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Analysis: Healthcare Ransomware Attacks Decline in First Half of 2018

July 18, 2018
by Heather Landi
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In the first half of 2018, ransomware events in major healthcare data breaches 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 new report form cybersecurity firm Rockville, Md.-based Cryptonite.

In its healthcare cyber research report, Cryptonite researchers also credit this decline in ransomware events to healthcare organizations’ deploying best practice technologies to better protect and defend their networks.

The report is based on an analysis and review of data on cyberattacks impacting healthcare institutions across the United States between January 1, 2018 and June 30, 2018. The firm’s analysis and review of government data, internet sources and the direct experience of its security operations center (SOC) provide the baseline data for the analysis.

The report finds ransomware attacks actually reversed course in 2018 and trends lower in the first half of this year. While ransomware attacks rose in 2017, with an 89 percent increase in the frequency of reported attacks, these attacks as major IT/hacking data breach events impacting over 500 patient records dropped from 19 major data breaches in the first half of 2017 (the comparison period) to 8 major data breaches in the first half of 2018, marking a decrease of 57 percent.

Ransomware attacks reported as a percent of major IT/hacking data breach events impacting over 500 patient records dropped to 13.56 percent in the first six months of 2018, the report states. This metric peaked in the first half of 2017, at 30 percent, and then has declined in the two subsequent periods, dropping to 22 percent in the second half of 2017.

The report authors credit this drop to healthcare organizations adding micro-segmentation to networks, as well as specialized software to address ransomware threats. In the largest hospitals, new Zero Trust technologies have been added to the existing mix of defense in depth technologies to expand and harden the defensive perimeters, the report states.

The report authors also note that this data appears to be consistent with other sources. Kaspersky Lab recently found that the total number of ransomware events decreased by approximately 30 percent from 2016-2017 to 2017-2018, the report notes. “The Kaspersky report notes that ransomware attackers are searching for more profitable activities such as cryptojacking. Per Kaspersky, they have found that ransomware is ‘rapidly vanishing,’ and that cryptocurrency mining is starting to take its place,” the Cryptonite report authors wrote.

“We do believe that ransomware still presents a formidable threat to healthcare and expect new variants, such as AI-based malware, to present very difficult challenges to healthcare institutions later in 2018 and into 2019,” the report authors wrote.

Based on the firm’s analysis, patient records (ePHI) breached in the first half of 2018 came in at 1,928,432, which is slightly higher than previous time periods. In context 1,674,793 ePHI records were breached in the first six months of 2017 and 1,767,955 ePHI records were breached in the second half of 2017.

Overall, total healthcare major data breaches so far in 2018 came in at 59 events, and seems headed towards a projected total of between 120 and 150 total events by the end of the year. The report notes that this appears to be trending lower than previous years. If the first half of 2018 was annualized to 118 events, this would compare favorably to 2017 measured at 140 reported major IT/hacking events, the report states.

The positive trend in reduction of the use of ransomware is overshadowed by the continue high volume of major attack, the report authors wrote.

In the report, the authors also offer recommendations to strengthen healthcare cyber defense. New best practice technologies such as moving target cyber defense (MTD) and network micro-segmentation, can detect and defeat many of the attacks leveraged by vulnerabilities found in most healthcare networks, the report authors wrote.

“A Zero Trust environment can be constructed by combining moving target cyber defense (MTD) and network micro-segmentation technologies. In summary, a Zero Trust environment allows healthcare networks to stop and defeat attackers, ransomware, and insider threats,” the report authors wrote.

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Anthem Agrees to Record Payment—$16M—for Largest U.S. Health Data Breach

October 16, 2018
by Heather Landi, Associate Editor
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Anthem, Inc., the second largest health insurance company in the U.S., has agreed to pay $16 million to the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) to settle potential Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules violations in the largest U.S. health data breach in history.

In early 2015, Anthem, based in Indianapolis, was hit with a series of cyberattacks that led to an unprecedented health data breach that exposed the electronic protected health information (PHI) of almost 79 million people.

The $16 million settlement is a record HIPAA settlement that eclipses the previous high of $5.55 million paid to OCR in 2016, according to a press release from OCR. As part of the settlement, Anthem also agreed to take substantial corrective action.

