Healthcare Cybersecurity

Data Breach Risk From Out of Date Operating Systems and Web Browsers Quantified

Posted by HIPAA Journal

The recent WannaCry ransomware attacks have highlighted the risks from failing to apply patches and update software promptly; however, a new study conducted by BitSight sought to quantify the level of risk that tardy updates introduce.

For the study, BitSight analyzed the correlation between data breaches and the continued to use old operating systems such as Windows 7, Windows Vista and Windows XP and old versions of web browsers.

Operating systems and browsers used by approximately 35,000 companies from 20 industries were assessed as part of the study. BitSight checked Apple OS and Microsoft Windows operating systems and Chrome, Internet Explorer, Safari, and Firefox web browsers.

2,000 of the companies studied (6%) had out of date operating systems on more than half of their computers. BitSight said 8,500 companies were discovered to be using out of date web browsers.

BitSight used its risk platform to study computer compromises and identified operating system and browser versions at those companies. BitSight was able to determine that organizations running out of date operating systems were three times more likely to suffer a data breach than those running newer operating systems. Organizations with out of date web browsers were two times more likely to experience a data breach.

The analysis did not confirm whether the data breaches occurred as a direct result of running outdated browsers and operating systems. The outdated software was only an indicator in the risk profile of those companies.

BitSight research scientist Dan Dahlberg said it is common knowledge that using outdated software and operating systems increases risk, but the big surprise from the study was the number of companies that were taking such big risks. For instance, prior to the WannaCry attacks, 20% of computers analyzed during the study were still running Windows XP.

The healthcare industry fared better than other industry sectors with 85% of organizations using up to date browsers and operating systems. However, 15% were taking risks by failing to update their browsers promptly and upgrade their operating systems.

Unsurprisingly, government organizations were some of the worst offenders, with more than a quarter of computers running on old operating systems and using out-of-date browsers.

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WannaCry Ransomware Continues to Cause Problems for U.S. Hospitals

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The Department of Health and Human Services (HHS) has issued a cyber notice to alert healthcare organizations of the continuing problems caused by the WannaCry ransomware attacks on May 12, 2017.

Following the attacks, the United States Department of Homeland Security (DHS) issued a statement saying the U.S. had suffered ‘limited attacks’ with only a small number of companies affected. However, the problems caused by those attacks have been considerable. The HHS says two large, multi-state hospital systems are still facing significant challenges to operations as a result of the May 12 attacks.

The Windows SMB vulnerability (MS17-010) exploited by the threat actors was addressed by Microsoft in a March 14, 2017 update, with an emergency patch released for unsupported Windows versions shortly after the attacks took place. The patches will prevent the MS17-010 vulnerability from being exploited and thus prevent WannaCry from being downloaded.

The encryption routine used by the WannaCry malware was deactivated quickly following the discovery of a kill switch. While the encryption process has been blocked, that does not stop infection. Vulnerable devices could still be infected if the patch has not been applied.

Further, if a device has already been infected prior to the patch being applied, the malware will still be present on the infected system. The HHS likens the patch to quarantining a patient. While that action will prevent the spread of the infection to other individuals, simply placing a patient in quarantine will not remove the infection in that patient.

While the ransomware component of the malware is not active, the presence of the malware on computer systems will have some effects. Those are dependent on the Windows version installed.

If the malware is present, it will be capable of scanning the network for other vulnerable devices and spreading to those devices.

The HHS says that if a device has been infected with WannaCry, reimaging and applying the patch will remove the virus and prevent it from being installed again. However, HHS explains that while the patch addresses a vulnerability in the Windows Server Message Block version 1 (SMBv1) protocol, that may not be the only vulnerability that is exploited to download WannaCry. Even patched systems may still be infected if the threat actors exploit a different vulnerability to introduce the malware. Patches must therefore be applied promptly after they have been issued to prevent future WannaCry – and other – malware attacks.

If you have been affected by WannaCry, the HHS recommends contacting your FBI Field Office Cyber Task Force or the US Secret Service Electronic Crimes Task Force to report the incident and request assistance.

