NHS Fife is one of three health boards that have been bailed out of the red with Government loans worth millions of pounds as the NHS struggles to make savings of £271 million this year.
NHS Fife along with NHS forth Valley and NHS Orkney all used Scottish Government support packages to make ends meet last year but did not clearly show this in their accounts, the public spending watchdog found.
The NHS in Scotland is having to make the savings to balance the books this year and those that borrowed are having to make repayments, putting further strain on budgets.
Audit Scotland points to the loans in a report published on Wednesday as a sign of how difficult health boards are finding it to run services with the funds available.
The report shows one-fifth of cost-cutting schemes outlined for 2012-13 are at high risk of failing.
It warns, in the face of other pressures such as a rising demand for treatment from an ageing population, it will be ”difficult to reduce costs while maintaining high quality services”.
Plans to shed 1,000 jobs across the Scottish health service by next April have already been outlined.
Between them Fife, Forth Valley and Orkney received more than £7 million in loans from the Scottish Government.
Auditor general for Scotland Caroline Gardner said: ”The annual accounts show a picture of good financial performance, but this doesn’t reflect the pressure boards faced in achieving this.”
NHS Fife finance director Chris Bowring said:”All boards must ensure that we break even every year and our financial progress is reported and communicated to the NHS Fife Finance and Resource Committee, NHS Fife Board and Scottish Government throughout every financial year.”