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Don’t Get Stranded without a Data Security Action Plan

August 26, 2016
by Mark Shelhart, Sikich LLP
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The cybersecurity challenges that face healthcare providers can seem staggering. Last year, the industry accounted for nearly 70 percent of all records exposed in data breaches, according to the Identity Theft Resource Center, and protected health information breaches impacted more than 113 million individuals, according to the Office for Civil Rights (OCR). Further, with health records increasing in value (surpassing credit card data) for criminals, hacking continues to rise.

Some institutions will report that they are “mostly secure.” And while awareness of threats has increased in the healthcare sector, many providers remain behind the curve on cybersecurity and lack the ability to prevent even common intrusions. Compounding the challenge for providers, state governments have responded to cyberattacks with increased scrutiny. Ever-changing laws dictate what actions a provider must take to both alert patients affected by a breach and offer remediation. Many of these amended laws expand the reach of current notification requirements, add to the definition of “personal information” and increase reporting requirements to state attorneys general.

For example, North Dakota modified its notification law to require any organization that “owns” or “licenses” state residents’ data that includes “personal information” to report the breach to the attorney general if it impacts more than 250 people. This applies even if the organization isn’t based in the state. North Dakota isn’t alone. Several other states, including Connecticut, Nevada, Oregon and Tennessee amended data breach notification laws in 2015 and 2016. And state attorneys general are making it clear that they want to be in the loop early when a breach occurs.

Mark Shelhart

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Navigating this increasingly complex maze of requirements from different states while simultaneously combatting data breaches is not an easy task. That’s why it’s critical for healthcare providers to prepare a comprehensive data security action plan by following these five steps:

1. Benchmark to identify vulnerabilities—A risk assessment is a key first step to help a provider determine where the greatest risks are within the organization. This helps the leadership team then determine what security resources to deploy and where to focus attention.

2. Adopt a consistent security posture—Healthcare providers need to take a consistent security stance across their organizations. This includes thorough application and network penetration testing, vulnerability scanning and ongoing server monitoring and patching. A robust security testing regimen can help reduce vulnerabilities and protect providers’ most important and sensitive information.

3. Evaluate and manage third-party relationships—Hospitals have many vendors that handle everything from payments to data storage. These vital operational relationships can also be perilous if the vendor falls victim to a breach that compromises sensitive hospital and patient data. That’s why it’s crucial to make security a key consideration when selecting vendors and to scrutinize current third-party relationships. Healthcare providers must learn what vendors are legally responsible for in the event of a breach and also do their best to evaluate vendors’ security practices. The bottom line is that all organizations should have a policy requiring their vendors to disclose any security incident.

4. Gain a full understanding of all state and federal regulations—With lawmakers passing new regulations related to breaches on a regular basis, providers need to ensure they have a grasp on their level of legal exposure in different states—well before a breach occurs. Trusted legal advisors, both internal and external, can play a key role in keeping providers up to speed on the latest regulations and should be an integral part of an incident response team.

5. Implement a communications strategy to protect your reputation—Providers also need a reputation management plan and a communications strategy to control their message and handle the flood of press inquiries after a breach. Planning ahead ensures the breached organization is equipped to comply with all relevant authorities and tell a clear and honest story to patients, the general public and the media. Breaches handled poorly can shatter reputations and lead to deteriorating trust. Organizations that invest in thoughtful communications and execute a well-grounded media relations strategy will set themselves up to preserve their reputation and regain their footing for future success.

Healthcare organization leaders should take immediate stock of their security stance. How secure is sensitive data? Is the organization ready to spring into action in case of a breach? With the healthcare industry in the crosshairs, and new laws putting added pressure on providers of all sizes, action can’t be delayed. The companies that adopt an ongoing commitment to security and implement a comprehensive action plan that addresses both pre-breach data security and post-breach reputation management can feel more confident in the face of today’s ever-evolving threats and regulations.

Mark Shelhart is a senior manager for incident response and forensics in the security and compliance practice at Sikich LLP. He can be reached at mark.shelhart@sikich.com.


