Health Secretary Patricia Hewitt is sending hit squads into three Midland hospital trusts to force them to bring budget deficits under control.
Another three hospitals in the region are to be monitored by the Department of Health to ensure they cut budgets.
Ms Hewitt is appointing a "turnaround director" to take control of finances at the Shrewsbury and Telford Hospital NHS Trust, which runs the Royal Shrewsbury Hospital and Princess Royal Hospital in Telford, and is heading for a £10 million deficit.
Turnaround directors will also be sent to the University Hospital of North Staffordshire, in Stoke, which has a projected £18 million deficit, and the George Eliot Hospital in Nuneaton, Warwickshire, which is heading for a £5 million deficit.
It follows an inquiry by chartered accountants KPMG on behalf of the DoH, which warned managers at 18 health trusts across the country were unable to get their finances under control without help.
The directors will report to the Financial Director of the NHS in Whitehall, who works directly with Ms Hewitt.
The other three trusts have been spared intervention after KPMG concluded they were capable of managing their budgets without help.
However, they have been ordered to make spending cuts.
The trusts include the Good Hope Hospital, which has a projected deficit of £5 million, and Sandwell & West Birmingham NHS Trust, which runs City Hospital in Birmingham and Sandwell General Hospital in West Bromwich, and has a £5 million projected deficit.
They also include Royal Wolverhampton Hospital, which runs New Cross Hospital in Wolverhampton and the Midland Counties Eye Infirmary, and has a projected deficit of £10 million.
Ms Hewitt said: "Despite having more money than ever before, small numbers of NHS organisations are struggling to manage the demand for new drugs and new services.
"Sixty-two NHS organisations are predicting significant deficits. Eighteen organisations need urgent intervention to help them turn around their finances. So next week we will appoint a turnaround director for each of the 18 organisations.
"They will help these organisations deal with what are particularly serious underlying problems, so important that we will run it directly from the department itself, with our financial director in charge.
"In those 18 organisations, KPMG are absolutely clear that even the best management would need additional support to turn the situation around.
"We are giving our managers extra support, not because we blame them but because we and they are determined to put patients first."
The Health Secretary admitted this could lead to "difficult decisions" in some hospitals.
"In some cases that will certainly mean reorganising services, or reconfiguring hospitals.
"Doing more treatment or diagnostics in the community, and generally organising services to get the best possible care for patients, along with the best value for money.
"These decisions can be very difficult which is why it is essential to involve the public at an early stage."