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Cyber Attack Update: Nuance Still Down, Researchers Believe “Petya” is not Ransomware

June 29, 2017
by Heather Landi
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Nuance Communications, a Burlington, Mass.-based technology company that provides cloud-based dictation and transcription service to hospitals and health systems, continues to be down following the global malware incident on Tuesday that affected multinational companies in at least 65 countries.

Portions of Nuance’s network was impacted by the malware incident, which includes a significant part of its services to healthcare organizations. The company is posting updates about the situation to its website. On Wednesday, Nuance said in a web post that it is offering alternative dictation services, specifically Dragon Medical One or Dragon Medical Network Edition, for customers impacted by the transcription services outage. The company also is offering other alternative dictation services.

“In addition to Nuance Transcription services and radiology critical test results, the following solutions also are impacted: Assure, Dragon Medical Advisor, Cerner DQR, Computer Assisted Coding, Computer Assisted-CDI, CLU software development kit, and our Quality Solutions products including Quality Measures, Claims Editor, and Performance Analytics/Clinical Analytics. Today our technical teams are continuing to work on network server recovery, determining the recovery process and timing, and other client options,” the company stated.

Nuance also said it is hosting a conference call today, Thursday, June 29th at 2:00 pm EST or 6:00 pm EST to answer frequently asked questions as well as discuss an alternative transcription platform option. Healthcare customers are urged to contact their account executive, account manager, or support for dial-in information.

According to a Nuance company fact sheet, the company’s healthcare solutions are deployed in 86 percent of all U.S. hospitals. More than 500,000 clinicians and 10,000 healthcare facilities worldwide use the company’s clinical documentation solutions.

In another development, some cybersecurity researchers have announced that Petya, or NotPetya as some call it, is not a ransomware attack and said that victims should not pay the ransom as they will not be able to restore or decrypt their files. Matt Suiche founder of security firm Comae Technologies posted on SecureList saying that this version of Petya is a “disguised wiper” and not ransomware. “The goal of a wiper is to destroy and damage. The goal of ransomware is to make money. Different intent. Different motive. Different narrative. A ransomware has the ability to restore its modification such as (restoring the MBR like in the 2016 Petya, or decrypting files if the victim pays) — a wiper would simply destroy and exclude possibilities of restoration, wrote Matt Suiche with Comae Technologies.

Researchers from Kaspersky Labs also confirmed that they believe Petya is a wiper and not ransomware. “After an analysis of the encryption routine of the malware used in the Petya/ExPetr attacks, we have thought that the threat actor cannot decrypt victims’ disk, even if a payment was made. This supports the theory that this malware campaign was not designed as a ransomware attack for financial gain. Instead, it appears it was designed as a wiper pretending to be ransomware,” wrote Anton Ivanov and Orkhan Mamedov in a post on SecureList.

Further, the Kaspersky Labs researchers concluded, “That means that the attacker cannot extract any decryption information from such a randomly generated string displayed on the victim, and as a result, the victims will not be able to decrypt any of the encrypted disks using the installation ID.”

And, they wrote, “What does it mean? Well, first of all, this is the worst-case news for the victims – even if they pay the ransom they will not get their data back. Secondly, this reinforces the theory that the main goal of the ExPetr attack was not financially motivated, but destructive.”

Some services at Heritage Valley Health System, based in Beaver, Pennsylvania, continue to be hampered by the effects of Tuesday’s cyber attack. The health system announced Thursday, on its website, that all lab and diagnostic services at neighborhood and community locations would remain closed for the second consecutive day as it worked to fully rectify the issue.

The incident at Heritage Valley affected the entire health system, including two hospitals and satellite and community locations scattered across western Pennsylvania, and the health system took its IT systems down, officials at Heritage Valley Health System stated on its website. The health system serves four Pennsylvania counties as well as parts of Ohio and West Virginia.

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

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

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

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

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

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Robert Lord

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

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

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

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

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

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

 


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

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

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

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

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

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

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

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

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

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

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Independence Blue Cross Notifies 17K Patients of Breach

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

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

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

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

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

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

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