Hospitals have been fined €5.8m for failing to reach targets to reduce waiting lists.
The Irish Times reports the level of fines is based on waiting list figures for August, which show thousands of patients are waiting longer than the 18-month target set by the Health Minister.
The Department of Health said the fines were designed to incentivise performance rather than meet the costs of treatments.
Fines will be levied on a monthly basis and will increase or decrease depending on the level of breach of the 18-month target.
More than 11,000 outpatients and more than 1,000 inpatients were on the waiting list at the end of August.