Healthcare Cybersecurity

HPH Sector Warned About Exploitation of Miracle Exploit Vulnerabilities in Oracle Systems

A critical vulnerability affecting multiple Oracle products is being exploited in the wild. The vulnerability was dubbed The Miracle Exploit by the security researchers who discovered it, due to its severity and the number of products they affected – all products based on Oracle Fusion Middleware and Oracle online systems. The vulnerability is one of a pair of related vulnerabilities that were discovered two years apart. The vulnerabilities can be chained, and both can lead to remote code execution.

The Oracle Fusion Middleware products are used to build web interfaces for Java EE applications and any website developed by ADF Faces framework is affected. The vulnerabilities also affect Oracle Business Intelligence, Enterprise Manager, Identity Management, SOA Suite, WebCenter Portal, Application Testing Suite, and Transportation Management. The vulnerabilities are tracked as CVE-2022-21445 (CVSS 9.8) and CVE-2022-21497 (CVSS 8.1) and can be exploited easily by an unauthenticated attacker with network access via HTTP for an application takeover. Successful exploitation can lead to a full system compromise and lateral movement within a network. The vulnerabilities could be exploited to steal sensitive data and could be leveraged by ransomware groups in the future.

CVE-2022-21445 is a deserialization of untrusted data vulnerability and CVE-2022-21497 is a server-side request vulnerability. The first vulnerability allows remote code execution, and the second one could be exploited for lateral movement to other Oracle systems and can also lead to remote code execution. Oracle released patches to fix the vulnerabilities in April 2022, 6 months after the CVE-2022-21445 vulnerability was discovered. In September, the Cybersecurity and Infrastructure Security Agency (CISA) added the CVE-2022-21445 Miracle Exploit vulnerability to its Known Exploited Vulnerabilities (KEV) Catalog. No information was released about the extent to which the vulnerability has been exploited, and there have been no public reports of exploitation, although CISA does receive some reports privately.

Due to the severity of the vulnerabilities and their impact, the Health Sector Cybersecurity Coordination Center has recently released an analyst note warning the healthcare and public health sector about the risk of exploitation. Healthcare organizations could be vulnerable if they use Oracle Fusion products that rely on the ADF Faces framework. HC3 warns that if the vulnerable Oracle middleware components are integrated into their software for managing electronic medical records or other critical systems, exploitation of the vulnerabilities could result in data breaches, operational disruptions, and potentially regulatory penalties.

HC3 recommends applying the latest patch for Oracle JDeveloper, segmenting networks and ensuring environments that use JDeveloper are isolated from production systems, and limiting access to JDeveloper environments to trusted users only and enforcing strong authentication mechanisms.

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HC3 Issues Warning About Scattered Spider Threat Actor

A warning has been issued by the HHS’ Health Sector Cybersecurity Coordination Center (HC3) about a financially motivated group known as Scattered Spider. Many cybercriminal groups are Russian-speaking and are based in Russia or the Commonwealth of Independent States; however, Scattered Spider is a native English-speaking group and its members are believed to be mostly located in the United States and the United Kingdom. There have been four arrests in those countries but the group remains active. Intelligence gathered on the group suggests the members are mostly in the 19-22 age group.

Rather than develop their own malware payloads and attack tools, Scattered Spider uses publicly available tools and malware developed by other threat actors. Legitimate tools known to have been leveraged by the group include remote monitoring and management solutions such as AnyDesk, Connectwise Control, ASG Remote Desktop, Screenconnect, and Splashtop; Mimikatz and LaZagne for credential theft; and Ngrok to create secure tunnels to remote web servers.

The group has previously used multiple malware variants in its operations including Atomic, Racoon Stealer, VIDAR Stealer, and Meduza Stealer, as well as phishing kits such as EIGHTBAIT and Oktapus, and the BlackCat and Ransomhub ransomware variants. The group has also collaborated with the Qilin threat group.

Information stealers are commonly used to obtain credentials for initial access, and then living-off-the-land techniques are used to evade security solutions while the group moves laterally within networks, disabling security solutions and stealing sensitive data. Attacks often end with the deployment of ransomware.

