bureau (NICB): Industry-funded nonprofit that investigates and combats insurance fraud across P&C and auto lines. Most directly comparable to NHCAA as a nonprofit, member-driven intelligence-sharing organization serving insurers and law enforcement against fraud.
• International Association of Special Investigation Units (IASIU): Professional association for insurance SIU professionals, offering training, certification, and conferences. Comparable to NHCAA as a membership body serving the same anti-fraud investigator community, with overlapping training and event-driven GTM.
• Association of Certified Fraud Examiners (ACFE): Global anti-fraud professional association administering the CFE certification, training, and chapter network. Comparable to NHCAA in mission and business model (membership, certification, conferences, publications) but operating across all fraud types, not only healthcare.
• National White Collar Crime Center (NW3C): Nonprofit providing training and investigative support to state and local law enforcement on economic and white-collar crime, including healthcare fraud. Comparable to NHCAA as a nonprofit intermediary delivering training and intelligence-sharing between government agencies and the private sector.
• Healthcare Fraud Prevention Partnership (HFPP): CMS-led public-private partnership combating healthcare fraud across federal and state programs and private payers. Comparable to NHCAA as a parallel anti-fraud public-private partnership with overlapping member agencies and information-sharing mission.

Broad incumbents

• National Association of Insurance Commissioners (NAIC): U.S. state insurance regulators' standard-setting and coordination body. Comparable to NHCAA as the broader governing/standards authority over insurance, of which healthcare anti-fraud is one sub-domain, but with regulatory rather than convener scope.

Emerging players

• Cotiviti: Healthcare payment-integrity and FWA detection vendor serving payers; Platinum Supporting Member of NHCAA. Comparable as a commercial alternative/adjacent in healthcare FWA detection, and a potential partner or competitive channel.
• Codoxo: AI-powered healthcare payment integrity and FWA detection company; NHCAA supporting partner. Comparable as an emerging technology vendor in the same anti-fraud space as NHCAA's members and SIRIS data domain.

Others

• SAS Institute (Fraud Management): Enterprise analytics vendor with healthcare fraud and abuse detection solutions used by payers. Comparable as infrastructure/analytics provider in healthcare FWA, serving the same payer customers as NHCAA's membership.
• LexisNexis Risk Solutions: Host of NHCAA's SIRIS database and a major data/analytics provider for healthcare fraud detection. Comparable as both an ecosystem partner and a broader data-and-analytics supplier to the anti-fraud community.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights6 records

Customer concentration

• LinkedInlinkedin.com/company/national-health-care-anti-fraud-association
• Xx.com/nhcaa

Revenue estimate

Valuation estimate

Number of profiles

Subsidiaries1 record

Funding overview

Funding rounds

Investors

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M&A

Investments

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Frequently asked questions about NHCAA