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Live from the CHIME-HIMSS Forum: A Sobering Dive into the Horrors of Hacking

February 19, 2017
by Mark Hagland
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Kevin Mitnick, a leading white-hate hacking consultant, live-demonstrated how easy hacking can be for skilled hackers, at the CHIME-HIMSS Forum

The more than 700 CIOs and other senior healthcare IT leaders gathered Sunday morning at the Hyatt Regency Orlando for the CHIME-HIMSS Forum, sponsored by the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME), in conjunction with the Chicago-based Healthcare Information & Management Systems Society (HIMSS), were “treated” to a live demonstration of the tremendous risks facing their patient care organizations on the part of criminal hackers. Kevin Mitnick, the famous hacker-turned-white-hat-hacking-consultant, spent nearly an hour demonstrating, live, how easy it is to hack organization’s information systems, individuals’ computers, and online/web and network connections.

The opening keynote address at the CHIME-HIMSS Forum, entitled “The Art of Deception: How Hackers and Con Artists Manipulate You and What You Can Do About It,” offered a chilling view into the world of hacking.

As described in the event’s brochure, “There is no one like Kevin. Kevin Mitnick is the world’s most famous hacker, bestselling author, and the top cyber security speaker. Once one of the FBI’s Most Wanted because he hacked into 40 major corporations just for the challenge, Kevin is now a trusted security consultant to the Fortune 500 and governments worldwide.”

“Why do hackers do social engineering?” Mitnick asked, near the beginning of his presentation. “Because it’s much easier than executing on technical exploitation.” Among the numerous reasons that hackers are flocking to social engineering-based hacking: “Social engineering evades all the security monitoring tools, and it’s basically free. It’s very low-risk for the attack; the chances of getting caught are very small. And it’s nearly 100-percent effective. Whenever an organization allows my team to use social engineering to white-hack, the success is almost certain. All it requires is one end-user to let the hackers in,” he said, pointing to the tremendous end-user-based vulnerabilities to which patient care organizations are exposed in U.S. healthcare.

“What’s the real problem? It’s your users. Their actions could cause problems. A few years ago,” he noted, “there was a conference in London called the Info Security UK Conference. They went to Waterloo Station in London, armed with free pens, and asked for their domain name and user password, in exchange for a pen. And nine out of 10 gave them their real user name and password. The next year, they went out to Marks and Spencer armed with Easter eggs, and got seven out of 10.” Mitnick shared a number of other examples as well of easy confidence-based hack jobs.


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Kevin Mitnick at the CHIME-HIMSS Forum

Why do hackers want to know the professional titles/positions of people in your organization? It gives them information. They can use LinkedIn and and target certain positions in the company. Target network engineers, system administrators, database managers. But more often, they’ll go after people in sales and marketing, because all they need is one “in” to get control.

What about Facebook and Twitter? “Hackers want to obtain the contacts to the circle of trust of individuals within organizations—partners, vendors, etc., because they’ll likely trust them. We could send a text message and make it look like a friend of the person. And you can break in through peer-to-peer online netowkring.

We will look at the target’s circle of trust and send them messages to infiltrate. I will put a red sticker, marked 'payroll salary history, third quarter 2016,' on a USB drive, and send it in the mail to a target, in a test. And the end-user might format that USB drive, because they don’t trust it. And it will say, 'format complete,' so it will be seen as a 'clean drive.' But it won't be."

Hackers, he asserted, are able to get virtually every American’s Social Security number and mother’s maiden name. Given those pieces of information, most verification questions are easy to answer.

He also demonstrated, live, how he could weaponize a HID-provided office building access card, duplicating it through physical proximity, and providing access to the building involved. I believe in attacking the user. Doing simulated online and phone attacks on end-users. Give them notice that th

So how do you manage the risk of social engineering. “I believe in attacking users in your organization, first giving them notice that you will be doing so. And it is very easy to spoof company identities. So do a domain spoof test regularly. And get your IT department to not only configure incoming firewall rules, but also outgoing ones,” Mitnick said. “Because you can make it harder for the malware to be connected to your organization. Establish a social engineering incident response program.”