Scattered Spider uses advanced social engineering tactics, with its members well-versed in spear phishing, smishing, and voice phishing. One campaign attributed to Scattered Spider involves spear phishing voice techniques, where members of the IT Help Desk are targeted over the phone with the group posing as employees, sometimes aided by artificial intelligence to impersonate voices.

The aim is to trick the IT Help Desk into performing password resets and registering their own devices to receive multifactor authentication codes. The Help Desk is provided with personal information about the person they are impersonating and usernames and employee IDs obtained in previous stages of its attacks. HC3 has previously issued a warning about this campaign as healthcare organizations were among the group’s victims.

Scattered Spider has been active since at least 2022 and was initially focused on customer relationship management (CRM), business process outsourcing (BPO), telecommunications, and technology companies; however, the group has since expanded its targeting and has been attacking a broader range of sectors. While the healthcare industry has not been extensively targeted by the group, healthcare organizations have been attacked. The Scattered Spider threat actor profile shares indicators of compromise and recommended mitigations to improve defenses.

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OCR Offers Advice on Recognizing, Avoiding, and Mitigating Social Engineering Attacks

The majority of healthcare data breaches reported in the past few years are due to hacking incidents but many of these security incidents do not involve the exploitation of vulnerabilities in software and operating systems for initial access. Far more common is the exploitation of human vulnerabilities, where healthcare workers are tricked into providing cyber actors with access to internal systems and sensitive data. According to the Verizon 2024 Data Breach Investigations Report, more than two-thirds of breaches involve the human element rather than the exploitation of weaknesses and vulnerabilities in technology.

One of the most common methods used is phishing, where a cyber actor makes contact with a healthcare employee and convinces them to visit a malicious website where they are asked to enter their credentials or are convinced to download a malicious file, both of which give the cyber actor the access they need. With phishing, the initial contact is often via email, although an increasing number of phishing attacks are now occurring via SMS (smishing), instant messaging platforms, social media networks, and over the telephone (vishing).

Phishing usually involves deception and impersonation. A trusted individual, company, or institution is impersonated, and the targeted individual is provided with a seemingly legitimate reason for taking the requested action. This could be a request for collaboration on a report, a notification about a failed delivery, a missed payment of an invoice, or a security warning. There is often a threat of negative consequences if no action is taken, commonly a pressing matter such as impending loss of service, a significant charge that will soon be applied to an account, or unauthorized account access that warrants immediate steps to secure the account.

The techniques used in phishing are known as social engineering – manipulation, influencing, or deceiving someone into taking a certain action, which in cybersecurity terms involves gaining unauthorized access to computer systems, financial accounts, or sensitive data. While phishing is one of the best-known attack methods that uses social engineering techniques, cyber actors use social engineering in other types of attacks to achieve similar goals. There is baiting, where social engineering is used to trick someone into taking an action to obtain something of value, such as to be entered into a free prize draw or get an amazingly low purchase price on goods and services. In order to get what is promised, sensitive information must be disclosed such as credentials, a credit/debit card number, or personal information.

Advances in artificial intelligence (AI) technology have provided cyber actors with a new way of manipulating individuals – deepfakes. Deepfakes take impersonation and deception to a new level, where trusted individuals are impersonated via audio or video. Deepfakes of authority figures can be created that are incredibly realistic, using synthesized facial images and speech or manipulated videos, photos, and audio recordings to trick people into taking any number of actions. Deepfakes can even be created in real-time, such as impersonating a CEO in a call to a help desk to request credentials be reset or to add an attacker-owned device to receive multifactor authentication codes, or in Zoom meetings where the meeting participants are convinced they are conversing with the genuine person.

Social engineering is the subject of the October 2024 cybersecurity newsletter from the HHS’ Office for Civil Rights. In the newsletter, OCR explains how social engineering is used in attacks on healthcare organizations and how to identify and avoid social engineering attacks. The newsletter also explains how compliance with the HIPAA Security Rule can help HIPAA-regulated entities improve their defenses against social engineering and mitigate threats.