Anthem is an independent licensee of the Blue Cross and Blue Shield Association operating throughout the United States and is one of the nation’s largest health benefits companies, providing medical care coverage to one in eight Americans through its affiliated health plans.  This breach affected electronic protected health information (ePHI) that Anthem, Inc. maintained for its affiliated health plans and any other covered entity health plans.

As reported by Healthcare Informatics Feb. 5, 2015, the payer announced details of the breach late Wednesday (Feb. 4) in a letter from President and CEO, Joseph R. Swedish. He said that Anthem was the target of a “very sophisticated external cyber attack.” The hackers gained access to current and former members’ names, birthdays, medical IDs/social security numbers, street addresses, email addresses and employment information, and income data. Anthem says that credit card and medical information, such as claims, test codes, and diagnostic codes were not compromised.”

On March 13, 2015, Anthem filed a breach report with the HHS Office for Civil Rights detailing that, on January 29, 2015, they discovered cyber-attackers had gained access to their IT system via an undetected continuous and targeted cyberattack for the apparent purpose of extracting data, otherwise known as an advanced persistent threat attack.  After filing their breach report, Anthem discovered cyber-attackers had infiltrated their system through spear phishing emails sent to an Anthem subsidiary after at least one employee responded to the malicious email and opened the door to further attacks.

According to OCR, the agency’s investigation revealed that between December 2, 2014 and January 27, 2015, the cyber-attackers stole the ePHI of almost 79 million individuals, including names, social security numbers, medical identification numbers, addresses, dates of birth, email addresses, and employment information.

“In addition to the impermissible disclosure of ePHI, OCR’s investigation revealed that Anthem failed to conduct an enterprise-wide risk analysis, had insufficient procedures to regularly review information system activity, failed to identify and respond to suspected or known security incidents, and failed to implement adequate minimum access controls to prevent the cyber-attackers from accessing sensitive ePHI, beginning as early as February 18, 2014,” according to the OCR press release.

In the Healthcare Informatics story at the time of the breach, reported by Gabriel Perna, Anthem faced criticism from industry observers for its lack of encryption. Trent Telford, CEO of Reston, Va.-based Covata and a member of Anthem, said, at the time, that the company was irresponsible for not protecting the data.

“We do not know what they were after and we do not know what they plan to do with the data—what we do know is that they were after the data itself and it was left exposed and unsecured. The data was not encrypted making it a valuable target for thieves,” he said in a statement that was quoted in the story. “It is irresponsible for businesses not to encrypt the data. We have to assume the thieves are either in the house or are going to break in—they will always build a taller ladder to climb over your perimeter security - we must protect the data itself.

In addition to the $16 million settlement, Anthem will undertake a robust corrective action plan to comply with the HIPAA Rules.  The resolution agreement and corrective action plan can be accessed here.

 

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Minnesota DHS Acknowledges Increase in Targeted Phishing Attacks

October 15, 2018
by Rajiv Leventhal, Managing Editor
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Two phishing attacks on employees at the Minnesota Department of Human Services (DHS) resulted in the possible leakage of about 21,000 Minnesotans’ personal information.

The state health agency issued a notice last week that explained over the last several months, several phishing campaigns have targeted Minnesota’s executive agencies, including DHS. Two of these attacks were deemed “successful,” in that hackers—once in June and another time in July—were able to gain access to the state email accounts of two DHS employees, using these accounts to send out spam emails. The agency’s IT department didn’t find out about the attacks until August, officials said.

According to DHS, the two email accounts contained information about some people who have interacted with DHS, including the Minnesota citizens who were notified. Examples of the type of information found in the email accounts at the time they were compromised include: first and last names, dates of birth, Social Security numbers, addresses, telephone numbers, medical information, educational records, employment records, and/or financial information, officials noted.

The agency did add in its notice, “We currently have no evidence that this information was actually viewed, downloaded, or misused.”

According to a report in the Minnesota Star Tribune, this is just the latest cyberattack on Minnesota’s state agencies, “which fend off about 3 million hacking attempts daily, state officials have said. In fact, attacks are increasing, said Aaron Call, the chief information security officer for Minnesota IT Services, which provides technology services to state executive agencies,” according to that report.

In fact, in just the past nine months, “more than 700 security incidents have been reported affecting state agencies, Call said, adding that the attacks are becoming ‘more pervasive and more sophisticated,’” according to the Star Tribune report.