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Healthcare’s “RegTech” Opportunity: Avoiding a 2008-Style Crisis

September 21, 2018
by Robert Lord, Industry Voice, Co-Founder and President of Protenus
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In the financial crisis of 2007 to 2009, the financial industry suffered a crisis of trust. A decade later, banks and other financial institutions are still working to regain the confidence of consumers and regulators alike. In 2008 and 2009, while working at one of the world’s top hedge funds, I had a front-row seat to the damage that occurred to our economy, watching as storied corporate institutions fell or were gravely damaged. Today, as co-founder of a health technology company, I see healthcare is approaching a similarly dangerous situation. We must get ahead of the curve to avoid disaster.

Like finance, healthcare is a highly-regulated industry where non-compliance can result in severe financial and reputational consequences for healthcare companies, and severe impact on people’s lives. We deal with HIPAA, MACRA, HITECH, and hundreds of other foreboding acronyms on a daily basis. A lot of attention goes to the terrific and important work of clinical decision support, wellness apps, and other patient care technologies, but problems in the back office of hospitals must be addressed as well. One of these problems is the amount and complexity of healthcare regulation, and our healthcare system’s inability to keep up.

In finance, where I spent the early part of my career, the adoption of what is termed “RegTech” (regulatory technology) was driven by the increasing complexity of financial technology and infrastructure sophistication.  As trades moved faster, and as algorithms, processes and organizations became more complex, the technologies needed to ensure regulatory compliance had to move in tandem.  The crisis we experienced in 2008 was partially the result of the inability of the industry’s regulatory capabilities to keep up with the pace of technological change.  In many ways, the industry is still playing a catch-up game.

As healthcare professionals, looking to the lessons learned by our colleagues in finance can help us predict patterns and stay ahead of the curve. Right now, I’m seeing alarming parallels to challenges faced in finance a decade ago.

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Robert Lord

The burden of regulation across our industry is simply staggering.  Thirty-nine billion dollars of regulatory burden is associated with healthcare annually, which is about $1,200 per patient, per year. Despite this high cost, we still have $1 trillion of fraud, waste and abuse in our healthcare system. With so much regulation, why are we seeing so little yield from that burden? In many cases, it’s because we’re merely checking boxes and not addressing core risks؅. Like finance, there was a great deal of effort on compliance with regulations, but not enough attention on addressing important systemic risks.

This is not to say I am against good regulation; in fact, many regulations serve to protect patients and improve care. The problem is that there are so many demands on healthcare systems, that compliance and regulation is often reduced to checking boxes to ensure that minimum defensible processes are built, and occasionally spot-checking that things look reasonable. We currently have nowhere near 100 percent review of activities and transactions that are occurring in our health systems every day, though our patients deserve nothing less. However, unless overburdened and under-resourced healthcare providers and compliance professionals can achieve leverage and true risk reduction, we’ll never be able to sustainably bend our compliance cost curve.

Systemic problems are often not discovered until something goes horribly wrong (e.g., Wall Street every decade or so, the Anthem data breach, etc.). Today In the financial industry, RegTech provides continual, dynamic views of compliance or non-compliance and allows management, compliance professionals and regulators to check compliance in real-time. They can view every record, understand every detail, and automate investigations and processes that would otherwise go undetected or involve lengthy and labor-intensive reviews.

The real promise of these new capabilities is to allow compliance professionals and regulators to perform the truest form of their jobs, which is to keep patient data secure, ensuring the best treatment for patients, and creating sustainable financial models for healthcare delivery. RegTech will open up lines of communication and help create conversations that could never have been had before—conversations about what’s not just feasible for a person to do, but what’s right to do for the people whom regulation seeks to protect.

No longer bound by limited resources that lead to “box-checking,” compliance officers can use new and powerful tools to ensure that the data entrusted to them is protected. At the same time, healthcare management executives can be confident that the enterprises they manage will be well served by risk reducing technological innovation.  Patients, the ultimate beneficiaries of healthcare RegTech, deserve as much.

