The Scottish Government is to relax its pay freeze for all NHS executives and senior managers earning more than £43,000 next year with a performance-related award of up to 4%.
The move was revealed by The Herald last month, but the full details of the pay packages have only now been made public.
Managers on £100,000 a year could be in line for an annual salary boost of £4000.
The scale of the rise contrasts with the 1% rise pencilled in for 2014 for all other NHS staff, including nurses, doctors and many other grades of health worker.
But the decision to hand out a higher award to managers was criticised yesterday by the Scotland Patients Association (SPA) and opposition politicians who said the increase was "hard to justify."
Margaret Watt, chairperson of the SPA, said: "This is obscene and absolutely shocking. This should not be happening at a time when many other key health workers are being restricted to 1% after many years of a pay freeze.
"These people are already on higher salaries than many of their colleagues and so there is no justification for them to be given more. If anything they should be taking less.
"This government needs to have a rethink about this, rather than enriching the fat cats."
The decision to raise executive salaries is understood to have been taken after senior NHS managers - some of whom earn up to £173,000 a year - expressed unhappiness at the pay freeze imposed in recent years as part of the UK Government's austerity measures.
Finance Secretary John Swinney has largely followed the UK-led policy of freezing the salaries of top and middle-income earners while sanctioning modest rises for lower-paid staff.
But at a conference last month, Health Secretary Alex Neil hinted at a U-turn when he said he was aware of "the concerns that now exist following several years of pay restraint."
Of the new policy, he said: "This settlement will be better than in recent years, but I accept that questions will remain about whether the management pay arrangements introduced by the previous administration continue to be fit for purpose."
Scottish Labour's health spokesman, Neil Findlay, said patients and staff on low pay "will find it unbelievable that senior managers already on hefty salaries could get a 4% performance-related pay award when complaints about the NHS are up, bed numbers are down, targets are being missed, IT systems are failing and patients are being treated in cupboards."
Liberal Democrat MSP Jim Hume said: "The potential to give already well-paid managers in the NHS a generous pay increase of up to 4% seems hard to justify, especially when the pay increase for nurses is capped. This will do little for the morale of front-line staff and does nothing to encourage new people into the NHS."
A Scottish Government spokesman defended the rises, saying: "Unlike other NHS staff groups, senior managers had their pay completely frozen in recent years, including for pay progression. It is important to note that automatic increments for doctors, nurses and other clinical staff are 3.5% to 4%, hence the total increase for any manager will not exceed that."
The dispute follows reports that a rise of 1% for NHS staff in England faces being cancelled after Department of Health officials told the health service's pay review body that the increase was now "unaffordable" alongside a system that also awards annual pay increments.
However, Mr Neil said he had "no intention" of withholding the rise in Scotland.
The Scottish Government had made its own proposals to the pay review bodies, proposing that the 1% rise be implemented in 2014/15 as well as giving further help to those on low wages by ensuring no-one employed by the health service earns less than the Scottish Living Wage.
The Health Secretary accused his Westminster counterpart, Jeremy Hunt, of "bad faith" and a "betrayal of the NHS".
"To steal the pay rise back from workers' hands will destabilise the NHS across the UK and damage morale," he said.