The HHS also recommends contacting the FDA’s 24/7 emergency line at 1-866-300-4374 if a suspected cyberattack affects medical devices.

HHS has issued the following advice to healthcare organizations on mitigating the risk of WannaCry infection:

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Final Healthcare Cybersecurity Task Force Report Details 6 Imperatives to Improve Security

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The Health Care Industry Cybersecurity (HCIC) Task Force was formed by Congress, as required by the Cybersecurity Act of 2015. The purpose of the HCIC Task Force is to address the cybersecurity challenges faced by the healthcare industry and help the healthcare industry improve cybersecurity defenses and prevent security breaches.

The Cybersecurity Information Sharing Act of 2016 required the Health Care Industry Cybersecurity Task Force to issue a report detailing improvements that can be made to improve cybersecurity in the healthcare industry. The final version of the report was released on Friday June 2.

The HCIC Task Force explains in the report that the high number of hacking incidents, ransomware attacks and data breaches reported to the Department of Health and Human Services’ Office for Civil Rights in recent years clearly show the healthcare industry is struggling to secure networks and data.

The HCIC Task Force says many healthcare organizations believe cybersecurity vulnerability is low. Recent breaches and ransomware attacks have shown that assumption is false. While recent data breaches have highlighted the very real risk of security incidents and data breaches, addressing vulnerabilities and improving security is a major challenge.

Most healthcare organizations have extremely limited budgets and lack highly skilled cybersecurity personnel.  Infrastructures make it difficult to identity and track threats and a lack of skilled staff means many healthcare organizations cannot easily translate threat data into actionable information. Even if threat information can be turned into actionable information, many organizations do not have the capability to act on that information.

However, these cybersecurity threats place the safety of patients at risk. Recent ransomware attacks have shown that access to patient data can be blocked, while vulnerabilities in medical devices could be exploited to cause patients serious harm. The report says, “health care cybersecurity is a key public health concern that needs immediate and aggressive attention.”

Prior to writing the report, the HCIC Task Force consulted experts from other critical infrastructure sectors and received briefings on strategies and safeguards that could be implemented to address key cybersecurity threats. The Task Force also spoke with stakeholders on the challenges faced by the healthcare industry.

One of the key problems identified in those discussions is severe budgetary constraints. That means healthcare organizations are faced with a choice of purchasing cybersecurity technologies to secure networks and data or buying new, much needed medical equipment or paying staff costs.

However, if vulnerabilities are not addressed and action not taken to improve security the safety of patients will be placed at risk.

In a recent blog post, Steve Curren, Director of the Division of Resilience in ASPR’s Office of Emergency Management, said “The Office of the Assistant Secretary for Preparedness and Response understands that healthcare facilities are facing these challenges right now and we have developed a collection of peer-reviewed resources on cybersecurity to help healthcare industry stakeholders better protect against, mitigate, respond to, and recover from cyber threats, in order to better defend patient safety and operational continuity.“

Task Force Co-Chairs Emery Csulak and Theresa Meadows explained that “While much of what we recommend will require hard work, difficult decisions, and commitment of resources, we will be encouraged and unified by our shared values as health care industry professionals and our commitment to providing safe, high quality care.”

In the report, the HCIC Task Force made several recommendations to improve healthcare cybersecurity and detailed six high-level imperatives:

 

The authors say, “The successful implementation of these recommendations will require adequate resources and coordination across the public and private sector. Once implemented, the recommendations will increase security for the health care industry’s organizations, networks, and associated medical devices.”

The report has changed little from the pre-release version released early last month. The final version of the 88-page report can be viewed on this link.

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Seton Healthcare Family Hospitals Targeted by Cybercriminals

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Ascension Health, which runs the Seton Healthcare Family hospital network in Austin, TX, announced earlier this week that a computer virus had been discovered on its computer network. The hospital network was alerted to a potential cyberattack on Sunday when ‘suspicious activity’ was detected on the network.