One of the key points Mitnick made with regard to end-users was this, in terms of “building the human firewall, as he called it: “I believe in the ‘keep it simple, stupid’ method. No one wants to read a telephone book-sized manual. You want to create brochures that are simple and entertaining, with lots of pictures. Perform social engineering pen-tests. Discover the weak links. Develop interactive social engineering resistance training, including phone training. Everyone is so afraid to be impolite.”

What’s more, he said, “Whenever possible, try to take away decision-making from your end-users. And don’t forget the periodic dumpster diving.”

Mitnick proceeded to do several demonstrations that should chill every IT executive in healthcare. He showed how incredibly easy it is for skilled hackers to penetrate organizational networks of all kinds, as well as to penetrate individual consumers’ information system defenses, and how to hack their social media accounts, credit card accounts, and other personal spaces, thus making it exceptionally easy to gain access to organizational networks. His live demonstrations, in minutes, showed the audience how profoundly easy it is for skilled hackers to penetrate nearly every kind of defense imaginable.

Following his live hacking demos, Mitnick responded to audience questions. The first question asked was, what would the first thing be that he would do if he were hired into a healthcare CIO position? “The first thing I would assess is,” Mitnick said, “is that I’d be really concerned about protecting HIPAA data; I’d want to make sure my network was segmented. My skill set is attack and defense, not management,” he emphasized. “Given that, I would look into architecting the network, and making sure  the data is properly segmented, that you have good authentication and audit controls on that data, so if it’s accessed, you can quickly detect where. I recently did a pen-test for an organization, and we were quickly able to penetrate their entire network, because there was no segmentation whatsoever. That’s one of the first areas.”

There will always be an exploitable human error. How do we protect against threats when humans are involved? was the second audience question. “Obviously, with regard to any attacks that target the human element, it’s really important to educate the people who are using and operating your systems, about the latest threats,” Mitnick emphasized. And in a lot of cases, a successful hack “requires the victim to do something, like tricking them into installing an update, before the exploit an take place. So I would do a show-and-tell every once in a while, to keep them involved.”

Do you think the federal government should get involved? one audience member wanted to know. “I’m not really a proponent of federal regulation of anything, given my experience” with investigation and incarceration, Mitnick said, to laughter. “I think companies really need to take this into their own hands. You need to take security into your own hands, and manage it properly, and do it well enough that you’re doing it well enough that you’re deflecting 80-85 percent of the attacks out there.”

Do you think the use of ransomware or malware has peaked? Or will we see a rise? Another audience member wanted to know. “I definitely am seeing an increase in ransomware, and of new, more sophisticated versions of ransomware. I recently was working with an oil and gas company; and it turned out that during one of our pen-tests, an employee opened a phish that claimed to be a credit card company’s email. The employee installed a Java update that installed ransomware, but fortunately, the company was able to restore quickly, to the backup of the night before.”

And, another audience member asked, should healthcare IT leaders use multi-factor authentication in their organizations? “Absolutely,” Mitnick said. “Will it stop all attacks? No, because hackers can steal session keys and can bypass two-factor authentication. Two-factor authentication usually works very well at the front door. But sophisticated hackers can still get in. But you should absolutely install two-factor authentication.”

Finally, asked the one piece of advice he might leave with the audience, Mitnick responded, “You can always mature your security processes. You can segment your network. You can make sure that people connecting you use VPM. You can enforce two-factor authentication. You can take the steps necessary to make you a harder target, so that the bad guys can go to another company that doesn’t use rigorous security controls.”

Shortly prior to Mitnick’s opening keynote presentation, CHIME president and CEO Russell P. Branzell referenced a survey that the association was set to publish on Sunday around cybersecurity. Branzell noted one key survey  result: that, even now in 2017, fewer than 50 percent of the organizations whose CIOs were surveyed had yet hired a full-time chief information security officer (CISO).





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Targeting Third Party Risk: Leading CISOs Detail Efforts to Secure the Healthcare Supply Chain

December 18, 2018
by Heather Landi, Associate Editor
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Healthcare information security leaders are faced with the dauting challenge of securing information systems and data at a time when the cyber threat landscape is evolving rapidly and becomingly increasingly complex.