“Attackers have learned how to convincingly imitate our loved ones and our business partners, meaning that nothing can be assumed or taken at face value. Attackers continue to refine their manipulation through social engineering tradecraft. All of these threats have a common theme; they all attempt to convince an individual to do something they would not otherwise do normally, or to provide details such as credentials someplace other than where they should be used,” explained OCR in the newsletter. “Educating workforce members on these attacks is essential when it comes to an individual’s ability to identify and potentially halt social engineering attacks before they start. Such knowledge is powerful not only to protect individuals in their personal online activities, but also by extension an individual’s employer. This is especially important in the current environment where work is taken home on laptops, smartphones, and through remote work.”

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BakerHostetler Report Identifies Healthcare Data Breach and Litigation Trends

BakerHostetler has released the 10th edition of its Data Security Incident Response Report, which shares data from the incidents the law firm has helped to manage. The report provides insights into the current cyber threat landscape and litigation trends.

Data Breach Insights

Healthcare accounted for 28% of data breach incidents, followed by finance and insurance (17%), business and professional services (15%), and education (13%). The biggest known root cause of all incidents was the exploitation of unpatched vulnerabilities (23% of incidents) followed by phishing (20%). By far the most common cause of security incidents in 2023 was network intrusions, which accounted for 51% of security incidents the law firm helped to manage, followed by business email compromise incidents (26%), and inadvertent disclosures (26%).

Cybercriminals are getting better at covering their tracks, as the root cause of 36% of network intrusions could not be determined. The main known cause of these incidents was vulnerability exploitation (25% of attacks). Phishing was involved in 9% of network intrusions, 5% involved brute force or credential stuffing, 4% were due to misconfigurations, 3% were due to RDP compromise, and 3% due to social engineering. 72% of successful network intrusions involved the deployment of ransomware, 57% involved data exfiltration, and 46% saw malware installed.

The average ransom demand was $2,644,647 and the average ransom payment was $747,651 but these were considerably higher in healthcare with an average demand of $3,492,434 and an average ransom payment of $857,933. In healthcare, it took an average of 13.4 days to acceptable data restoration and an average of 158,362 notifications had to be sent. As has been seen in other data, the percentage of victims paying a ransom is falling. 27% of attacked companies paid a ransom in 2023, compared to 40% in 2022.

The was a significant increase in data breaches at vendors. In 2023, business associates were responsible for 60% of the breaches of 500 or more records that were reported to the HHS’ Office for Civil Rights (OCR), compared to 35% in 2022. There was also a major increase in the size of healthcare data breaches, jumping by almost 200% from 2022 to 2023, from 56.9 million individuals to 144.5 million in 2023. The median time from incident to discovery was 2 days, 0 days to containment, 33 days to complete the forensic investigation, and 60 days from discovery to notification. The average time from occurrence to detection was 42 days and from detection to notice was 75 days.

Phishing and social engineering attacks have been getting more sophisticated. New social engineering scams that have become common involve threat actors contacting IT helpdesks to request password resets and enroll new devices to accept MFA codes. Several business email compromise attacks occurred as a result of QR code phishing attacks (Quishing), and many phishing attacks occurred via SMS messages (smishing). While multifactor authentication was sufficient to keep threat actors out of email accounts, MFA is increasingly bypassed in attacks. 43% of incidents required notifications to be issued, with an average of 98,504 notifications required. Out of the 493 incidents that required notifications to be issued, 58% resulted in lawsuits being filed, up from 42 in 2022.

Class Action Lawsuits Over Tracking Technologies Soar

Class action lawsuits over website tracking technology breaches are increasingly being filed, especially against healthcare organizations following guidance from the HHS’ Office for Civil Rights warning that the technologies violated HIPAA. The Federal Trade Commission (FTC) is also cracking down on organizations that use the technology without informing consumers.

BakerHostetler is currently defending more than 300 privacy or data security lawsuits and over 100 of those lawsuits involve data breaches due to the use of tracking technologies. More than 200 lawsuits have now been filed against healthcare organizations as a result of the use of tracking technologies, 75% of which were filed in the past year. Many of these lawsuits are still in the early stages, with only one case so far granted class certification and one that has had class certification denied. The first trial in a healthcare website tracking technology lawsuit is due to take place this summer. Several lawsuits have been quickly settled, with each individual due to receive an average of between $4 and $5. Since those settlements have been announced there has been an increase in the initial demands for damages.