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CISOs, CIOs Not Confident in Their Medical Device Security Strategy, New KLAS Research Finds

October 9, 2018
by Heather Landi, Associate Editor
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According to a survey of CIOs and CISOs, healthcare organizations have an average of 10,000 connected medical devices
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The healthcare industry continues to be bombarded with security attacks, and these cyber attacks are continuously evolving and become more sophisticated over time. At the same time, the healthcare ecosystem has become more connected with the increasing use of Internet of Things (IoT) medical devices, and these medical devices introduce vulnerabilities into healthcare organizations.

Unsecured and poorly secured medical devices put patients at risk of great harm if those devices are hacked, while also posing a threat to the security and privacy of patients’ protected health information (PHI). A recent medical device security report, the result of a collaborative effort between the College of Healthcare Information Management Executives (CHIME), the Association for Executives in Healthcare Information Security (AEHIS), and the Orem, Utah-based KLAS Research, sheds light on the current state of the medical device security industry. For the report, KLAS interviewed 148 CIOs, chief information security officers (CISOs), chief technology officers (CTOs) and other professionals at provider organizations to gauge their level of confidence in their medical device security strategies, the most common challenges they face, their perceptions of the security and transparency of major medical device manufacturers, and the best practices they leverage to overcome medical device security challenges.

The author of the report, Dan Czech, director, market analysis, cybersecurity at KLAS Research, will provide an in-depth overview of this report and medical device security trends during Healthcare Informatics’ Seattle Health IT Summit Oct. 22-23 at the Grand Hyatt Seattle.

The sheer number of connected medical devices that the average healthcare provider is trying to manage speaks to the tremendous challenge IT security leaders face, says Czech. “We spoke to organizations ranging from small to mid-sized clinics all the way to large multi-hospital IDNs (integrated delivery networks), and everyone in between, and the average number of connected medical devices was just under 10,000 medical devices. You think of the enormity of that problem, for an organization to wrap their arms around the problem of managing 10,000 devices,” he says.

What’s more, respondents reported that, among the thousands of connected medical devices that their organizations are managing, about one-third (33 percent) of those devices are “unpatchable.”

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According to the research, 18 percent of provider organizations had medical devices impacted by malware or ransomware in the last 18 months, although few of these incidents resulted in compromised PHI or an audit by the Office for Civil Rights, U.S. Department of Health and Human Services (HHS OCR).

Czech notes that there have not been any patient safety events, to date, as a result of a medical device security issue; however, respondents cite patient safety as a top concern. “Let’s take an infusion pump,” he says. “The ability for a bad actor to gain access to that pump and change the dosage of the medication that’s being injected into a human, that is the kind of patient safety issue that we are concerned about.”

Czech continues, “Another way medical device security affects patient safety is if a device is on Windows XP, and WannaCry ransomware hits; if something like that happens, that device is taken out of production. You may have an oncology patient who needs consistent treatment with a medical device, and if you take that out of production, it disrupts patient care and impacts patient safety.”

The report found that most respondents are either neutral about or not confident in their current medical device security strategy, with CISOs and CIOs more likely to report concern. Only 39 percent of respondents said they were very confident or confident that their current strategy protects patient safety and prevents disruptions in care. Thirty-one percent said they were unconfident or very unconfident, and another 30 percent were neutral. About one-fifth of respondents feel that the inherent risks of medical devices—several of which are outside of their control—will prevent them from ever feeling confident.

Those healthcare leaders who expressed confidence most often point to their security processes and policies, including access limitations, network segmentation and regular device monitoring and risk assessment, as the source of their confidence, followed by strong technology. To support these processes and policies, many leverage security technologies, such as access controls, asset tracking, firewalls, and medical device monitoring. Strong executive support (financial and organizational) and cross-department collaboration also drive confidence, as evidenced by the fact that large IDNs, who more commonly have greater financial resources, are more likely to be confident in their strategies, according to the report.

“Respondents who report they are more confident also are those that have a clear line of ownership, not a shared responsibility,” Czech notes.

Those respondents that lacked confidence in their medical device security cited lack of manufacturer support as the top reason. Almost as common are internal issues related to basic—but hard-to-master—security tasks, such as understanding what assets exist in their organization, which have been patched, which are connected to their network, and what systems those devices are talking to. “Asset and inventory visibility is the basic blocking and tackling of medical device security strategy—you can’t protect what you don’t know. They are looking for tools and processes that they can put in place that will help them understand all the devices they have, what’s connected to their networks, and some cases, what software is on the devices” Czech says.

