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What Risk Do Privileged Users Pose to Healthcare Data Security?

August 26, 2016
by Heather Landi
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Employees with the most access to high value information assets continue to be seen as a serious insider risk, according to a recent Ponemon Institute study, and healthcare organizations need to ensure their governance processes decrease the risk of privileged user abuse.

In the study, The 2016 Study on the Insecurity of Privileged Users, sponsored by Forcepoint, Ponemon Institute presents three years of research findings on how privileged users of information technology resources are often the riskiest employees. For the study, researchers surveyed 704 individuals with in-depth knowledge about how their organizations manage privileged users due to their access to their organizations’ IT networks, enterprise systems, applications and information assets. Of the respondents, 9 percent are from healthcare organizations. Privileged users include those in positions such as database administrators, network engineers, IT security practitioners and cloud custodians.

According to the findings of this study, these individuals often use their rights inappropriately and put their organizations’ sensitive information at risk. For example, the majority of respondents say privileged users feel empowered to access all the information they can view and although not necessary will look at an organization’s most confidential information out of curiosity, the study authors wrote.

“While the study reveals companies are taking steps to manage the risk, the perception among those knowledgeable about access rights in their organizations is that the risk is either unchanged or increasing,” the study authors wrote. The study indicated that 91 percent of respondents believe the risk of privileged user abuse will increase or stay the same in the next 12 to 24 months.

And the study authors noted that this finding is almost unchanged from five years ago when 86 percent of respondents were concerned about the threat. “Based on this finding, new solutions and governance processes are needed to decrease the risk of privileged user abuse,” the study authors wrote.

According to 79 percent of respondents, privileged access rights are required to complete their current job assignments. And 21 percent of respondents reported they do not need privileged access to do their jobs but have it, and cited two primary reasons. “First, everyone at his or her level has privileged access even if it is not required to perform a job assignment (43 percent of respondents). Second, the organization failed to revoke these rights when they changed their role and no longer needed access privileges (34 percent of respondents),” the study authors wrote of the survey findings.

The study findings uncovered 12 trends with regard to the risks created by the inability to control unauthorized access by privileged users.

When respondents were asked what factors will change their organizations’ approaches to access governance, 63 percent say it is the increasing number of regulations or industry mandates. However, privileged user abuse is becoming more influential in access governance processes. Thirty-two percent of respondents cited that as a factor in the latest survey compared to 19 percent in 2011.

According to the survey findings, it is becoming increasingly difficult to detect if insider behavior is a threat. “This is because security tools yield more data than can be reviewed in a timely fashion and behavior involved in the incident is consistent with the individual’s role and responsibility. Monitoring and reviewing of log files, SIEM and manual oversight are the primary steps taken to determine if an action taken by an insider is truly a threat,” the study authors wrote.

Forty-two percent of organizations represented in this study are correlating activity from multiple sources such as trouble tickets and badge records to determine risky privileged user behavior. More than half of the respondents, 57 percent, say their organizations do not have the capabilities to effectively monitor privileged user activities. Respondents cited a lack of resources, in-house expertise and technologies as barriers to correlating of trouble tickets and badge records to minimize the privileged user risk.

There is a growing concern about the risk privileged users pose to data security, as increasingly, malicious insiders target privileged users to obtain their access rights, according to the study findings.

In 2011, only 21 percent of respondents said it would be likely that malicious insiders would use social engineering or other measures to obtain someone’s access rights. According to the 2016 survey, this concern has increased significantly, as 46 percent of respondents said it woudl be likely that malicious insiders would target privileged users' access rights. In addition, the study authors noted, more respondents say it is likely that social engineers outside the organization target privileged users to obtain their access rights.

And the study findings indicate that the most common scenarios that create the insider threat have not changed since 2014. Of the respondents, 74 percent say privileged users believe they are empowered to access all the information they can view, 66 percent say privileged users access sensitive or confidential data because of curiosity and 58 percent say the organization assigns privileged access rights that go beyond the individual’s role or responsibility.

Malicious insider threats are not the only risk when regard to employee misuse of data security. As reported by Healthcare Informatics, recent study by professors and research scientists from Dartmouth College, the University of Pennsylvania and the University of Southern California found that medical workers, nurses and physicians frequently workaround cyber security controls in healthcare settings, which leaves healthcare organizations vulnerable to cyberattacks and data breaches. According to those study findings, clinicians are doing so because information security systems often were developed without sufficiently considering clinical workflow and health IT usability.

“The problem,” the researchers in the Dartmouth College study wrote, “is the workers who build, use and maintain the systems—often chief information or technology officers (CIOs/CTOs), chief medical informatics officers (CMIOs), sometimes cybersecurity experts, and often just IT personnel—did not sufficiently consider the actual clinical workflow.”

According to the recent Ponemon Institute study, companies are increasing their deployment of processes for granting privileged user access, the study found. The use of commercial off-the-shelf automated solutions increased from 35 percent of respondents in 2011 to 60 percent in 2016. Since 2011, the use of manual processes such as by phone or email increased from 22 percent to 36 percent of respondents.

And, the study findings indicate that companies still struggle to keep pace with the number of access change requests that come in on a regular basis with an increase from 53 percent in 2011 to 61 percent in 2016.

Among the respondents, information security is rarely responsible for insider threat programs. Instead, information technology and lines of business are most accountable for the reduction of insider threats.

As far as solutions to mitigate risk, companies are increasingly relying on background checks, with 63 percent of respondents saying their organizations perform thorough background checks before issuance of privileged credentials and 60 percent conduct regular privileged user training programs.

Thirty-seven percent of respondents say their organizations use identity and access control technologies to detect the sharing of system administration access rights or root level access rights by privileged users. This is an increase from 20 percent in 2011 and 33 percent in 2014.

According to respondents, a lack of visibility continues to hinder the ability to determine if users are complying with policies. “The study findings reveal that 39 percent of respondents are not confident that they have the enterprise-wide visibility for privileged user access and can determine if users are compliant with policies. Only 18 percent are very confident that they have this visibility,” the study authors wrote.

The study also examined how companies are allocating resources to reduce insider threat. “Forty-four percent of respondents say they have a budget specifically allocated for investment in enabling technologies to reduce the insider threat but a similar percentage (41 percent) say their organizations do not have one. An average of 10 percent of the overall IT budget is allocated to insider threat technology investments,” the study authors wrote.

The study authors concluded that organizations need to consider solutions and governance processes that will decrease the risk of privileged user abuse.

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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.

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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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