NHS Forth Valley's finance chief has warned that the health board is facing a financial challenge on an unprecedented scale in the three years time, with a £40 million shortfall expected.
There are fears that a lack of funding could mean ambitious plans to modernise GP surgeries and redevelop Falkirk Community Hospital could be at risk.
Finance director Scott Urquhart stressed to members of NHS Forth Valley's board at a meeting this week that the financial plan is just a projection and the numbers will almost certainly change.
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But he warned that as things stand there is a real risk that the local NHS will not manage to balance the books.
While there will be a slight increase in funding from the Scottish Government, of two per cent, that will almost certainly be eclipsed by rising costs in several areas.
Energy prices are estimated to rise by 30 per cent, while it is thought that the price of drugs will increase by around 10 per cent.
Forth Valley is particularly vulnerable to rising inflation as the cost of three PFI contracts - including the Larbert hospital - are tied to the Retail Price Index. PFI charges account for around 10 per cent of the board's expenditure every year.
The board is also facing a massive increase in rates, which are expected to rise by 34 per cent.
NHS Forth Valley is currently being overseen by the Scottish Government, with an improvement plan now in place as it struggles to cut waiting times in its emergency department.
The government has also demanded improvement in its GP out-of-hours services, psychological therapies and Child and Adolescent Mental Health Services (CAMHS).
Forth Valley Royal Hospital in Larbert was also heavily criticised for using five beds in wards that are meant for four.
Mr Urquhart presented the board with a financial plan to be delivered over the next three years, but he warned that currently they are aiming to find £25 million worth of savings, which will be far short of what could be needed.
In order to make savings, the board will expect to see a reduction in the use of nurse bank and agency staff.
They also hope that reducing the number of extra beds the hospital has been using will also bring costs down.
There will also be a major focus on staff absence rates, which are currently eight per cent, twice the target rate.
The board also intends to find ways to save on prescribings across primary and secondary care and to make better use of digital opportunities.
Mr Urquhart's report to the board warned: "The scale of the financial challenge is unprecedented and given the nature of the current financial environment and operating context, our initial assessment of the position suggests that it is extremely unlikely that financial balance will be delivered during the three-year timeframe of the plan."
A detailed savings update and plan will be presented to the policy and resources committee in April.
