Which laws are in place to protect Medicare from fraudulent billing practices, and how are these laws enforced?

n a somewhat contested race, you were recently elected to an emergency medical services (EMS) officer position on your volunteer fire department. Your “platform” when running for the position was to move the department forward by expanding Advanced Life Support (ALS) services, developing additional mutual aid agreements, starting an interfacility transport service, and increasing continuing education opportunities for providers. While the department is renowned for drama within the ranks, especially regarding EMS operations, you were looking forward to the challenge.

After you have spent a few months in your new position, the fire department is notified that it is being sued in a qui tam action for violating the federal Anti-Kickback Statute by developing agreements with local nursing homes to provide interfacility transports at a reduced cost for the purposes of increasing Medicare billing. Unfortunately, as a volunteer, you have very little knowledge of how EMS billing works (a third-party company provides that service for your agency) and are not familiar with the federal Anti-Kickback Statute. While you fear it may be too late, this notice has prompted several questions:

Which laws are in place to protect Medicare from fraudulent billing practices, and how are these laws enforced?
What is a qui tam action and how does it relate to Medicare billing?
Which other laws exist to govern how your EMS operations are managed? What are the potential penalties for failure to comply with these laws?