In recent years, medical insurance fund fraud incidents have repeatedly appeared in the media and gradually become the focus of public opinion. Based on the Grounded Theory research method, with the help of NVivo12 Plus qualitative analysis software, 100 cases of medical insurance fund fraud exposed by the National Healthcare Security Administration from 2019 to 2022 were selected for analysis, and the current medical insurance fund fraud scene was comprehensively examined so as to discover and summarize the main challenges of medical insurance fraud governance in China. Drawing on anti-fraud governance measures at home and abroad, extracting relevant anti-fraud experience, and on the basis of social governance theory, we have built a "five-in-one medical insurance fund anti-fraud system" that integrates "government, non-governmental organizations, medical service providers, medical insurance institutions, and medical service buyers", explored the anti-fraud paths of medical insurance fund in line with Chinese characteristics, and made suggestions for further improving the anti-fraud work of medical insurance, so as to cope with the current increasingly severe situation of medical insurance fraud, and ensure the smooth operation of the basic medical security system with Chinese characteristics.