What’s more, 76 percent of provider organizations report that their resources are insufficient or too strained to adequately secure their medical devices.

More Manufacturer Support and Collaboration Needed

Taking a deep dive into the root causes of medical device security struggles, the report finds that interviewed organizations are almost unanimous in citing manufacturer-related factors as a cause of their medical device security issues. Most provider organization see this issue as one of shared responsibility. As one CISO explained in the report, “I think there needs to be a coordinated effort between the manufacturers, the provider sites, and the regulators. I wish there were some other way for us to address this issue, but without that three-way partnership, I just don’t see how things will work out.”

According to Czech, the research findings indicate there is a gap between how long organizations expect to be able to use a device and how long vendors feel they can keep a device up to date and secure. As a result, nearly all interviewed organizations (93 percent) have struggled with out-of-date operating systems or the inability to patch a device throughout its expected life cycle. Currently, many manufacturers do not allow customers to patch devices themselves, or void warranties if they do.

Insufficient security controls, insufficient encryption, and hardcoded passwords are each cited as manufacturer-caused issues by about half of respondents. Adding to provider organizations’ frustration, on average, almost one-third of medical device vendors decline to offer contract provisions favorable to security.

However, the industry is beginning to shift, Czech notes. "Many provider organizations have drawn a line in the sand to say all contracts now and going forward will include standardized security contract language," he says. "This trend has been led by forward-thinking provider organizations and it also has benefited smaller organizations that may not have the legal teams or the cybersecurity teams that bigger organizations have, but they can use that standardized language in their contracts as well."

What’s interesting, Czech notes, is that many respondents spontaneously brought up frustrations regarding the role of the U.S. Food and Drug Administration (FDA) in medical device security, though KLAS did not specifically ask respondents about it. “It gets back to shared responsibility,” he says. “Respondents feel that manufacturers have a stake in this, they have a stake in this, but so does the FDA. Predominantly, the concern that they shared was that their manufacturer would hide behind their perceptions of the FDA regulations."

Almost two-thirds of respondents said manufacturers blame FDA policies, claiming the policies prevent them from making devices more secure. About a third said FDA policies are unclear, giving manufacturers ways to skirt around responsibility and a third said that even when policies are clear, the FDA doesn’t hold manufacturers accountable, according to the report.

Cybersecurity Programs Advancing Forward

According to the research, organizations are increasingly adopting a number of best practices to strengthen medical device security. There are foundational best practices that organization should implement, such as performing risk assessments, ensuring the inclusion of security provisions in their contracts, and ensuring they receive a software bill of materials, Czech notes. Organizations also report using the most common and basic defense techniques such as network segmentation, antivirus software, and vulnerability scanning to ameliorate security risk.

With regards to organizations’ patching strategies, many provider organizations have begun requesting that vendors use contract language that clearly outlines patching responsibilities and timelines.

Providers also are leveraging third-party solutions to improve medical device security, with nearly 75 percent of respondents currently using or planning to use third-party software or services, according to the report. Network access control (NAC) is most often used to segment networks and approve/deny access. To reduce costs and clearly define ownership, other organizations outsource their clinical engineering as well.

Looking at overall cybersecurity trends, the report indicates that organizations are investing more resources, both operationally and financially, in their cybersecurity programs. Almost 70 percent of organizations (68 percent) report having a VP or C-level leader in charge of the security program, and that’s up from only 42 percent in 2017, representing a 26-percent increase.

“Large IDNs are definitely leading the way with CISO leadership, as about 80 percent of their organizations have a CISO in charge, whereas if you look at clinics and community hospitals, those would be hospitals under 200 beds, only less than 10 percent have a CISO in charge,” Czech says. “Many of those smaller organizations have a CIO that wears two hats—an IT hat and a security hat.”

Organizations also reported improvements to security programs compared to a year ago. Twenty-seven percent considered their security programs to be fully functional and 47 percent said they were developed or starting to function in 2018, compared to 16 percent and 41 percent, respectively, in 2017.   

More than half of organizations (57 percent) report that security is an agenda item at board meetings monthly or quarterly. In addition, 83 percent of organizations have increased their security budget in the last two years, and, on average, budgets increased by 85 percent, according to the report.

 


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