OCR Enforcement Insights

After three years of relatively high numbers of enforcement actions, 2023 saw a fall in OCR enforcement activity. In 2023 there was a notable reduction in enforcement actions over HIPAA Right of Access violations (4) than the average of 14 over the previous three years. While there was an increase in enforcement actions for other HIPAA violations – 10 in 2023 vs 5 in 2022 and 3 in 2021 – OCR only imposed 11 penalties in 2023 to resolve HIPAA violations, compared to an average of 19 in the three previous years. BakerHostetler suggests the drop off in enforcement actions may be due to OCR focusing on another enforcement priority. OCR has issued guidance on HIPAA compliance with respect to website tracking technologies, and BakerHostelter suggests that may now be an enforcement focus for OCR.

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Healthcare Ransomware Attacks Involve 20% of Stored Sensitive Data

Ransomware groups target the healthcare sector because a successful attack gives them access to large amounts of sensitive data that can be easily monetized and used as leverage to get a ransom paid. Healthcare organizations are also heavily reliant on access to data to operate, therefore there is a higher probability that a ransom will be paid to regain access to encrypted data. Attacks on the sector are also increasing. According to Recorded Future, there were 358 ransomware attacks on healthcare organizations in 2023, a year-on-year increase of 46%.

A recent study by the cybersecurity firm Rubrik assessed the impact of ransomware attacks and found that attacks on healthcare providers impact more data than other industry sectors. Researchers at Rubrik Zero Labs determined that 20% of a healthcare organization’s sensitive data holdings are affected by a ransomware encryption event, compared to 6% in other industry sectors. That means 20% of healthcare data is encrypted, deleted, or stolen in an attack.

Healthcare organizations generally hold more sensitive data than other industry sectors. According to Rubrik’s analysis, healthcare organizations typically need to secure 50% more data than the global average, with healthcare organizations holding an average of 42 million sensitive data records compared to the global average of 28 million sensitive records.  The amount of data stored grows at a faster rate than other industries. In 2023, a typical healthcare organization saw its data estate grow by 27% compared to 23% for a typical global organization, and the number of sensitive data records in healthcare grew by 63% in the past year compared to the global average of 13%.

The data for Rubrik’s report – The State of Data Security: Measuring Your Data’s Risk – came from telemetry across the company’s customer base of 6,100 organizations and a study conducted by the Wakefield Research of more than 1,600 IT and security leaders. Across all industry sectors, 94% of IT security leaders said they had experienced a significant cyberattack in 2023, and an average of 30 attacks in the past year. One-third of IT security leaders said they had been affected by at least one ransomware attack, and 93% of organizations paid a ransom, with 58% of those paying to prevent the leaking of stolen data.

Dependence on the cloud is growing, with cloud architecture used to store 13 % of an organization’s data on average, compared to 9% the previous year. According to Rubrik’s telemetry, cloud storage has inherent risks as there are security blind spots. Rubrik reports that 70% of all cloud-stored data is in object storage, which typically has much lower security coverage than other areas. 88% of all data stored in object storage is not confirmed as machine-readable or is not covered by prominent security technologies and services, and more than 25% of object storage data is subject to regulatory or legal requirements, such as HIPAA.

“Despite the fallout of cyberattacks dominating headlines, data risk is an issue that continues to be murky — especially in terms of what security teams can actually change and what they cannot,” said Steven Stone, Head of Rubrik Zero Labs. “With this report, we aim to provide quantifiable insights that IT and security leaders can bring back to their organization to drive greater cyber resilience-in particular with their partners in the business and governance teams.”

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Threat Actors Increasingly Targeting Vulnerabilities for Initial Access

The exploitation of vulnerabilities in software and operating systems is becoming far more common for initial access to networks, with phishing declining in prevalence, according to Mandiant’s M-Trends 2024 Report. Manidant, part of Google Cloud, is a leading provider of dynamic cyber defense, threat intelligence, and incident response services. The latest report is based on data from Mandiant Consulting investigations of targeted attack activity conducted between January 1, 2023, and December 31, 2023.

