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FBI Agent to CHIME Attendees: The Cybersecurity Environment Is Becoming More Dangerous

August 15, 2016
by Mark Hagland
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FBI Agent Timothy J. Wallach shared with CHIME/AEHIS LEAD Forum attendees some of the latest disturbing trends

The level of cybersecurity threat is growing exponentially in healthcare right now, but there are some very clear strategies that the leaders of patient care organizations can and should do in order to fight back. That was the core of the message that Timothy J. Wallach, a supervisory special agent in the Cyber Task Force in the Seattle Field Office of the Federal Bureau of Investigation (FBI) told attendees Monday morning at the CHIME/AEHIS LEAD Forum Event, being held at the Seattle Marriott Waterfront in Seattle, and sponsored by the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) and by the Institute for Health Technology Transformation (iHT2—a sister organization to Healthcare Informatics under the Vendome Group, LLC umbrella).

Supervisory Special Agent Wallach began his presentation on Monday morning by discussing the main groups that pose threats to healthcare IT security and to IT security across industries. There are six main groups and sources of threats: hacktivists; cyber-criminals; insiders; espionage; terrorism; and warfare, he noted. Hacktivists are low-level threats primarily motivated to deface websites and initiate DDOS (distributed denial of service) attacks against entities they are politically opposed to. Insiders are individuals within organizations who either purposefully or inadvertently expose their organizations to breaches and cybercriminality. Terrorists are beginning to consider how they might use technology to attack potential targets. And warfare involves actual nations waging war on each other. The two biggest threats by far, he said, are cybercriminals and those involved in cyber-espionage—including hostile foreign governments.

With regard to the biggest group of those threatening healthcare organizations right now, Wallach noted that the cyber-criminals involved now are conducting activity to steal information and monetize it. “Healthcare information is worth a lot of money on the dark web,” he said. “The bad guys want to target information that they can eventually monetize.” And patient records are treasure troves of usable data, unfortunately for the leaders of patient care organizations.

Meanwhile, the leaders of nation states are now actively also involved in cyber-criminality, Wallach said. They are generally attempting to steal information for economic or political gain or for espionage purposes. What’s important to understand in this context, he said, is that hostile foreign governments’ cyber-criminal activities are “generally well-funded, highly technically adept, and very sophisticated.” He added that there is no coincidence that some of the most high-profile attacks in 2014 were waged against health insurers like Anthem and Premera, as insurers in the U.S. are insuring a lot of state and local governments. Hostile national governments are also targeting academia and governments, he noted. They are motivated to attack academic organizations (and of course, academic medical centers are connected to research organizations) in order to steal their intellectual property.

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So what are some of the latest trends in what cybercriminals and nation-state actors doing right now to attack healthcare and other organizations? “They’re exploiting our trust” as end-users, Wallach said, “primarily through trusted or spoof e-mails. In fact,” he said, “the majority of network compromises are caused by bad guys sending e-mails to a target and getting that target to open the e-mail or to click on a link. In other words, they’re exploiting the trust that that individual has in an organization or entity.”

There are many variations on the various themes involved, too, of course. For example, Wallach noted, vendor relationships can be very vulnerable, too. “Unfortunately, the Target hack was based on the Target Corporation’s relationship with a vendor, where the vendor was compromised” by an insider, with a group of criminals using their access to Target stores to physically place credit card readers adjacent to checkout counters, where they could steal credit card information.

More broadly, a successful hack “starts with reconnaissance, with the penetration testing of a network,” Wallach told his audience. The cyber-criminals also “do reconnaissance of individuals on social media—Facebook, LinkedIn, Snapchat, etc. In fact,” he said, “90 percent of all network compromises are based on spear phishing, based on social media reconnaissance.” In other words, the cyber-criminals investigate to find out the social media vulnerabilities of individuals, and shape phishing attacks based on such vulnerabilities. “And then,” he said, “when they get someone to open a phishing communication, the average amount of time between when that breach occurred and the leaders of the organization realize that it has happened, is 270 days, or nine months. That time is starting to come down now,” he conceded, “as organizations have been getting better at identifying compromises. But in those 90 days, they’ve established a foothold, and they’re exploring to find out where the crown jewels are stored in the organization. They’re find out which data and systems are segmented and which are not segmented; they’re moving laterally across the organization over time. And they’re expanding their presence, like an amoeba that’s spreading across a body.” Importantly, as the cybercriminals expand their presence horizontally, they are exfiltrating data as they go along. And, interestingly, “They’re using Google Drive, Dropbox, all the tools we all use. And then they maintain their presence, even as they escalate privileges.”

