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A New Cross-Industry Report Looks at the Spreading Global Threat from Data Breaches

April 28, 2017
by Mark Hagland
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A new report from Verizon Security Research puts the phenomenon of data breaches in the healthcare industry into a trans-industry context

A new report from Verizon Security Research offers insights into how the healthcare industry compares with other industries with regard to data security, and in particular data breaches of various types. On April 27, the organization released its “2017 Data Breach Investigation Report,” the tenth annual such report, based on researchers’ examination of actual cyberattacks in several different industries.

Researchers have analyzed more than 42,000 cybersecurity incidents and nearly 2,000 data breaches from across 84 different countries, and from across several industries, defined as “accommodation and food services,” “educational services,” “financial and insurance,” “information,” manufacturing,” “public administration,” “retail,” and “healthcare.”

In the press release accompanying the release of the report, it was noted that “Healthcare has the unenviable task of balancing protection of large amounts of personal and medical data with the need for quick access to practitioners. Internal actors are well represented, with employees accessing patient data out of curiosity, or to commit identity fraud.” Meanwhile, the report’s authors noted, “privilege misuse, miscellaneous errors, and physical theft and loss represent 80 percent of breaches within healthcare,” with 68 percent of the threat actors being internal, 32 percent external, and 6 percent “partner.”

The report’s authors write of healthcare, “Being an information security professional for a healthcare organization is not easy. You have to deal with a multitude of medical records, stored electronically (in centralized databases and laptops alike), and possibly still on paper,” they note. “Those records also have personal information (name, address, social security number) often riding along. This information needs to be accessible quickly for patient care, so draconian access control mechanisms may do more harm than good. Another item to add to the ‘things-that---healthcare-CISOs’ list is the disclosure requirements for the industry. Insider misuse is a major issue for the Healthcare industry,” they point out. “In fact it is the only industry where employees are the predominant threat actors in breaches. Interestingly enough,” they write, “figure 20 shows the insiders’ motives are almost equally divided between financial and fun. This is a product of a lot of sensitive data that may be accessed by legions of staff members containing PII —that is perfect for identity theft—and medical history (sometimes of friends or relatives), that is very tempting for enquiring minds (that want to know!).”

What’s more, they state, “Doctors losing laptops, X-rays accidentally ending up in landfills, and employees giving J. Tinker’s discharge papers to J. Evers (and Evers’ to Chance) all help Miscellaneous Errors remain a top 3 pattern again this year. The breach counts in Figure 21 show that misdelivery, disposal errors and lost assets combine for almost 30 percent of all healthcare breaches—showing that it isn’t just malicious insiders that you need to worry about.”


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One important qualification in terms of the methodology and conclusions in the report is around they’ve defined ransomware. “In our dataset, ransomware attacks are not counted as breaches, because typically we cannot confirm that data confidentiality was violated,” the report’s authors note. “However, the U.S. Department of Health and Human Services (HHS) has given guidance that ransomware incidents should be treated as a breach for reporting purposes. This year, ransomware accounts for 72 percent of malware incidents in the healthcare industry.”

Drilling down across all types of data breaches and across all seven industries covered by the report—accommodation, education, finance, healthcare, information, manufacturing, public, and retail—the report’s authors provide data points on page 10 of the report that offer further insight.

The table on that page spans three conceptual areas—“pattern,” “action,” and asset.”

In healthcare, under the “pattern” category, the data breaches recorded in the report break down as follows, by type; in descending order of numbers, they are as follows: “privilege misuse,” 125 incidents; “miscellaneous errors,” 114; “lost and stolen assets,” 92; “crimeware,” 54; “web app attacks,” 32; “point of sale,” 4; “denial of service,” 3; “cyber-espionage,” 2; and “everything else,” 40. It is interesting to compare the volume of incidents involving “privilege misuse,” “lost and stolen assets,” and “crimeware” in healthcare, with the volume of those types of other incidents in other industries, internationally. In that context, the volume of such incidents in healthcare parallels the volume of such incidents in the public sector, and differs from such volume across the accommodation, finance, education, manufacturing, and retail industries.

Meanwhile, in the “action” section, the categorization of data breaches in healthcare breaks down as follows: “error,” 154 incidents; “misuse,” 125; “hacking,” 84; “physical,” 73; “malware,” 66; and “social,” 37. In this “action” section as well, the volume of incidents in these specific categories, in healthcare, matches the public sector as well, and contrasts with the patterns of action in the other major industries.

And in terms of assets involved, the breakdown is as follows: “server,” 184; “media, 145; “user dev,” 76; “person,” 41; and “network,” 3.