In response to the suspected cyberattack, Seton Healthcare shut down around 3,600 devices as a precautionary measure while the incident was investigated. The suspicious activity was attributed to a virus, although no details have been released on the nature of the malware.

IT teams worked quickly to remove the virus and secure its network. The computer systems used by Dell Seton Medical Center and Dell Children’s Medical Center were quickly restored, although Seton Medical Center Williamson and Seton Medical Center Hays continued to be impacted by the incident until Wednesday, May 31. The Seton Smithville Regional Clinic and Seton Shoal Creek facility were unaffected.

The fast response by Seton Healthcare reduced the impact of the cyberattack. Staff had been drilled to expect incidents such as this and policies and procedures could be quickly implemented in case of malware, ransomware or hacking incidents. As this incident shows, healthcare organizations need to be prepared for security incidents and have the capability to respond rapidly.

A statement about the incident was issued earlier this week by Ascension Health confirming there were “no patient safety issues” and “no devices have been reported as encrypted by ransomware.” Systems were shut down as a safety precaution, with staff members moving to paper records while systems were down and the virus was removed. Ascension Health said “The attempt was unsuccessful, so no data was encrypted or lost.”

Out of an abundance of caution, emergency medical services were instructed to redirect some patients to other hospitals during the seven hours that the systems were down on Sunday night out of safety concerns. Additional members of staff were also called in to ensure patient safety was not affected.

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OCR Reminds Covered Entities of Security Incident Definition and Notification Requirements

Posted by HIPAA Journal

The ransomware attacks and high number of healthcare IT security incidents last month has prompted the Department of Health and Human Services’ Office for Civil Rights to issue a reminder to covered entities about HIPAA Rules covering security breaches.

In its May 2017 Cyber Newsletter, OCR explains what constitutes a HIPAA security incident, preparing for such an incident and how to respond when perimeters are breached.

HIPAA requires all covered entities to implement technical controls to safeguard the confidentiality, integrity and availability of electronic protected health information (ePHI). However, even when covered entities have sophisticated, layered cybersecurity defenses and are fully compliant with HIPAA Security Rule requirements, cyber-incidents may still occur. Cybersecurity defenses are unlikely to be 100% effective, 100% of the time.

Prior to the publication of OCR guidance on ransomware attacks last year, there was some confusion about what constituted a security incident and reportable HIPAA breach. Many healthcare organizations had experienced ransomware attacks, yet failed to report those incidents to OCR or notify patients that their ePHI may have been accessed.

OCR has reminded covered entities in its newsletter of the HIPAA definition of a security incident. The HIPAA Security Rule (45 CFR 164.304) describes a security incident as “an attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with system operations in an information system.”

OCR has taken the opportunity to remind covered entities that they need to prepare for those incidents. Policies and procedures should be developed that kick into action immediately following the discovery of a security incident or data breach.

If covered entities react quickly to security incidents and data breaches it is possible to minimize the impact and reduce legal liability and operational and reputational harm. Contingency plans should exist for a range of security incidents and emergency situations. OCR says “policies, procedures, and plans should provide a roadmap for implementing the entity’s incident response capabilities.”

When a breach occurs, the HIPAA Breach Notification Rule requirements must be followed. The HIPAA Breach Notification Rule (45 CFR 164.402) requires OCR to be notified of a breach and notifications to be sent to patients in the event of “an impermissible acquisition, access, use, or disclosure under the HIPAA Privacy Rule that compromises the security or privacy of the protected health information.”

Each month, Databreaches.net tracks healthcare data breach incidents, with the Protenus Breach Barometer report showing the time taken for covered entities to report their breaches to OCR. The past few reports show some improvement, with covered entities reporting their breaches more promptly. That said, there have been several cases where data breach notifications have been submitted late and patients have had their notification letters delayed.

OCR reminds covered entities that the HIPAA deadline for reporting security incidents and sending notifications to patients/health plan members is 60 days* from the discovery of the breach.

This is a deadline, not a recommendation. Many covered entities delay issuing notifications until day 59. OCR points out that the HIPAA Breach Notification Rule requires notifications to be issued “without reasonable delay.”