Robert Lord is the co-founder and president of Protenus, a compliance analytics platform that detects anomalous behavior in health systems.  He also serves as a Cybersecurity Policy Fellow at New America.

 


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HIPAA Settlements: Three Boston Hospitals Pay $1M in Fines for “Boston Trauma” Filming

September 20, 2018
by Heather Landi, Associate Editor
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Three Boston hospitals that allowed film crews to film an ABC documentary on premises have settled with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) over potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.

According to OCR, the three hospitals—Boston Medical Center (BMC), Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital (MGH)—compromised the privacy of patients’ protected health information (PHI) by inviting film crews on premises to film "Save My Life: Boston Trauma," an ABC television network documentary series, without first obtaining authorization from patients.

OCR reached separate settlements with the three hospitals, and, collectively, the three entities paid OCR $999,000 to settle potential HIPAA violations due to the unauthorized disclosure of patients’ PHI.

“Patients in hospitals expect to encounter doctors and nurses when getting treatment, not film crews recording them at their most private and vulnerable moments,” Roger Severino, OCR director, said in a statement. “Hospitals must get authorization from patients before allowing strangers to have access to patients and their medical information.”

Of the total fines, BMC paid OCR $100,000, BWH paid $384,000, and MGH paid $515,000. Each entity will provide workforce training as part of a corrective action plan that will include OCR’s guidance on disclosures to film and media, according to OCR. Boston Medical Center's resolution agreement can be accessed here; Brigham and Women’s Hospital's resolution agreement can be found here; and Massachusetts General Hospital's agreement can be found here.

This is actually the second time a hospital has been fined by OCR as the result of allowing a film crew on premise to film a TV series, with the first HIPAA fine also involving the filming of an ABC medical documentary television series. As reported by Healthcare Informatics, In April 2016, New York Presbyterian Hospital (NYP) agreed to pay $2.2 million to settle potential HIPAA violations in association with the filming of “NY Med.”

According to OCR announcement about the settlement with NYP, the hospital, based in Manhattan, violated HIPAA rules for the “egregious disclosure of two patients’ PHI to film crews and staff during the filming of 'NY Med,' an ABC television series.” OCR also stated the NYP did not first obtain authorization from the patients. “In particular, OCR found that NYP allowed the ABC crew to film someone who was dying and another person in significant distress, even after a medical professional urged the crew to stop.”

The OCR director at the time, Jocelyn Samuels, said in a statement, “This case sends an important message that OCR will not permit covered entities to compromise their patients’ privacy by allowing news or television crews to film the patients without their authorization. We take seriously all complaints filed by individuals, and will seek the necessary remedies to ensure that patients’ privacy is fully protected.” 

OCR’s guidance on disclosures to film and media can be found here.

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Independence Blue Cross Notifies 17K Patients of Breach

September 19, 2018
by Rajiv Leventhal, Managing Editor
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The Philadelphia-based health insurer Independence Blue Cross is notifying about 17,000 of its members that some of their protected health information (PHI) has been exposed online and has potentially been accessed by unauthorized individuals.

According to an article in HIPAA Journal, Independence Blue Cross said that its privacy office was informed about the exposed information on July 19 and then immediately launched an investigation.

The insurer said that an employee had uploaded a file containing plan members’ protected health information to a public-facing website on April 23. The file remained accessible until July 20 when it was removed from the website.

According to the report, the information contained in the file was limited, and no financial information or Social Security numbers were exposed. Affected plan members only had their name, diagnosis codes, provider information, date of birth, and information used for processing claims exposed, HIPAA Journal reported.

The investigators were not able to determine whether any unauthorized individuals accessed the file during the time it was on the website, and no reports have been received to date to suggest any protected health information has been misused.

A statement from the health insurer noted that the breach affects certain Independence Blue Cross members and members of its subsidiaries AmeriHealth HMO and AmeriHealth Insurance Co. of New Jersey. Fewer than 1 percent of total plan members were affected by the breach.

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