Passion + Integrity
Myers and Stauffer provides meaningful careers where our associates know their work truly makes a difference in the lives of others. This month, we feature Kimberly Forrest, RHIA (Senior Manager, Indianapolis), as she talks about how her own earlier experiences have influenced her values and her work, shaping her outlook, inspiring her to even greater vigilance in her work, and ultimately fueling her fire in her desire to help others.
“My interest in program integrity began with an early job in a provider setting where I experienced one review after another from external auditors – program integrity staff – coming in to review our work and operations and make recommendations for corrections. Those visits left us – on the provider side – scrambling to secure resources to fix problems, hopefully, but oftentimes not, before the next audit. I decided to try a new career in the world of Medicaid program integrity.
I have never looked back.
I came to Myers and Stauffer with experience working primarily in a state Medicaid agency, with direct oversight of program integrity. In that role, I developed first-hand appreciation for the importance of monitoring usage of scarce resources. I also developed an understanding of the importance of fighting fraud, waste, and abuse (FWA) for the sustainability of the Medicaid programs designed to care for our most vulnerable of populations.
From my position of oversight on most every Medicaid provider type, I saw significant waste of dollars, possibly caused by system or policy vulnerabilities, misapplied coding, unclear guidelines, and inadequate staff training.
Unfortunately, I had similar insight into a certain segment of providers – those who, seeking to abuse taxpayer monies, deliberately sidestepped and manipulated well-intended guidelines written for honest providers. I saw dishonest providers who billed repeatedly for the same services when they knew they had already been paid; providers who billed for services they never actually delivered; and providers who simply lied to obtain reimbursement they had no business claiming.
Seeing that kind of bold arrogance and abuse lights a passion in an honest person. I am proud to be passionate about helping safeguard state and federal dollars. As the nation’s public health insurance program for people with low incomes, Medicaid covers one in five Americans, including many with complex and costly needs for care. Medicaid’s expected spending is projected to exceed $1 trillion for the first time in 2028, and the vast majority of Medicaid enrollees lack access to other affordable health insurance.
Our work on the Benefit/Program Integrity (BPI) team on behalf of our clients means that fraud, waste, and abuse of those dollars are: prevented through education or early identification; addressed via tightening policies to eliminate program vulnerabilities or reviews that identify unsupported services or billings; or resolved through specific compliance actions that often include recovery of misspent funds.
I feel this is my obligation – my purpose – in my work with the firm, and as a taxpayer who wants to see those dollars safeguarded. Our goal is not to prevent providers, plans, or health care vendors from being paid, but rather to ensure there are sufficient dollars available so more members can receive services and those services are provided in compliance with payer guidelines.
If I do my job well, providers, health plans, and health care vendors can continue to serve our communities – and members will have continued access to services they need. I am proud to have a career where I feel like I can make a difference every day” Kim Forrest, RHIA (Senior Manager, Indianapolis)
Get to Know Kim
Kim brings to Myers and Stauffer more than 20 years of public- and private-sector experience in various forms of program integrity (PI) work for the state of Indiana, including contract implementation and oversight, evaluation and implementation of data analytics, audit coordination, and provider/stakeholder relations and education. She also provides oversight of the development and implementation of a comprehensive, program integrity, case tracking and analytics system. With that experience, she serves as a subject matter expert to incorporate the state PI perspective in the design.
Kim’s most recent role includes serving as the project manager responsible for all aspects of recovery audit contract operations, ranging from policy/procedure impact analysis to evaluation of state guidelines to identify potential vulnerabilities. She provides fraud, waste, and abuse detection technical expertise to the firm’s Benefit/Program Integrity engagement team and serves as a resource on false claims and litigation support engagements.
Myers and Stauffer is proud to help our clients serve those who are most vulnerable. Our staff feel empowered to know that their hard work and dedication each day makes a difference. We believe it and so do the millions of individuals helped by the clients we serve. We will release new stories each month highlighting associates and their stories. Follow along with our LinkedIn, Twitter, and Instagram for more information.