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Cybersecurity Report: November Had Highest Number of Breaches in 2016

December 16, 2016
by Heather Landi
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November saw an acceleration in the growing trend of health data breaches with 57 separate breach incidents, or an average of almost two per day, the highest in 2016, according to the latest Protenus Breach Barometer report.

The Protenus Breach Barometer is a monthly snapshot of reported or disclosed breaches impacting the healthcare industry, with data compiled and provided by DataBreaches.net. This month’s analysis showed 35 incidents either reported to the U.S. Department of Health and Human Service or first disclosed in media or other sources.

“With an average of almost 2 breaches per day, November has seen a record number of breach incidents, the highest of any month in 2016.  What’s even more concerning is that employees (insiders) are responsible for more than half of this month’s breaches to patient data, a notable increase from past months,” the report authors wrote.

The report authors note that the November breach incident data reinforces the need for health data security to be a top priority for healthcare organizations.

The past two months had shown a decline in total patient records breached and number of incidents reported when compared to the summer months. However, November has seen a sharp increase in the number of breach incidents, with 60 percent more breaches than in October. Up until November, the highest number of monthly breach incidents occurred in August with 42 incidents. For comparison, June had 28 separate breach incidents, July had 39 and then after the 42 incidents in August, the number of incidents began to decline with 37 in September and 35 in October.

The Protenus Breach Barometer’s November analysis indicates 57 incidents either reported to HHS or first disclosed in media or other sources. Information was available for 49 of these incidents, totaling 458,639 records breached.  The report also notes that it is not clear if one of the entities only reported themselves to HHS or if they also reported their affiliated clinic.  

Of the November breach incidents, 54.4 percent, or 31 incidents, were the result of insiders. The largest single incident involved 170,000 patient records as a result of a business associate’s insider error. Further, 17 of these incidents were a result of an error or accident, while 14 were a result of insider wrongdoing. In the 12 insider-error incidents for which Protenus has numbers, 264,099 patient records were involved.  In the nine incidents caused by insider-wrongdoing, 17,237 patient records were involved.

“Nine breach incidents to patient data were a result of hacking, down from 14 hacking incidents in October. Three of November’s incidents specifically mentioned ransomware and another incident mentioned ransom/extortion but not ransomware. TheDarkOverLord struck again, as he was responsible for the ransom/extortion demand. In the six hacking incidents for which we have numbers, 102,883 patient records were involved,” the report authors wrote.

Further, of the 57 reported incidents in November, 40 incidents involved healthcare providers (70 percent of reported entities), followed by 11 incidents involving health plans, and three incidents involving business associates. There were three other entities that reported a data breach: a financial services firm, an anti-doping agency, and one other business.

At least 25 of the 57 incidents (44 percent) involved business associates or third parties, and 11 different BAs or vendors were involved in these 25 breach incidents. The report also notes that paper records were involved in two incidents.

According to the report’s November analysis, it took an average of 135 days from the time the breach occurred to when HHS is notified, which is significantly longer than the average number days it took from breach to reporting for incidents in October.

“It’s important to note that HHS requires entities to report their breach within 60 days of discovery. Sixty-five percent of reporting entities for which we have numbers took longer than the 60-day window to report their breach. It goes without saying that it is essential for organizations to be proactive when monitoring patient data. The sooner a breach is detected, the quicker the healthcare organization can mitigate the risk of significant damage being done with their patient’s data. The longer PHI is exposed, the more it can cost the healthcare organization and ultimately become troublesome for the patients,” the report authors wrote.

 

 

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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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Twelve States File First Multistate Healthcare Data Breach Lawsuit

December 5, 2018
by Heather Landi, Associate Editor
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State Attorneys General from a dozen states filed a lawsuit Monday against several health IT companies, and their subsidiaries, alleging that poor security practices led to theft of protected health information (PHI) of 3.9 million individuals during a data security incident in 2015.

The 66-page complaint, filed in the U.S. District Court for the Northern District of Indiana, names four companies or subsidiaries, including Fort Wayne, Ind.-based Medical Informatics Engineering and NoMoreClipboard LLC. In the lawsuit, the state AGs allege that the companies failed to take “adequate and reasonable measures” to ensure their computer systems were protected.

