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During Congressional Hearing, Security Experts Cite Need for IoT Security Regulations

November 17, 2016
by Heather Landi
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The lack of adequate security standards for connected devices, and vulnerabilities in these devices, pose significant risks to the country’s digital infrastructure and could result in serious consequences if cyberattacks target medical devices in particular, according to several security experts who testified during a Congressional hearing.

Two panels of the U.S. House of Representatives Energy and Commerce Committee—the subcommittee on commerce, manufacturing and trade and the communications and technology subcommittee—held a hearing Wednesday to explore issues about the cybersecurity of connected devices. The hearing focused on the role of connected devices, or Internet of Things (IoT) devices, in recent cyberattacks, with legislators specifically focused on a massive distributed denial-of-service (DDoS) attack that occurred back in October on Internet-infrastructure provider Dyn.

The hearing was intended to review the recent series of connected device-based DDoS attacks, understand current countermeasures, and consider future efforts to combat malicious actors that could target vulnerabilities in modern digital infrastructure. Several security experts testified that with the exploding proliferation of IoT devices, the lack of security on these devices poses a serious risk and the current lack of any security standards for IoT devices needs to be addressed.

There are currently billions of IoT devices in operation and Rep. Marsha Blackburn cited a report that there would be 20 to 50 billion IoT devices by 2020. In a statement to House committee members, the College of Healthcare Information Management Executives (CHIME) stated that “tens of thousands of medical devices can be used throughout large healthcare systems, many of which are connected directly to the patient or serving to provide information to inform clinical decision making.”

“The highly interconnected nature of medical devices, combined with the constraints of inconsistent patching cycles, has created an ecosystem ripe with technical vulnerabilities that cannot be managed with standard processes and procedures,” CHIME said in its statement.


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CHIME emphasized the need for improved threat and information sharing across the industry. “Only by pulling together and sharing best practices can we thwart cyber criminals and protect patients.” And, to improve the cyber hygiene of networked medical devices, CHIME specifically noted that Congress should “ensure that manufacturers configure their devices according to an industry accepted security standard that accounts for the basic principles of cybersecurity controls and alleviates risks.” CHIME advocated that manufacturers should, as part of the pre-market approval process, be required to undergo a level of security validation in order to provide healthcare providers with a simple and easy to implement mechanism for managing its security.

During the hearing, legislators were particularly interested in gaining insight into what regulation, if any, was needed at the federal level and what kinds of security standards should be implemented. While none of the security experts were from the healthcare sector, the topic of medical devices, and the potential cybersecurity risks to hospitals and healthcare systems, was a frequent point of discussion.

As a researcher, Kevin Fu, CEO of Virta Labs and associate professor, department of electrical engineering and computer science at the University of Michigan, said, “We’re going to have some serious trouble if we don’t answer these questions. I fear for the day that every hospital system is down because an IoT attack brings down the entire healthcare system. We need to spend more time on the pre-market.”

Dale Drew, senior vice president, chief security officer at Level 3 Communications, said, “What we’ve seen, the Internet of Things has changed the nature of the game, as its easier to break into those devices and it goes unnoticed for longer periods of time.”

Drew also said, “I think that the average chief security officer has to manage 75 separate security vendors and to bolt on security controls for products and services that they are purchasing. You get one of those dials wrong and there are some significant consequences. So focusing on making sure that free market controls are placed on that infrastructure will be a significant adaptable win for us,” he said.

Many of the security expert witnesses emphasized the need to place more responsibility on the device manufacturers.

“Security needs to be built into IoT devices, not bolted on,” Fu said. “If cybersecurity is not part of the early design of an IoT device, it’s too late for effective risk control."

According to Fu, one issue that needs to be resolved is the economics of device security as customers, such as hospitals, don’t want to pay more for better security, and manufacturers want to upsell in order to include better security on devices.

On the topic of medical device security, Blackburn asked the security experts about mitigation strategies for hospitals and health systems to address device security.