If you missed the email newsletter, you can download a copy on this link: https://www.hhs.gov/sites/default/files/may-2017-ocr-cyber-newsletter.pdf

*Breaches impacting fewer than 500 individuals can be reported to OCR annually, with the deadline 60 days after the end of the year when the breach was discovered. Breaches impacting 500 or more individuals must be reported to OCR within 60 days of the discovery of the breach. Individuals must be notified of a breach of PHI or ePHI within 60 days of the discovery of the breach, regardless of how many individuals have been impacted by the breach.

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Study Uncovers More Than 8,000 Security Flaws in Pacemakers from Four Major Manufacturers

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Over the past 12 months, security vulnerabilities in implantable medical devices have attracted considerable attention due to the potential threat to patient safety.

Last year, MedSec conducted an analysis of pacemaker systems which revealed security vulnerabilities in the Merlin@home transmitter and the associated implantable cardiac devices manufactured by St. Jude Medical. Those vulnerabilities could potentially be exploited to cause device batteries to drain prematurely and the devices to malfunction.

A recent study of the pacemaker ecosystem has uncovered a plethora of security flaws in devices made by other major manufacturers. Those flaws could potentially be exploited to gain access to sensitive data and cause devices to malfunction.

Billy Rios and Jonathan Butts, PhD., of security research firm WhiteScope has recently published a white paper detailing the findings of the study.

The pair conducted an analysis of seven cardiac devices from four major device manufacturers. The researchers evaluated home monitoring devices, implantable cardiac devices and physician programmers, with most effort concentrated on four programmers with RF capabilities.

All of the devices under study were obtained from auction sites such as eBay, even though the devices are supposed to be controlled and returned to the manufacturer or hospital when no longer required. The report explained that all of the manufacturers under test had home monitoring equipment listed for sale on public auction sites. The researchers found security flaws existed on all pacemaker systems under study.

The filesystems used by the pacemaker systems were unencrypted, with data stored on removable media. Some of the devices stored highly sensitive data such as medical histories and Social Security numbers, yet the data were not encrypted to prevent unauthorized access.

The pacemaker systems allowed physicians to reprogram the devices without authentication and pacemaker programmers did not authenticate with pacemaker devices. The researchers explained that any pacemaker programmer could be used to reprogram any pacemaker from the same manufacturer.

The software used by the pacemaker systems was discovered to contain more than 8,000 known vulnerabilities in third-party libraries across all the devices. One vendor had 3,715 vulnerabilities in its third-party libraries. The researchers said it was clear there was “an industry wide issue associated with software security updates.”

The study also revealed firmware used by the devices was not cryptographically signed, therefore it would be possible to replace firmware with a custom firmware.

Rios and Butt said, “The findings are relatively consistent across the different vendors,” and recommended “vendors evaluate their respective implementations and validate that effective security controls are in place to protect against identified deficiencies that may lead to potential system compromise.”

The researchers did not disclose the specifics of the vulnerabilities, although they were passed to the Department of Homeland Security’s ICS-CERT, while a report has been submitted to “the appropriate agency” about the discovery of Social Security numbers and other sensitive data from a patient of a prominent east coast hospital.

The researchers now plan to evaluate the home monitoring systems associated with implantable cardiac devices.

The report – Security Evaluation of the Implantable Cardiac Device Ecosystem Architecture and Implementation Interdependencies – can viewed on this link.

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Molina Healthcare Patient Portal Discovered to Have Exposed Patient Data

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Earlier this month, security researcher Brian Krebs was alerted to a flaw in a patient portal used by True Health Group that allowed patients’ test results to be viewed by other patients. While patients were required to login to the patient portal before viewing their test results, a security flaw allowed then to also view other patients’ results.

Now, the Medicaid and Affordable Care Act Insurer Molina Healthcare is investigating a similar flaw in its patient portal that has allowed the sensitive medical information of patients to be accessed by unauthorized individuals. In the case of Molina Healthcare, patients’ medical claims could be accessed without authentication.