Over several weeks in May, hackers infiltrated and accessed the “inadequately protected computer systems” of the companies and were able to access and exfiltrate the electronic PHI of 3.9 million individuals, whose PHI was contained in an electronic medical record stores in the companies’ computer systems. The personal information obtained by the hackers included names, addresses and Social Security numbers, as well health information such as lab results, health insurance policy information, diagnosis and medical conditions.

The lawsuit marks the first time state Attorneys General have joined together to pursue a HIPAA-related (Health Insurance Portability and Accountability Act) multistate data breach case in federal court, according to the Arizona Attorney General’s office. The lawsuit was filed by attorneys general from Arizona, Arkansas, Florida, Indiana, Iowa, Kansas, Kentucky, Louisiana, Minnesota, Nebraska, North Carolina and Wisconsin.

According to a media report from azcentral.com, Arizonians were among those affected when hackers infiltrated WebChart, a web application operated by Indiana-based Medical Informatics Engineering Inc. and NoMoreClipboard (collectively known as MIE).

The 12 state AGs allege that the companies “failed to take reasonably available steps to prevent the breaches,” and “failed to disclose material facts regarding the inadequacy of their computer systems and security procedures to properly safeguard patients’ PHI, failed to honor their promises and representations that patients’ PHI would be protected, and failed to provide timely and adequate notice of the incident, which caused significant harm to consumers across the U.S,” according to the complaint.

Further, the companies’ actions resulted in the violation of the state consumer protection, data breach, personal information protection laws and federal Health Insurance Portability and Accountability Act (HIPAA) statutes, the lawsuit states.

In July 2015, MIE issued a statement acknowledging the data breach, classifying it as a “data security compromise that has affected the security of some personal and protected health information relating to certain clients and individuals who have used a Medical Informatics Engineering electronic health record.” The company also referred to it as a “sophisticated cyber attack.”

The company said that on May 26, 2015 it discovered suspicious activity in one of its servers. “We immediately began an investigation to identify and remediate any identified security vulnerability. Our first priority was to safeguard the security of personal and protected health information, and we have been working with a team of third-party experts to investigate the attack and enhance data security and protection. This investigation is ongoing. On May 26, 2015, we also reported this incident to law enforcement including the FBI Cyber Squad. Law enforcement is actively investigating this matter, and we are cooperating fully with law enforcement's investigation. The investigation indicates this is a sophisticated cyber attack. Our forensic investigation indicates the unauthorized access to our network began on May 7, 2015. Our monitoring systems helped us detect this unauthorized access, and we were able to shut down the attackers as they attempted to access client data,” the company said in a statement three years ago.

At the time, the company said it was continuing to take steps to remediate and enhance the security of its systems. “Remedial efforts include removing the capabilities used by the intruder to gain unauthorized access to the affected systems, enhancing and strengthening password rules and storage mechanisms, increased active monitoring of the affected systems, and intelligence exchange with law enforcement. We have also instituted a universal password reset,” the company said.

In a statement, Arizona Attorney General Mark Brnovich said the 12 AGs allege MIE is liable because, among other things, “it failed to implement basic industry-accepted data-security measures to protect ePHI from unauthorized access; did not have appropriate security safeguards or controls in place to prevent exploitation of vulnerabilities within its system; had an inadequate and ineffective response to the breach; and failed to encrypt the sensitive personal information and ePHI within its computer systems, despite representations to the contrary in its privacy policy.”

Minnesota Attorney General Lori Swanson said in a news release, “Patients expect health companies to protect the privacy of their electronic health records. This company did not do so.”

The lawsuit says the states are seeking unspecified statutory damages and civil penalties.

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Top Three 2019 Healthcare Cybersecurity Trends

December 3, 2018
by Christian Aboujaoude, Industry Voice, Senior Director Enterprise Architecture, Scripps Health
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There are non-complex strategies that can be easily implemented that can help keep data secure

In recent months, the healthcare industry has been the number one target of cyberattacks, exposing tens of millions of customers’ identities around the world, costing more than $1 billion USD in losses.