“I can’t give you a satisfying answer. If you were to be a fly on the wall in the board room in the hospitals as they are discussing the topic of how does IoT security affect their assurance of their clinical operations being continuous, at the moment, they don’t have a plan,” Fu said. “It’s more along the lines of, ‘We need to get a plan, what can we do.” Fu said one particular problem is that chief information security officers and healthcare IT leaders typically don’t know their inventory.

“For the security officers, they don’t know what devices they have. There is a lot of contraband, or shadow IT, that comes in. Typically it’s a clinician who accidentally connects a device to an important network, maybe a music player that is simply providing comfort to a patient during surgery, but the clinician doesn’t realize they are introducing a new safety and security risk because they don’t have the security baked into these devices. So the IoT risk is more about unvetted assets into a very safety-critical arena. They can’t have a good answer right now because it’s not built in,” he said.

The security experts also said device and technology solution manufacturers need to be held responsible for security software updates for technology being used in critical infrastructure industries such as utilities and healthcare. “It’s about economics,” Fu said. “On the high-end devices, such as radiation therapy devices in hospitals, these are multi-million dollar machines. When hospitals buy one, they get a new operating system, but most hospitals have capital equipment costs and they don’t want to buy a new MRI machine every 10 years. So I’m still seeing Window 98 machines in hospitals. When they go to manufacturers and say, ‘I want my operating system to be kept secure,’ the manufacturer say, “Buy a new machine.' It’s an unwritten assumption that the software will be maintained and secured, but from the manufacturer standpoint, it’s ‘We provided you this device.’"

Rep. Gus Bilirakis voice concerns about ransomware attacks targeting hospitals and asked the security experts how hospitals could best protect their systems and operations using current technology.

“In the short term, hospitals are in a sticky place. There’s not a whole lot of mitigating solutions. My best advice is for hospitals to know their inventory of medical devices. I saw some discussion in a report that hospitals don’t even know the software running in their facilities and they said if we only knew what was on the medical devices, then we could better understand the risks that we’re taking,” Fu said.

"So what mechanism should we have so hospital systems are fully aware of what’s in their hospitals?” Rep. Susan Brooks asked.

“Hospitals want to make sure they have continuity of operations in their clinical workflow so they don’t have to shut down like MedStar health system shut down in this area for several days. So the problem is, when you don’t know what your assets are, how are you going to protect that? If you don’t know what ports are open? Manufacturers aren’t willfully causing harm, but they are not providing enough information so that the hospital staff can do their jobs to assure the continuity of their clinical facilities,” Fu said. He suggested that device manufacturers should provide customers, such as hospitals, a bill of materials of what software comes on a device when it enters a hospital. “It won’t completely solve a problem, but it will help. We can’t do step two until we do step one. You have to know your assets and inventory before effectively doing security mitigation controls.”

U.S. Rep Frank Pallone suggested that federal regulation, such as on the part of the Federal Communications Commission (FCC), could be part of the solution, yet voiced concerns that regulation would constrain innovation. Bruce Schneier, adjunct lecturer, Kennedy School of Government, Harvard University, and fellow at Berkman Klein Center, Harvard University, said that whiile regulations would constrain innovation, to a certain degree, he believes regulation is the only solution and compared it to how the government regulates automobile safety by requiring airbags.

“The government could impose minimum security standards on IoT manufacturers, forcing them to make their devices secure even though their customers don’t care. They could impose liabilities on manufacturers, allowing companies like Dyn to sue them if their devices are used in DDoS attacks. The details would need to be carefully scoped, but either of these options would raise the cost of insecurity and give companies incentives to spend money making their devices secure,” Schneier said.

When asked by legislators if he believed a government mandate would be necessary, Fu said, “I do believe, long-term, it will require a governmental mandate. In my experience, even though they mean well, they [the manufacturers] don’t have the economic drivers. With IoT, we know the risk is there and we know it can cause harm. There are millions of unsecure devices, but it’s a small fraction of what the market will look like by 2020. On a positive side, if we take action now, we could win this and we could have secure ecosystem,” Fu said.

