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Experian: Healthcare Orgs will Continue to be Heavily Targeted by Hackers in 2017

November 30, 2016
by Rajiv Leventhal
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Ransomware will remain a top concern next year as well

In its fourth annual “Data Breach Industry Forecast” white paper, Costa Mesa, Calif.-based security company Experian gives five data breach trends that are expected to unfold in 2017.

The report stated that while many companies have data breach preparedness on their radar, it takes constant vigilance to stay ahead of emerging threats and increasingly sophisticated cybercriminals. “While some tried and true attacks continue to serve as go-to methods for hackers, there are evolving tools and targets that are likely to become front-page news in 2017. Organizations can’t wait until an attack happens to ensure they are protected—they need to look at the signs early on to start preparing for new types of security threats,” the report said.

Regarding healthcare specifically, “The consequences of a medical data breach are wide-ranging, with devastating effects across the board—from the breached entity to consumers who may experience medical ID fraud to the healthcare industry as a whole. There is no silver bullet for cybersecurity, however, making good use of trends and analysis to keep evolving our cyber protections along with forecasted threats is vital,” said Ann Patterson, senior vice president, Medical Identity Fraud Alliance (MIFA).

As such, Experian has outlined five predictions for the data breach industry for next year. Last year at this time, for the healthcare sector, Experian predicted that big healthcare hacks will make headlines, but small breaches will cause the most damage. Looking back on that prediction, Experian gave itself a “B” grade for that estimation. It said, “In 2016, there were 181 reported healthcare breaches ranging in size from 500 to 3.6 million effected individuals. While several large breaches like Banner Health and 21st Century Oncology lost more than 5 million records combined, small breaches also had a large impact. Breaches impacting 200,000 people or less accounted for 96 percent of all healthcare related breaches and impacted 1,400,872 individuals.”

The 2017 anticipated issues include nation-state cyberattacks possibly moving from espionage to full-scale cyber conflicts and new attacks targeting the healthcare industry:

Healthcare organizations will be the most targeted sector with new, sophisticated attacks emerging. The healthcare sector may continue to be the focal point for hackers as medical identity theft remains lucrative and easy for cyber criminals to exploit. Personal medical information remains one of the most valuable types of data for attackers to steal, and cyber criminals will continue to find a market for reselling this type of sensitive information on the dark web. According to a report from IBM, more than 100 million healthcare records were compromised, making them a hacker’s top target.

Experian also anticipates mega breaches will move on from focusing on healthcare insurers, which served as a popular attack victim in 2015, to focus on other aspects of healthcare, including hospital networks. These more distributed networks present a ripe target for attackers as it is often harder to maintain security measures as compared to more centralized organizations. 

What’s more, of the potential sources for a breach, electronic health records (EHR) are likely to be a primary target for attackers. The portable nature of this information and the number of different entities and end-points that need access to them mean the potential for them to touch a vulnerable computer system is high. While there may be significant protections in place to secure them in transit, it only takes one compromised or outdated system to lead to exposure. Further, as more healthcare institutions deploy new mobile applications, it’s possible that they will introduce new vulnerabilities that will also be attractive targets for attackers.

Of the many threats healthcare organizations face, Experian predicts that ransomware will continue to be a top concern in 2017, particularly because a disruption of healthcare system operations could be catastrophic. Ransomware presents an easier and safer way for hackers to cash out; given the potential disruption to a company, most organizations will opt to simply pay the ransom. This has unintended consequences of funding more research and development by attackers who will in turn develop more sophisticated and targeted attacks. These new variants will likely be able to evade many of the security detection systems that were developed and are now widely deployed to stop the previous generation of attacks.

As such, as attackers shift their focus, an increase in hospital breaches means the consequences for healthcare organizations that don’t properly manage this risk will increase. Healthcare organizations of all sizes and types need to ensure they have proper, up to date security measures in place, including contingency planning for how to respond to a ransomware attack and adequate employee training about the importance of security.

Aftershock password breaches will expedite the death of the password. A new industry trend emerging this year, in 2017 Experian predicts “aftershock” breaches as companies are facing the impacts of previous data breaches. As more and more personal credentials are compromised, the risk for users may extend far beyond the initial breach as attackers continue to sell old username and password information on the dark web, sometimes years after the credentials were originally stolen.

As a result, companies that didn’t experience a first-hand data breach may see repeat unauthorized log-ins and be forced to notify their users that their information is being misused. This can be compared to an earthquake “aftershock” where the effects of an attack reverberate and are felt long after the initial disaster. Given the continued success of aftershock breaches involving username and passwords, Experian predicts that attackers are going to take the same approach with other types of attacks involving even more personal information, such as social security numbers or medical information. Experian advises companies to push toward using two-factor authentication to verify users, which helps solve the password reuse problem.

Nation-State cyber-attacks will move from espionage to war. Building upon last year’s prediction that cyber conflicts between countries are leaving consumers and businesses as collateral damage, there may be a clear evolution of these types of threats moving from espionage to active conflict and possibly war between countries.

In 2016, state-sponsored cyber-attacks came up during the U.S. presidential campaign. Both candidates were questioned about the U.S. potential response to the use of targeted cyber-attacks by foreign nations, and each candidate expressed that they would be in favor of using cyber weapons to retaliate against countries. Experian believes that cyber warfare attacks against the U.S. will continue in 2017, and with both presidential candidates taking such a strong and pointed position on how to respond, it predicts an escalation in cyber-attack conflict in 2017.

Read all of Experian’s data breach trends in its report here.

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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.

Related Insights For: Cybersecurity

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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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