Exploited software vulnerabilities were the initial access method in 38% of intrusions investigated by Manidant, up 6% from 2022, with phishing used for initial access in 17% of incidents, down from 22% in 2022. Attackers are increasingly targeting edge devices and are exploiting a wide variety of vulnerabilities. In 2023, Mandiant identified 97 unique zero-day vulnerabilities being exploited in the wild, up 56% from 2022. The exploitation of zero day vulnerabilities used to be limited to a small number of threat actors, typically nation-state cyberespionage groups. While state-sponsored threat actors continue to target zero-day flaws, especially China-nexus threat actors, ransomware and data extortion groups are increasingly acquiring and utilizing 0days, helped by the rise of commercially available turnkey exploit kits.

Threat actors are combining exploits of zero-day flaws with living-off-the-land techniques, which involve native, legitimate tools within a system to allow them to maintain persistence for longer and avoid detection. One of the reasons for the decline in phishing as an initial attack vector is the widespread adoption of multifactor authentication (MFA). While MFA is effective at preventing phishing attacks, Mandiant has identified an increase in the use of web proxies and adversary-in-the-middle phishing pages that can steal credentials and login session tokens to bypass MFA. Defenses can be improved against these attacks by adopting phishing-resistant MFA.

Mandiant has also observed an increase in malware, with 626 new malware families identified in 2023, more than any other year to date. The most common malware families were backdoors (33%), downloaders (16%), droppers (15%), credential stealers (7%) and ransomware (5%). The industries most commonly targeted by threat actors were financial services (17%), business and professional services (13%), high technology (12%), retail and hospitality (9%), and healthcare (8%), with attacks increasingly targeting cloud environments, as more organizations transition to the cloud. The most likely reason for targeting these sectors is they store a wealth of sensitive information, including proprietary business data, personally identifiable information, protected health information, and financial records.

Mandiant’s data show that organizations are getting better at identifying intrusions. Last year, attackers were present in networks for a median of 10 days before the intrusions were detected, down from a median of 16 days in 2022. “Defenders should be proud, but organizations must remain vigilant. A key theme throughout M-Trends 2024 is that attackers are taking steps to evade detection and remain on systems for longer, and one of the ways they accomplish this is through the use of zero-day vulnerabilities,” Jurgen Kutscher, Vice President, Mandiant Consulting at Google Cloud, told The HIPAA Journal. “This further highlights the importance of an effective threat hunt program, as well as the need for comprehensive investigations and remediation in the event of a breach.”

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March 2024 Healthcare Data Breach Report

March was a particularly bad month for healthcare data breaches with 93 branches of 500 or more records reported to the Department of Health and Human Services (HHS) Office for Civil Rights (OCR), a 50% increase from February and a 41% year-over-year increase from March 2023. The last time more than 90 data breaches were reported in a single month was September 2020.

The reason for the exceptionally high number of data breaches was a cyberattack on the rehabilitation and long-term acute care hospital operator Ernest Health. When a health system experiences a breach that affects multiple hospitals, the breach is usually reported as a single breach. In this case, the breach was reported individually for each of the 31 affected hospitals. Had the breach been reported to OCR as a single breach, the month’s breach total would have been 60, well below the average of 66.75 breaches a month over the past 12 months.

Healthcare data breaches in the past 12 months

 

 

healthcare data breaches in March 2020-2024

While the breach total was high, the number of individuals affected by healthcare data breaches fell for the fourth consecutive month to the lowest monthly total since January 2023. Across the 93 reported data breaches, the protected health information of 2,971, 249 individuals was exposed or impermissibly disclosed – the lowest total for March since 2020.

records compromised in healthcare data breaches in the past 12 months

healthcare records breached in march 2020-2024

Biggest Healthcare Data Breaches in March 2024

18 data breaches were reported in March that involved the protected health information of 10,000 or more individuals, all of which were hacking incidents. The largest breach of the month was reported by the Pennsylvanian dental care provider, Risa’s Dental and Braces.  While the breach was reported in March, it occurred 8 months previously in July 2023. A similarly sized breach was reported by Oklahoma’s largest emergency medical care provider, Emergency Medical Services Authority. Hackers gained access to its network in February and stole files containing names, addresses, dates of birth, and Social Security numbers.