Fu recommended that the government needs to incentivize built-in, basic cybersecurity hygiene for IoT devices by establishing meaningful security milestones and encouraging use of strong cryptography. He also emphasized the need to support agencies such as the National Institute of Standards and Technology (NIST) and NSF to advance understanding of how to protect IoT devices and to establish a cybersecurity workforce that meets industry needs.

Additionally, he suggested that legislators study the feasibility of standing up an independent national embedded cybersecurity testing facility modeled after the National Transportation Safety Board (NTSB), automotive crash safety testing, or the Nevada National Security Site.

Fu also suggested that Congressional leaders investigate the barriers to enhanced cybersecurity with IoT devices. “I think likely after seeing the same problems I’ve seen, you’re going to think about the need to have incentive systems built in. Economically, I don’t know what these will resemble, could they be regulations? Maybe. More financial incentives or financial penalties? Is it more about corporate liability? Perhaps,” he said.


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OCR Fines Providers for HIPAA Violations, Failure to Follow “Basic Security Requirements”

December 12, 2018
by Heather Landi, Associate Editor
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Florida-based Advanced Care Hospitalists PL (ACH) has agreed to pay $500,000 to the Office for Civil Rights (OCR) of the U.S. Department of Health and Human Services (HHS) for a number of HIPAA compliance failures, including sharing protected health information with an unknown vendor without a business associate agreement.

ACH provides contracted internal medicine physicians to hospitals and nursing homes in west central Florida. ACH provided services to more than 20,000 patients annually and employed between 39 and 46 individuals during the relevant timeframe, according to OCR officials.

Between November 2011 and June 2012, ACH engaged the services of an individual that claimed to be a representative of a company named Doctor’s First Choice Billings, Inc. (First Choice). The individual provided medical billing services to ACH using First Choice’s name and website, but allegedly without the knowledge or permission of First Choice’s owner, according to OCR officials in a press release published last week.

A local hospital contacted ACH on February 11, 2014 and notified the organization that patient information was viewable on the First Choice website, including names, dates of birth and social security numbers. In response, ACH was able to identify at least 400 affected individuals and asked First Choice to remove the protected health information from its website. ACH filed a breach notification report with OCR on April 11, 2014, stating that 400 individuals were affected; however, after further investigation, ACH filed a supplemental breach report stating that an additional 8,855 patients could have been affected.

According to OCR’s investigation, ACH never entered into a business associate agreement with the individual providing medical billing services to ACH, as required by the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules, and failed to adopt any policy requiring business associate agreements until April 2014. 

“Although ACH had been in operation since 2005, it had not conducted a risk analysis or implemented security measures or any other written HIPAA policies or procedures before 2014. The HIPAA Rules require entities to perform an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of an entity’s electronic protected health information,” OCR officials stated in a press release.

In a statement, OCR Director Roger Severino said, “This case is especially troubling because the practice allowed the names and social security numbers of thousands of its patients to be exposed on the internet after it failed to follow basic security requirements under HIPAA.”

In addition to the monetary settlement, ACH will undertake a robust corrective action plan that includes the adoption of business associate agreements, a complete enterprise-wide risk analysis, and comprehensive policies and procedures to comply with the HIPAA Rules. 

In a separate case announced this week, OCR also fined a Colorado-based hospital, Pagosa Springs Medical Center, $111,400 to settle potential HIPAA violations after the hospital failed to terminate a former employee’s access to electronic protected health information (PHI).

Pagosa Springs Medical Center (PSMC) is a critical access hospital, that at the time of OCR’s investigation, provided more than 17,000 hospital and clinic visits annually and employs more than 175 individuals.

The settlement resolves a complaint alleging that a former PSMC employee continued to have remote access to PSMC’s web-based scheduling calendar, which contained patients’ electronic protected health information (ePHI), after separation of employment, according to OCR.

OCR’s investigation revealed that PSMC impermissibly disclosed the ePHI of 557 individuals to its former employee and to the web-based scheduling calendar vendor without a HIPAA required business associate agreement in place. 