Most patient care organizations’ supply chains are filled with third parties who support the care delivery process and require access to patient information. Properly vetting and monitoring these third parties is a major challenge, and in some cases, insurmountable for many organizations who simply don’t have the expertise or resources, according to healthcare IT security leaders.

Many healthcare chief information security officers (CISOs) have found that effectively assessing the security posture up and down the supply chain is expensive given the complexity of the risks posed by privacy and security concerns, as well as an everchanging regulatory landscape. Currently, the process of managing third-party risk is often inefficient and time-consuming, for both vendors and providers, while still leaving organizations vulnerable to security threats.

During a recent webinar, sponsored by HITRUST, focused on healthcare cybersecurity and managing third party risk, John Houston, vice president, privacy and information security at the 40-hospital UPMC health system in Pittsburgh, outlined a number of factors that have made third-party risk management increasingly challenging and complex.

“There has been a fundamental change in IT, and a rapid move to the cloud. At the same time, we all see an increasingly complex cyber threat landscape where the threats are more sophisticated, and the technology solutions are more sophisticated as our business requirements are changing. It’s an increasingly complex landscape,” Houston said.


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He further noted, “As a result, there is a lot of confusion about how we best ensure our information is secure and available, and what is reasonable in terms of trying to achieve that. And finally, we are all worried about risk, and the biggest risk is patient safety. We worry about the cost of litigation and penalties, but first and foremost, we need to think about ensuring that we are able to deliver the best care to our patients.”

The stakes are changing, Houston noted, as federal regulators are investigating and penalizing organizations for failure to monitor third parties’ security practices, and hackers are increasingly targeting medical devices, he said.

“From a CISO perspective, we need to ensure that we are applying proper oversight over all of this. We can’t assume third parties are doing the right thing,” he said.

What’s more, healthcare organizations are increasingly reliant on cloud technology. A year ago, Nuance Communications, a provider of voice and language tools, was knocked offline when the company was hit with the Petya ransomware virus.

“I was around during Y2K, and about 95 percent of all our applications at UPMC, we ran within the data center, on premise. About 95 percent of newly acquired applications were run on on-premise, there was little on the cloud. In that environment, it falls upon the entity to secure data within its possession,” he said.

Contrast that with today’s environment, as Houston noted that “very little of what we acquire today runs on-premise. In some way, shape or form, at least one copy of the data is in the cloud.”

Studies have estimated that by 2023 no more than 25 percent of applications will be run on-premise in an organization’s data center, with about 75 percent run in the cloud, Houston said. “Many copies of our data end up in the cloud, and it’s not just one cloud provider. We get services from a lot of different vendors, all of which are in the cloud. That speaks to the fact we, as CISOs, can no longer directly secure our own information. We are dependent upon third parties to secure our data for us. We can’t simply trust that they are going to adequately secure that information.”

From a healthcare CISO’s perspective, a vendor’s IT and data security practices should be at least as effective as the provider’s security posture, Houston said. “I should expect nothing less. As soon as I expect less, that’s a sign of defeat.”

Across the healthcare industry, ineffective security, compliance and assurance methods drive cost and confusion within organizations and across third parties, according to IT leaders.

While most healthcare organizations are taking the right steps to monitor and screen vendors and their products and services during the pre-selection and on-boarding phases and are also conducting security risk assessments, it’s still not enough to protect IT systems, data, and, most importantly, patients, said Taylor Lehmann, CISO at Wellforce, the Burlington, Mass.-based health system that includes Tufts Medical Center and Floating Hospital for Children. “We are still seeing breaches, and the breaches are still coming after we do all this screening,” he said.

“We’re not being effective and it’s difficult to be effective with the current paradigm,” Houston added.

From the CISO’s perspective, there are inefficiencies in the third-party supply chain ecosystem. Suppliers are commonly required by their customers to respond to unique questionnaires or other assessment requests relating to their risk management posture. Vendors often must fill out questionnaires with 300-plus questions. What’s more, there’s no assurance or audit of the information the vendor provides, and the process is completely inefficient for suppliers who are audited 100 times annually on the same topics, but just different questions, Lehmann and Houston noted. What's more, the security assessment often occurs too late in the process.