Philips Respironics, a provider of respiratory care products, initially reported a hacking-related breach to OCR involving the PHI of 457,152 individuals. Hackers gained access to the network of the Queens, NY-based billing service provider M&D Capital Premier Billing in July 2023, and stole files containing the PHI of 284,326 individuals, an August 2023 hacking incident was reported by Yakima Valley Radiology in Washington that involved the PHI of 235,249 individuals, and the California debt collection firm Designed Receivable Solutions, experienced a breach of the PHI of 129,584 individuals. The details of the breach are not known as there has been no public announcement other than the breach report to OCR.

 Name of Covered Entity State Covered Entity Type Individuals Affected Breach Cause
Risas Dental & Braces PA Healthcare Provider 618,189 Hacking Incident
Emergency Medical Services Authority OK Healthcare Provider 611,743 Hacking Incident
Philips Respironics PA Business Associate 457,152 Exploited software vulnerability (MoveIT Transfer)
M&D Capital Premier Billing LLC NY Business Associate 284,326 Hacking Incident
Yakima Valley Radiology, PC WA Healthcare Provider 235,249 Hacked email account
Designed Receivable Solutions, Inc. CA Business Associate 129,584 Hacking Incident
University of Wisconsin Hospitals and Clinics Authority WI Healthcare Provider 85,902 Compromised email account
Aveanna Healthcare GA Healthcare Provider 65,482 Compromised email account
Ezras Choilim Health Center, Inc. NY Healthcare Provider 59,861 Hacking Incident (data theft confirmed)
Valley Oaks Health IN Healthcare Provider 50,034 Hacking Incident
Family Health Center MI Healthcare Provider 33,240 Ransomware attack
CCM Health MN Healthcare Provider 28,760 Hacking Incident
Weirton Medical Center WV Healthcare Provider 26,793 Hacking Incident
Pembina County Memorial Hospital ND Healthcare Provider 23,811 Hacking Incident (data theft confirmed)
R1 RCM Inc. IL Business Associate 16,121 Hacking Incident (data theft confirmed)
Ethos, also known as Southwest Boston Senior Services MA Business Associate 14,503 Hacking Incident
Pomona Valley Hospital Medical Center CA Healthcare Provider 13,345 Ransomware attack on subcontractor of a vendor
Rancho Family Medical Group, Inc. CA Healthcare Provider 10,480 Cyberattack on business associate (KMJ Health Solutions)

 

Data Breach Causes and Location of Compromised PHI

As has been the case for many months, hacking incidents dominated the breach reports. 76 of the month’s breaches were classed as hacking/IT incidents, which involved the records of 2,918,585 individuals, which is 98.2% of all records compromised in March. The average breach size was 38,402 records and the median breach size was 3,144 records. The nature of the hacking incidents is getting harder to determine as little information about the incidents is typically disclosed in breach notifications, such as whether ransomware or malware was used. The lack of information makes it hard for the individuals affected by the breach to assess the level of risk they face. Many of these breaches were explained as “cyberattacks that caused network disruption” in breach notices, which suggests they were ransomware attacks.

Causes of March 2024 healthcare data breaches

There were 11 unauthorized access/disclosure incidents reported involving a total of 36,533 records. The average breach size was 3,321 records and the median breach size was 1,956 records. There were 4 theft incidents and 1 loss incident, involving a total of 15,631 records (average: 3,126 records; median 3,716 records), and one improper disposal incident involving an estimated 500 records. The most common location for breached PHI was network servers, which is to be expected based on the number of hacking incidents, followed by compromised email accounts.

Location of breached PHI in March 2024 healthcare data breaches

Where Did the Data Breaches Occur?