The day after the release of the report, its lead author, Marc Spitler, a senior manager at the Washington, D.C.-based Verizon Security Research, a division of the Baskin Ridge, N.J.-based Verizon Enterprise Solutions, spoke with Healthcare Informatics Editor-in-Chief Mark Hagland, regarding the report, and his perspectives on data breach issues in healthcare, compared with those in the other industries that he and his team studied for the report. Below are excerpts from that interview.

Overall, how would you compare healthcare with the other industries you looked at for the report?

It’s a fascinating industry to look at; and it was one of the key reasons that we did an industry-by-industry view. It’s interesting that you picked up that the patterns were closest to the public, or government sector [which also includes law enforcement]. We get a lot of data from both sectors, because of the disclosure requirements for both sectors. Misappropriation of devices and other issues have to be disclosed. So for example, we can pick things up right from the HHS website. We have a really good view into both of those industries, which is why we always try to carefully frame things. And we say, don’t look at this and decide that one industry is ‘better’ than another. That being said, both healthcare and the public sector can have multiple motivations going against them, and they both have an insider threat.

The fact that healthcare actually has a majority of internal actors behind the data breaches, that’s certainly interesting. That’s why I enjoy talking about, what are the struggles of a security practitioner in healthcare? Their jobs are so difficult. A lot of people have access to data that is either rife for identity fraud, or for curiosity. And we see the same thing in the public sector—that ‘fun and curiosity’ motive, in criminal databases, where people in a police department will look at the criminal records of people without authorization.

Marc Spitler

The use of audit trails and behavioral monitoring to detect and prevent data breaches is becoming more and more important in healthcare. Is that also true in other industries?

Yes, absolutely. Regardless of what industry you’re in, one of the main tactics of a cybercriminal is that, once they get in, they’re not going to launch every area they can get into, because that will trigger awareness of their activities, so they’ll want to trigger some malware, etc. And so you need to monitor activities, because it’s not just about employees, anymore, it’s about everybody. So it’s paramount for healthcare to do this, but it’s not unique.

Is healthcare behind other industries in its capability to ramp up to meet cybercriminality and other causes of breaches?

It’s very hard to compare attempts to malware breaches. That said, there are trends in healthcare that I’d like to see changed. And in healthcare, not only do you have lots of people with access to data that everybody needs all the time, for patient care, and there’s that curiosity, that internal threat; also, the use of credit card incidents exists in healthcare as well in other industries. I’d also like to see a downtick in the number of lost and stolen devices in healthcare. It’s 2017: it’s time to encrypt your laptops and your thumb drives. And if a doctor leaves a laptop or smart phone or tablet on the subway. It’s not a data breach, it’s a security incident.

Is healthcare worse than other industries in terms of data being potentially exposed through loss or theft of devices?

I’m not willing to make that statement. There is an element of exposure. The thing is, it happens in other industries; they just don’t have to report it. So healthcare needs to encrypt.

Is there anything that stood out for you or that was surprising, in the healthcare industry results?

No, we definitely saw an increase in ransomware, but we saw that across industries. And in terms of how we categorize events as incidents or confirmed data breaches—we typically don’t categorize ransomware as a data breach unless there’s evidence of data exfiltration. That’s somewhat different from how ransomware is categorized. So I’m not sure that healthcare is more targeted than other industries; it appears opportunistic. I’m not going to make the statement that you’re more likely to get hit in healthcare; most ransomware turns out to be opportunistic. The challenge in healthcare is that the data access is constantly needed for the most noble of purposes, patient care. We do see it in what I call the ‘spray and pray’ spear-phishing attacks, as well as drive-by attacks, which are typically opportunistic in nature. So I’m not going to say you’re worse in healthcare than anyone else; but certainly, you’re  a high-value target; and the data is very important.

What will happen in the next couple of years, in healthcare and in other industries?

I’m always looking for simple solutions. I’ve already talked about one, which is encryption. So I’d like to see encryption become more commonplace. I know there won’t be a reduction in loss or theft of assets, but I’d like to see those devices being encrypted beforehand. And I’d like to see greater awareness of the staff that in fact, we are auditing your access. It may not stop everything, but a good, solid warning banner, combined with security awareness training, could really help. Tell your staff, if you’re being nosey and curious, we’re going to find you out. And hopefully, that message will be received loud and clear.

Is there anything else you’d like to add?

It’s good to have a thorough conversation about the healthcare industry. I’m hoping that your readership will be able to take a look at that section and nod their heads. It will affirm how challenging it is to do their jobs. And what is the culture and the nature of the industry? And what are the business conditions, and why would that influence what the adversary is doing? And a lot of that is internal.


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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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