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Report: Healthcare Organizations Struggle with Human Error in Securing PHI

October 19, 2017
by Heather Landi
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In the first nine months of 2017, unintended disclosure accounted for 41 percent of healthcare data breach incidents, according to a report from specialist insurer Beazley. The high level of unintended disclosure incidents remains more than double that of the second most frequent cause of loss, hack or malware (19 percent), the report states. 

Beazley’s quarterly breach insights report examines the major causes of data breaches reported by healthcare insureds in the first nine months of 2017. “Whether it is an email containing protected health information (PHI) sent to the wrong recipient, discharge instructions given to the wrong patient, or a server containing PHI accidentally left open to the public, healthcare entities continue to struggle with human error on a regular basis,” the report authors wrote.

What’s more, unintended disclosure incidents are a persistent threat and expose organizations to greater risks of regulatory sanctions and financial penalties. Yet, the report authors note, unintended disclosures can be much more easily controlled and mitigated than external threats, which underscores why healthcare organizations shouldn’t ignore this significant risk and should invest time and resources towards employee training.

As noted, 19 percent of data breaches were caused by hack or malware. What’s more, the report found that 15 percent of healthcare data breaches were caused by insiders, 8 percent were caused by a physical loss, 6 percent were attributed to a portable device and 3 percent were attributed to social engineering.

While insider incidents only accounted for 15 percent of breach incidents, healthcare insureds have reported more insider incidents thus far in 2017 compared to 2016. Insider incidents accounted for 12 percent of healthcare incidents in 2016. Typically, insider incidents involve an employee viewing patient records without a work-related reason to do so, perhaps looking at a celebrity patient’s record or the record of an ex-spouse or neighbor. These “employee snooping” incidents are usually discovered y audits run on the electronic medical records system or by another employee or patient reporting the suspected snooping.

The report authors note, “It is unclear what has led to the increase in insider incidents in healthcare, but what is clear is that increased employee vigilance and auditing will help organizations identify such behavior early on, reducing the number of affected patients and hopefully lessening the likelihood of regulatory inquiry.”

Another noticeable trend across all industries in 2017 is the nine-fold increase in social engineering attacks. A social engineering attack occurs when a hacker uses deception to manipulate individuals into divulging confidential or personal information.

The report also notes that there has been a marked increase in the number of Department of Health and Human Services (HHS) Office for Civil Rights (OCR) enforcement activities in recent years. As the number of investigations and resolution agreements have increased, so too has the average settlement payment.

The combined total of 13 resolution agreements in 2014 and 2015 saw settlement amounts ranging from $125,000 to $3.5 million (an approximate average of $1 million each), the report notes. In 2016, there were about 13 resolution agreements and so far in 2017 there have been nine. The 2016 and 2017 resolution agreement settlements range from $31,000 to $5.5 million (an average of $1.8M million each), according to the report.

The report authors also note that there may be two reasons for the increase in enforcement activities--OCR has more resources at its disposal and has far less patience for HIPAA non-compliance, and OCR representatives have also expressed frustration at entities’ failure to comply with HIPAA’s privacy and security rules, which have been on the books since 2003 and 2005, respectively.

Healthcare organizations should also be aware that when they report a breach, it opens the door for OCR to investigate the entity’s basic HIPAA compliance, the report authors note. The investigation in turn can lead to corrective action plans and settlements. Typically, it takes three to six years from the time the breach was first reported to OCR to resolution, imposing a long-term drain on managerial resources as well as finances.

“But with the increase in OCR’s resolution agreements, a trend of OCR’s hot button issues has emerged. Organizations should review previous resolution agreements (all of which are available on OCR’s website) and familiarize themselves with what OCR considers to be best practices, such as: device encryption; workforce education and training; updating of policies and procedures; the elimination of old data; security risk assessments; risk mitigation plans; vendor management and using the minimum amount of PHI.

Katherine Keefe, global head of Beazley Breach Response Services, said in a statement, “All organizations face the reality that data breaches have become inevitable. And the stakes are high: they hold personal data on trust for customers, employees and patients. The volume of protected health information maintained by healthcare organizations and the digitization of electronic health records have increased the vulnerability for large breaches. It is important to understand the underlying causes so as to mitigate and manage them effectively.”

 

 

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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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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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