“We’re creating a lot of waste; we’re taking time away from our organizations and we’re taking time away from suppliers,” Lehmann said. “The current way we’re doing supply chain risk management, it doesn’t work, and it doesn’t scale, and there is an opportunity to improve.”

To address these issues, a group of CISOs from a number of healthcare organizations established the Provider Third Party Risk Management (TPRM) Initiative to develop a standardized method to assess the risk management posture of third-party suppliers to healthcare firms. Launched this past August, the founding member organizations for the Provider TPRM Council include Allegheny Health Network, Cleveland Clinic, University of Rochester Medical Center, UPMC, Vanderbilt University Medical Center and Wellforce/Tufts University. Working with HITRUST and PwC, the Council aims to bring uniformity and consistency to the process while also reducing the burden on providers and third parties.

The healthcare industry, as a whole, will benefit from a common set of information security requirements with a standardized assessment and reporting process, Lehmann noted.

In the past four months, the governing members have been expanded to include Nuance, The Mayo Clinic, Multicare, Indiana University Health, Children’s Health Dallas, Phoenix Children’s Hospital, and Banner Health.

The Provider TPRM initiative is increasing membership and gaining momentum as security leaders from both healthcare providers and their suppliers embrace the unified approach, Lehmann said.

One of the goals for the Council is to address the inefficiencies found in the third-party supply chain ecosystem. By reducing the multiple audits and questionnaires, the financial savings will allow business partners to invest in substantive risk reduction efforts and not redundant assessments, the Council leaders say.

“By reducing wasted effort and duplication, suppliers will find their products and services will be acquired more quickly by healthcare providers. This will also reduce the complexity of contracts and provide third parties with better visibility regarding the requirements to do business with providers,” said Omar Khawaja, VP and CISO of Allegheny Health Network and Highmark Health. Khawaja’s organization is a founding participant and governing member of the Provider TPRM initiative.

As part of this initiative, going forward, provider organizations that join the effort will require third-party vendors to become HITRUST CSF Certified within the next two years, by September 2020. The HITRUST CSF Certification will serve as the standard for third parties providing services where they require access to patient or sensitive information and be accepted by all the Council’s organizations. HITRUST CSF is an industry privacy and security framework that is continuously evolving with the changing cyber landscape.

 “After September 1, 2020, third parties without certification cannot do business with participants,” Khawaja said.

Houston added, “We recognize that there are limitations in our current processes, and what we’re putting in place is at least as good or better than what we’re already doing. This will lead to faster onboarding, less waste, better transparency, and simpler compliance.”

By choosing to adopt a single comprehensive assessment and certification program, healthcare organizations represented by the council are prioritizing the safety, care, and privacy of their patients by providing clarity and adopting best practices that their vendors can also adopt, while providing vendors the expectation of what it takes to do business with their organizations.

“It provides transparency,” Houston said “It sends a message to suppliers that we’re an open book about what it takes to do business. That’s powerful.”

Moving forward, the Provider TPRM initiative will focus on adding business associates to the effort to increase membership and impact, Lehmann said. “The simple fact is, many of us are pushing this through our supply chain and there are organizations that may not have a process or low maturity process. But, through the efforts of council members, more suppliers will show up, which is means safer products are possible to purchase.”

Further, the program will likely develop additional requirements on vendors such as breach response and monitoring security threats and alerts observed as third-party vendors.

The Council also plans to focus on certification programs for smaller vendors. “A lot of innovation in healthcare is coming from smaller companies, and we understand there is a gap between what those companies can do with respect to cyber. We’re not lowering our standards, but we want to be thoughtful and create a certification program for those areas. We want to do business and we need a vehicle to bring them in in a safe and secure way,” Lehmann said.

“We want to build a community of health providers working together, business associates working together, to share information,” Lehmann said. “We want to better inform ourselves and align other programs, like cyber insurance, to enable more effective planning throughout the supply chain. The things we learn through these relationships can translate to other aspects of our organizations.”

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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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