The hospital also agreed to adopt a substantial corrective action plan as part of the settlement, and, as part of that plan, PSMC has agreed to update its security management and business associate agreement, policies and procedures, and train its workforce members regarding the same.

“It’s common sense that former employees should immediately lose access to protected patient information upon their separation from employment,” Severino said in a statement. “This case underscores the need for covered entities to always be aware of who has access to their ePHI and who doesn’t.”

Covered entities that do not have or follow procedures to terminate information access privileges upon employee separation risk a HIPAA enforcement action. Covered entities must also evaluate relationships with vendors to ensure that business associate agreements are in place with all business associates before disclosing protected health information. 


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Eye Center in California Switches EHR Vendor Following Ransomware Incident

December 11, 2018
by Rajiv Leventhal, Managing Editor
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Redwood Eye Center, an ophthalmology practice in Vallejo, Calif., has notified more than 16,000 patients that its EHR (electronic health record) hosting vendor experienced a ransomware attack in September.

In the notification to the impacted patients, the center’s officials explained that the third-party vendor that hosts and stores Redwood’s electronic patient records, Illinois-based IT Lighthouse, experienced a data security incident which affected records pertaining to Redwood patients. Officials also said that IT Lighthouse hired a computer forensics company to help them after the ransomware attack, and Redwood worked with the vendor to restore access to our patient information.

Redwood’s investigation determined that the incident may have involved patient information, including patient names, addresses, dates of birth, health insurance information, and medical treatment information.

Notably, Redwood will be changing its EMR hosting vendor, according to its officials. Per the notice, “Redwood has taken affirmative steps to prevent a similar situation from arising in the future. These steps include changing medical records hosting vendors and enhancing the security of patient information.”

Ransomware attacks in the healthcare sector continue to be a problem, but at the same time, they have diminished substantially compared to the same time period last year, as cyber attackers move on to more profitable activities, such as cryptojacking, according to a recent report from cybersecurity firm Cryptonite.

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Report: 30 Percent of Healthcare Databases Exposed Online

December 10, 2018
by Heather Landi, Associate Editor
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Hackers are using the Dark Web to buy and sell personally identifiable information (PII) stolen from healthcare organizations, and exposed databases are a vulnerable attack surface for healthcare organizations, according to a new cybersecurity research report.

A research report from IntSights, “Chronic [Cyber] Pain: Exposed & Misconfigured Databases in the Healthcare Industry,” gives an account of how hackers are tracking down healthcare personally identifiable information (PII) data on the Dark Web and where in the attack surface healthcare organizations are most vulnerable.

The report explores a key area of the healthcare attack surface, which is often the easiest to avoid—exposed databases. It’s not only old or outdated databases that get breached, but also newly established platforms that are vulnerable due to misconfiguration and/or open access, the report authors note.

Healthcare organizations have been increasingly targeted by threat actors over the past few years and their most sought-after asset is their data. As healthcare organizations attempt to move data online and increase accessibility for authorized users, they’ve dramatically increased their attack surface, providing cybercriminals with new vectors to steal personally identifiable information (PII), according to the report. Yet, these organizations have not prioritized investments in cybersecurity tools or procedures.

Healthcare budgets are tight, the report authors note, and if there’s an opportunity to purchase a new MRI machine versus make a new IT or cybersecurity hire, the new MRI machine often wins out. Healthcare organizations need to carefully balance accessibility and protection.

In this report, cyber researchers set out to show that the healthcare industry as a whole is vulnerable, not due to a specific product or system, but due to lack of process, training and cybersecurity best practices. “While many other industries suffer from similar deficiencies, healthcare organizations are particularly at risk because of the sensitivity of PII and medical data,” the report states.

The researchers chose a couple of popular technologies for handling medical records, including known and widely used commercial databases, legacy services still in use today, and new sites or protocols that try to mitigate some of the vulnerabilities of past methods. The purpose of the research was to demonstrate that hackers can easily find access to sensitive data in each state: at rest, in transit or in use.

