A 42-year-old paramedic has allegedly been killing sick patients in an ambulance and selling funeral services to grieving families.

According to Palermo Republic, the man would inject air into the patients' arms, causing them to die writhing in agony. Three cases have been confirmed and about 50 are being investigated by Italian police in the past year. Two of three victims are described as elderly and sick.

The man has been accused of voluntary homicide and allegedly worked with Cosa Nostra – the Sicilian Mafia. The deaths were originally dismissed as "died by the hand of God". It is estimated the practice started in 2012 and occurred between the homes of patients and the Biancavilla hospital in Catania.

According to a person involved, who spoke openly to TV program The Hyenas, the patients would die on the way back from the hospital to their homes. Once dead, the grief-stricken families would be offered a funeral service in the time of shock. The paramedics would then be awarded "a little present" of around €300.

The Palermo Republic is reporting that "the bosses were putting men on the ambulance" and all of the profits went back to the "organisation". The vehicles used have been nicknamed the "ambulances of death".

The prosecution believes many of the people involved were already in jail and were "less afraid".