Executives from the National Association of County and City Health Officials say that healthcare breaches can cost up to $400 a patient, and yet, only 33 percent of the industry has taken the preventative measure of protecting themselves properly.  With billions of people across the world entrusting healthcare organizations to protect their identities, and these same organizations relying on their critical infrastructure to secure it all, it becomes crucial to not just have the right cybersecurity solution in place to stop an attack before it has a catastrophic impact, but to ensure they are able to prevent future ones from ever happening.

My provider organization— the San Diego-based Scripps Health—takes cybersecurity seriously, and has for many years. In 2013, we determined to take an identity-first approach to protect both internal and external data, and engaged with firms such as SecureAuth to pioneer an identity solution that would protect both internal and external data according to our unique needs. Today, we continue to evolve our solution to keep up emerging threats, and to stay ahead of threat trends and attackers.

Below are some of the biggest cybersecurity threat trends facing the healthcare industry for 2019, and some recommendations to combat them.

The growing trend of blurring lines between personal and business activities online

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We are starting to see a kind of “blurring-of-the-lines” between personal activity on the Internet, and the activities that are done from a business perspective. For example, people often use their work email address for personal things, and/or they don’t know how to disable certain device tracking settings, such as cookies, that track their every move. Unfortunately, they don’t believe that it’s actually a problem, when indeed, it is. It’s like leaving the door open for people with malintent to send phishing emails so targeted that it’s often hard to decipher what’s real.  

Even more sophisticated, very targeted phishing attacks

According to one 2018 study, mobile device phishing attacks are up 85 percent, year-over-year, since 2011, and the reason has to do with the increasing amount of data collected by every site and app visited on your mobile device.

The easiest thing to do is go on your phone, do a search on the Internet, and within a couple of hours, you go onto Facebook or Instagram, for example, and you’ll notice that all of a sudden, you have targeted marketing in your feed based on your previous search.  That data from your search is also sent to other organizations, which means many things people do online is no longer private, leaving you open for a very targeted phishing attack.

To try to prevent these emails from getting through, we're constantly improving the environment by adding triggers that identify whether our users should trust or not.

The continual rapid rise of identity theft

2017 saw an unprecedented amount of identities stolen, to the tune of 158 million social security numbers and 16.5 million credit card numbers—and 27 percent of those thefts belonged to the healthcare industry, according to Experian’s latest identity theft statistics. It’s the continual rise of these thefts that has prompted us to think outside of the box, and into the future, on how to protect patients and employees.

We need to create an external identity and an internal identity, and what I mean by that is, we need the external world to see us one way (our presence on the Internet), and then the internal systems need to have a mask of sorts, like a VPN, to prevent attackers from being able to monitor activity.  From a cloud perspective, it’s imperative to use a service proxy from an identity provider to authenticate back and forth.

We use biometrics to ensure that the right user is supposed to be taking the action they are trying to take. We also lock down access to certain websites to be from an internal IP range, versus having the open Internet all the time.  Taking these measures reduces the amount of exposure that attackers have from an outside perspective.

What’s more, here are some things that are easily implemented that can help keep data secure:

Continuous education

At Scripps Health, we implemented a mandatory, continuous education program for employees that helps them to understand how their personal actions on business devices, emails, and so forth, can have a detrimental effect on the organization.

It all starts with humans, and whether intentional or unintentional, we all make mistakes.  Thus, we are working to reduce these behaviors while avoiding the creation of a negative and overly complex experience for our employees.  From a user perspective, security is attached to everything we do. We aren’t always aware of that, and we need to be.  From an IT perspective, it’s around understanding business process in order to build the right cybersecurity framework.

Continuous evolution

While education is a significant preventative measure, the evolution of the environment to account for future new kinds of attacks is even greater.

Most people have not spent a lot of time thinking about how they change their environment, how they change their actions, and leverage a Security Operations Center (SOC), and in my opinion, that needs to change significantly.  I really like to implement processes that we can leverage and expand on. It’s vital to the health of our infrastructure.

Having the right tools in place

To continue to protect the environment, we have made a significant investment in the tools we use to keep our infrastructure safe.

We believe that having the right tools in place reduces negativity and complexity in our environment.  In fact, I don’t subscribe to the opinion of needing to have complexity to have security. The more complex your infrastructure is, the more exposed you are.


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