The researchers note that the tactics used were pretty simple: Google searches, reading technical documentation of the aforementioned technologies, subdomain enumeration, and some educated guessing about the combination of sites, systems and data. “All of the examples presented here were freely accessible, and required no intrusive methods to obtain. Simply knowing where to look (like the IP address, name or protocol of the service used) was often enough to access the data,” the report authors wrote.

The researchers spent 90 hours researching and evaluated 50 database. Among the findings outlined in the report, 15 databases were found exposed, so the researchers estimate about 30 percent of databases are exposed. The researchers found 1.5 million patient records exposed, at a rate of about 16,687 medical records discovered per hour.

The estimated black-market price per medical record is $1 per record. The researchers concluded that hackers can find a large number of records in just a few hours of work, and this data can be used to make money in a variety of ways. If a hacker can find records at a rate of 16,687 per hour and works 40 hours a week, that hacker can make an annual salary of $33 million, according to the researchers.

“It’s also important to note that PII and medical data is harder to make money with compared to other data, like credit card info. Cybercriminals tend to be lazy, and it’s much quicker to try using a stolen credit card to make a fraudulent purchase than to buy PII data and run a phishing or extortion campaign. This may lessen the value of PII data in the eyes of some cybercriminals; however, PII data has a longer shelf-life and can be used for more sophisticated and more successful campaigns,” IntSights security researcher and report author Ariel Ainhoren wrote.

The researchers used an example of hospital using a FTP server. “FTP is a very old and known way to share files across the Internet. It is also a scarcely protected protocol that has no encryption built in, and only asks you for a username and password combination, which can be brute forced or sniffed

by network scanners very easily,” Ainhoren wrote. “Here we found a hospital in the U.S. that has its FTP server exposed. FTP’s usually hold records and backup data, and are kept open to enable backup to a remote site. It could be a neglected backup procedure left open by IT that the hospital doesn’t even know exists.”

According to the report, hackers have three main motivations for targeting healthcare organizations and medical data:

  • State-Sponsored APTs Targeting Critical Infrastructure: APTs are more sophisticated and are usually more difficult to stop. They will attempt to infiltrate a network to test tools and techniques to set the stage for a larger, future attack, or to obtain information on a specific individual’s medical condition.
  • Attackers Seeking Personal Data: Attackers seeking personal data can use it in multiple ways. They can create and sell PII lists, they can blackmail individuals or organizations in exchange for the data, or they can use it as a basis for further fraud, like phishing, Smishing, or scam calls.
  • Attackers Taking Control of Medical Devices for Ransom: Attackers targeting vulnerable infrastructure won’t usually target healthcare databases, but will target medical IT equipment and infrastructure to spread malware that exploits specific vulnerabilities and demands a ransom to release the infected devices. Since medical devices tend to be updated infrequently (or not at all), this provides a relatively easy target for hackers to take control.

The report also offers a few general best practices for evaluating if a healthcare organization’s data is exposed and/or at risk:

  • Use Multi-Factor Authentication for Web Applications: If you’re using a system that only needs a username and password to login, you’re making it significantly easier to access. Make sure you have MFA setup to reduce unauthorized access.
  • Tighter Access Control to Resources: Limit the number of credentials to each party accessing the database. Additionally, limit specific parties’ access to only the information they need. This will minimize your chance of being exploited through a 3rd party, and if you are, will limit the damage of that breach.
  • Monitor for Big or Unusual Database Reads: These may be an indication that a hacker or unauthorized party is stealing information. It’s a good idea to setup limits on database reads and make sure requests for big database reads involve some sort of manual review or confirmation.
  • Limit Database Access to Specific IP Ranges: Mapping out the organizations that need access to your data is not an easy task. But it will give you tighter control on who’s accessing your data and enable you to track and identify anomalous activity. You can even tie specific credentials to specific IP ranges to further limit access and track strange behavior more closely.


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