The 251 cases in 2015/16 is almost double the tally from five years ago, and an increase of 38 from the previous year.
Scottish Conservative public health spokesman Miles Briggs uncovered the information following a parliamentary question to the Scottish Government.
The Lothians MSP said ministers had to explain why there has been such a rise, and if this was due to an increasing frequency of actual negligence, or a growing compensation culture.
It means taxpayers north of the border have to fund the settling of a negligence case almost five times each week.
Health secretary Shona Robison explained in her response that the year of payment didn’t necessarily mean the case had occurred during that period, with some taking several years to settle.
Scottish Conservative public health spokesman Miles Briggs said:
“It’s right that when someone has suffered as a result of clinical negligence they should be compensated.
“But the increase in these payments is extremely worrying.
“Either the NHS is becoming more negligent or simply quicker to address failings with a pay-off, and neither of those outcomes are positive.
“The NHS can’t simply sweep incidents of clinical negligence under the carpet with a compensation deal.
“Lessons have to be learned and those responsible held accountable, otherwise these payments will just continue to increase in number.
“It is also clear that this increase in the number of clinical negligence payments will be impacting already hard-pressed NHS budgets.”