Abstract: Instances of fraud in basic medical insurance occur from time to time， posing a significant threat to the security of medical insurance funds and exerting pressure on fund supervision while attracting societal attention. This paper adopts a public policy perspective and utilizes the classic policy implementation model as a theoretical foundation. Using the fuzzyset qualitative comparative analysis（fsQCA） method， it selects typical cases from 31 provinciallevel regions published by the national healthcare security administration to explore the factors and pathways influencing fraudulent activities in basic medical insurance. The following conclusions are drawn: three configurations contribute to the high incidence of health insurance fraud， namely， the “insufficient fund surplus”type， the “economicregulatory imbalance” type， and the “weak economic development” type. The overall strategy for governance is to adjust and optimize the level of financial social security. Specific countermeasures for the aforementioned configurations include implementing refined management of healthcare insurance funds， strengthening information technology infrastructure， and promoting the development of peoples livelihood economy.

Key words: basic medical insurance; fraud; influencing factors; countermeasures; fsQCA