The OCR data breach portal shows there were 77 data breaches at healthcare providers (2,030,568 records), 10 breaches at business associates (920,522 records), and 6 data breaches at health plans (20,159 records). As OCR recently confirmed in its Q&A for healthcare providers affected by the Change Healthcare ransomware attack, it is the responsibility of the covered entity to report breaches of protected health information when the breach occurs at a business associate; however, the responsibility for issuing notifications can be delegated to the business associate. In some cases, data breaches at business associates are reported by the business associate for some of the affected covered entity clients, with some covered entities deciding to issue notifications themselves. That means that data breaches at business associates are often not abundantly clear on the breach portal. The HIPAA Journal has determined the location of the breaches, with the pie charts below show where the breaches occurred, rather than the entity that reported the breach.

Data breaches at HIPAA-regulated entities in March 2024

Records breached at HIPAA-regulated entities in March 2024

Geographical Distribution of Healthcare Data Breaches

In March, data breaches were reported by HIPAA-regulated entities in 33 U.S. states. Texas was the worst affected state with 16 breaches reported, although 8 of those breaches were reported by Ernest Health hospitals that had data compromised in the same incident. California experienced 10 breaches, including 3 at Ernest Health hospitals, with New York also badly affected with 7 reported breaches.

State Breaches
Texas 16
California 10
New York 7
Pennsylvania 6
Indiana 5
Colorado & Florida 4
Illinois, Ohio & South Carolina 3
Arizona, Idaho, Massachusetts, Michigan, Minnesota, New Mexico, North Carolina, Oklahoma & Utah 2
Alabama, Georgia, Kansas, Kentucky, Nevada, New Jersey, North Dakota, Oregon, Tennessee, Virginia, Washington, West Virginia, Wisconsin & Wyoming 1

HIPAA Enforcement Activity in March 2024

OCR announced one settlement with a HIPAA-regulated entity in March to resolve alleged violations of the HIPAA Rules. The Oklahoma-based nursing care company Phoenix Healthcare was determined to have failed to provide a daughter with a copy of her mother’s records when the daughter was the personal representative of her mother. It took 323 days for the records to be provided, which OCR determined was a clear violation of the HIPAA Right of Access and proposed a financial penalty of $250,000.

Phoenix Healthcare requested a hearing before an Administrative Law Judge, who upheld the violations but reduced the penalty to $75,000. Phoenix Healthcare appealed the penalty and the Departmental Appeals Board affirmed the ALJ’s decision; however, OCR offered Phoenix Healthcare the opportunity to settle the alleged violations for $35,000, provided that Phoenix Healthcare agreed not to challenge the Departmental Appeals Board’s decision.

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Only 28% of Ransomware Victims Choose to Pay Ransom

According to the Q1, 2024 ransomware report from the ransomware remediation firm Coveware, ransom payments have fallen to a record low with only 28% of victims opting to pay the ransom to recover files and/or prevent the exposure of stolen data. In Q1, 2019, more than 80% of victims of ransomware attacks paid the ransom, but the percentage has been steadily falling, with only 29% of victims paying up in Q4, 2023, and just 28% in Q1, 2024.

Coveware suggests several reasons for the decline in payments, including better preparation and more advanced protective measures that allow victims to recover files without having to pay the ransom, legal pressure on victims not to give in to demands, and growing distrust of ransom groups. There have been an increasing number of attacks where payment has been made only for the attackers to continue to leak data or trade stolen data with other groups. For instance, the recent Blackcat ransomware attack on Change Healthcare saw the operators pocket the $22 million ransom payment and not pay the affiliate, who switched to the RansomHub group, which started leaking the data to pressure Change Healthcare into paying another ransom payment.

Coveware also reports that the confidence of ransomware affiliates has been shaken by recent law enforcement operations against LockBit and BlackCat. While groups were able to recover from the takedowns, the operations demonstrated that ransomware groups are not beyond the reach of Western law enforcement agencies. Further, the actions of the groups following the attacks have not helped to restore affiliates’ confidence. Both groups have had public disputes with affiliates and refused to pay them their cut of the ransoms, and coupled with the risk of having their identities discovered by law enforcement, many have chosen to quit conducting attacks for those groups and potentially quit ransomware altogether.

Based on the attacks where Coveware has been engaged to assist with recovery, Akira is now the dominant group with a market share of 21%, followed by Blackbasta and Lockbit which each have a 9% share, medusa, Phobos, and BlackCat with 6%, and Rhysida, BlackSuit and Inc Ransom with a 4% market share. BlackBasta has returned to the list of top ransomware groups, which suggests that affiliates have been leaving BlackCat and Lockbit, while the increase in Phobos attacks suggests that some affiliates are choosing to set up their own operations.