Buying services on the dark web

Frighteningly, Wallach told his audience, an entire ecosystem of networked connections is emerging across the Internet, in the dark web sphere. Cybercriminals “can buy servers, buy services, on the dark web. They can get everything they need” in terms of products and services available to help them do what they need to do to fully compromise business organizations. Even the financing of things is shifting, he noted. “Money transfers are easy, and digital current is common, though eventually, they have to be able to convert that digital currency into real currency. One of the things the cybercriminals are doing now is participating in money-mill schemes in which individuals receive money and transfer it to other accounts.”

What’s more, Wallach said, “Ninety percent of all cybercriminals have a membership on some forum on the dark web,” speaking of the exploding number of online criminal networks. “In 2002,” he noted, “we identified 12 dark web forums; today, there are over 800 forums in 25 different languages, and involving more than 1.25 million monikers.”

Cybercriminals are busy these days stealing huge amount of data and information of all different types, including credit card information; personally identifiable information; personal health information; fraudulent documents; e-mail account credentials; bank account credentials; and the credentials from all sorts of other types of accounts, such as PayPal, Netflix, and Facebook accounts.”

Indeed, in 2015, between 700 and 800 million credentials were stolen, Wallach noted. Among those were 145 million sets of credentials from eBay users; 100 million from JPMorgan Chase account holders; 80 million from Target customers; 78.8 million from Anthem health plan members; 56 million from Home Depot customers; 37 million from Ashley Madison participants; 22 million from federal government employees in the U.S. Office of Personnel Management; 11 million from Premera Blue Cross members; 4.6 million from Scottrade investors; and 3.16 million from Staples customers. The data and information from all those accounts, once stolen, is sold in bulk, in full records referred to as “fulls.” And, he said, “The more information in a record, the more valuable it is on the dark web. And the “fulls” are further broken down into batches, to be sold in dark web forums.

Increasingly, Wallach told his audience, cybercriminals are turning to ransomware schemes, because they are so easy to execute; all that is needed is for one end-user in an organization to open a phishing e-mail, and then for the ransomware to begin to penetrate the organization, and for ransom to be demanded at a certain point down the road. “We do not recommend that organizations pay the ransom; that is our official line,” he said. Paying a ransom, he emphasized, “doesn’t get rid of the malware; it encourages the scheme to go on. What we do recommend is that organizations back up their files on a storage space not connected to their network, because some of the sophisticated malware can locate backups. We also recommend that you encrypt your phone data, because if it’s encrypted or stolen, it can’t be utilized.”

Key strategies

Wallach noted that the FBI is recommending several key strategies for all organizations to protect against cybercriminality and hacking. The core strategies include:

>  User awareness and training
>  Dual-factor authentication
> Password management
> Data backup and recovery plans
> Encryption of sensitive data
> Patching managementand updates
> Managing social media habits

With regard to passwords, Wallach said, “We recommend 15 characters or more in passwords. The algorithm it takes to break a 15-character password is much more difficult than the algorithm needed to break a shorter password.” In fact, he said, “More organizations are turning to entire passphrases,” which are not difficult to remember, and are very difficult to break.

Social media participation on the part of individuals who work for healthcare and other business organizations remains a point of considerable vulnerability, Wallach warned his audience. “For those of us on social media, be careful what you post and whom you share your information with. If you’re getting LinkedIn requests from people who are clearly outside your network, be careful, those are usually people who want to take advantage. And be careful listing the computer applications you use, in LinkedIn. Even that kind of information can be used against you and your organization.”



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Florida Provider Pays $500K to Settle Potential HIPAA Violations

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) to settle potential 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, a Colorado-based hospital, Pagosa Springs Medical Center, will pay OCR $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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