A health board has been forced to pay back around £1m after failing to hit waiting list targets.
The Welsh Government has taken action after almost 6,000 patients in North Wales waited over eight months for hospital treatment.
It has contributed to Betsi Cadwaladr University Health Board overspending its budget by £41.3m during the last financial year, which ended in March.
The board, which is still in special measures, fell short of its goal of bringing the waiting list down to 5,700 patients by 216 during 2018/19.
It came despite the Cardiff administration injecting almost £20m to try and improve performances against referral to treatment (RTT) figures in the region.
Ministers have now triggered a claw-back mechanism to retrieve some of the money.
The move was revealed in papers which are set to go before Betsi Cadwaladr officials next week.
In a report, director of finance Russell Favager warned they also face a number of major risks in the next 12 months as spending on agency staff has spiralled into tens of millions of pounds.
He said: “In total, the health board received £19.5m funding for additional activity to reduce the long waiting lists this year.
“However during April, there was a clawback of £1m of this funding by Welsh Government as waiting times did not meet the requirement.
“The clawback related to the final confirmed activity level of 5,916, against a target of 5,700.
“March saw the highest agency spend for the year as a whole, with total agency spend for 2018/19 amounting to £31.6m.
“There are a number of critical financial risks which are being carried forward and will need to be carefully managed in 2019/20, including individual packages of care, pay costs, particularly agency costs associated with waiting times and performance and the need to develop and deliver savings schemes.”
An update is also set to be given at the meeting on the ongoing dispute over payments to the Countess of Chester Hospital, which has led the English trust to stop accepting outpatient referrals from Wales.
Senior figures blamed the move on an ongoing funding row with the Welsh Government after claiming it was not being paid enough to look after patients from over the border.
However, the change which affects thousands of people in Flintshire has been greeted with anger.
Welsh health minister Vaughan Gething said the decision was ‘unacceptable’ while negotiations regarding tariffs are ongoing between various government and NHS representatives on both sides.
Mr Ravager said the potential tariff changes posed a further risk to the board’s financial status.
He added: “The issue of the potential significant financial impact of English tariff changes on Welsh Health Specialised Services Committee commissioned services has not been concluded and remains a risk going into 2019/20.”
The Countess dispute and the board’s current financial position will be discussed at a meeting being held at Venue Cymru in Llandudno on Thursday.
By Liam Randall – Local Democracy Reporter (more here).