There has been a trend for increasing ransom payments since 2019 and a sharp increase in payments in Q1, 2023; however, by Q3, 2024, ransom payments started to fall. That fall has continued, with Q1, 2024 seeing an average payment of $381,980, down 32% from the previous quarter. Median payments have been increasing slowly and jumped by 25% to $250,000 in Q1, 2024. This is due to ransomware groups demanding more reasonable payments to increase the likelihood of being paid.

The threat of publication of stolen data is often enough to get victims to pay up. 23% of victims who were only faced with the threat of publication of their data chose to pay the ransom in Q1; however, there is no guarantee that the stolen data will be deleted. The law enforcement disruption of LockBit confirmed that the group still held a lot of data from attacks where the victims had paid to have their data deleted. There have been several cases where payment has been made to one group, only for the data to be provided to another ransomware group for re-extortion.

Coveware tracks the ransomware vectors used to gain initial access to networks; although that is becoming increasingly difficult, with the initial access vector unclear in more than 40% of Q1, 2024 attacks. Remote access compromise is the most common of the confirmed attack vectors, with software vulnerabilities and phishing both in decline. It is also common for multiple attack vectors to be used to achieve an extortion-level impact. While few sectors have escaped ransomware attacks, in Q1, 2024, healthcare was the worst affected industry, accounting for 18.7% of attacks, followed by professional services (17.8%), the public sector (11.2%), and consumer services (10.3%).

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CISA & Partners Share New Threat Intelligence on Akira Ransomware

The Cybersecurity & Infrastructure Security Agency (CISA), Federal Bureau of Investigation (FBI), Europol’s European Cybercrime Centre (EC3), and the Netherlands’ National Cyber Security Centre (NCSC-NL) have issued a joint cybersecurity advisory about the Akira ransomware operation, which has conducted more than 250 attacks and has been paid around $42 million in ransom payments. The group’s operators are highly skilled and are associated with the infamous Conti ransomware operation.

Akira is a relatively new ransomware group that emerged in April 2023 that mostly targets small- to medium-sized businesses and demands ransom payments from around $200,000 to millions of dollars. The group has attacked many verticals including finance, real estate, manufacturing, and healthcare. Attacks on healthcare targets prompted the Health Sector Cybersecurity Coordination Center to issue a Sector Alert about Akira ransomware in September 2023. The latest cybersecurity advisory from CISA and Partners shares information on the latest tactics, techniques, and procedures (TTPs) used by the group, updated indicators of compromise (IoCs), and recommended mitigations for network defenders.

Akira has been observed gaining initial access to victims’ networks through a Virtual Private Network (VPN) service without multifactor authentication, primarily through the exploitation of the Cisco vulnerabilities CVE-20203259 and CVE-2023-20269. The group also targets external facing services including Remote Desktop Protocol (RDP), abuses valid credentials, and conducts spear phishing attacks.

When a corporate network has been breached, the group moves laterally and attempts to obtain Windows domain credentials, then deploys ransomware to encrypt files. The group engages in double extortion tactics, stealing sensitive data from victims and demanding payment to prevent stolen data from being leaked and for the keys to decrypt files. Initially, the group only attacked Windows systems but has developed a Linux encryptor and now also targets VMware ESXi virtual machines. The group uses Kerberoasting techniques and Mimikatz to obtain credentials, LaZagne to help with privilege escalation, PowerTool to exploit the Zemana AntiMalware driver and terminate antivirus-related processes, and FileZilla, WinRAR, WinSCP, and RClone for data exfiltration.

The cybersecurity advisory includes several recommended mitigations to prevent and reduce the impact of Akira ransomware attacks, some of the most important of which are ensuring that patches are applied to fix known exploited vulnerabilities – especially CVE-20203259 and CVE-2023-20269, enforcing phishing-resistant multifactor authentication across the organizations in particular for VPNs, webmail, and accounts linked to critical systems, and ensuring that software is kept up to date.

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