Brian Krebs contacted Molina Healthcare to alert the company to the flaw. An investigation was conducted and its patient portal was shut down while the issue was resolved.

It is unclear for how long the flaw existed, whether medical claims had been viewed by unauthorized individuals, and if so, how many patients had their privacy violated. Potentially, the flaw resulted in the exposure of all customers’ medical claims. Molina Healthcare serves 4.8 million individuals in 12 states and Puerto Rico.

The individuals who identified the flaw and reported the issue to Brian Krebs was able to demonstrate it was possible to access other patients’ names, addresses, birthdates, medical procedure codes, prescribed medications and other sensitive data related to health complaints. Anyone with a link to a medical claim could change a digit in the URL and view other individuals’ medical claims.

In contrast to the security flaw at True Health, Brian Krebs said anyone with a link to a medical claim would be able to access the URL without any authentication required. The link could be clicked and the medical claim could be viewed.

On Friday last week, Molina Healthcare issued a statement saying “We are in the process of conducting an internal investigation to determine the impact, if any, to our customers’ information and will provide any applicable notifications to customers and/or regulatory authorities.”

Molina Healthcare has also engaged the services of Mandiant to improve its system security. Molina Healthcare says the security vulnerability in the patient portal has now been remediated.

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US-CERT: Patch Samba Now to Address Wormable Code Execution Bug

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A worldwide cyberattack in a similar vein to the WannaCry ransomware attacks on Friday 12, May could be repeated using a different Windows Server Message Block vulnerability. US-CERT has issued a security alert about the SMB flaw advising organizations to apply a patch as soon as possible to fix the vulnerability.

The vulnerability, which is being tracked as CVE-2017-2764, affects Samba 3.5.0 and later versions. Samba provides Windows-style file and print services for Linux and Unix servers and is based on the Windows SMB file-sharing protocol.

US-CERT says the flaw is a remote code execution vulnerability that could be exploited by “a malicious client to upload a shared library to a writable share, and then cause the server to load and execute it.” If the flaw is exploited, an attacker could run arbitrary code with root-level permissions.

Ars Technica says the flaw can only be exploited on un-patched computers if port 445 is open to the Internet and if a machine permits permanent write privileges from a shared file with a known or guessable server path.

A patch has been issued to fix the vulnerability in Samba versions 4.4 and later, although organizations that are unable to apply the patch can fix the vulnerability without applying the patch. The workaround involves adding “nt pipe support = no” to the global section of smb.conf and restarting the smbd daemon.

The fix prevents clients from accessing named pipe endpoints, although US-CERT warns that the workaround may also disable some functionality for Windows clients.

Samba is also used on NAS devices, often without users’ knowledge. NAS environments are commonly used to store backup files. If the flaw was exploited in a similar fashion to the May 12 attacks and ransomware is installed, backups could be rendered useless. Organizations should therefore ensure that at least one copy of a backup file is stored on an offline, unnetworked device.

The wormable-code execution bug has existed for 7 years and there are currently more than 104,000 Internet-exposed devices that are vulnerable to attack according to cybersecurity firm Rapid7. A proof-of-concept exploit is believed to be available, although no attacks have been detected to date.

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Medical Device Security Testing Only Performed by One in Twenty Hospitals

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The security of medical devices has attracted a lot of attention in recent months due to fears of device vulnerabilities being exploited by cybercriminals to cause harm to patients, gain access to healthcare networks and steal patient data.

Cybercriminals have extensively targeted the healthcare industry due to the high value of patient data on the black market, combined with relatively poor cybersecurity defenses. While there have been no reported cyberattacks on medical devices with the specific aim of causing harm to patients, there are fears it is only a matter of time before such an attack occurs.

Even if harming patients is not the goal of cybercriminals, ransomware attacks – which take essential computer systems out of action – can place patient safety at risk. Those attacks are already occurring. Some healthcare providers experienced medical device downtime as a result of the recent WannaCry ransomware attacks.

Much attention has focused on device manufacturers for failing to incorporate appropriate security protections to prevent cyberattacks and not considering security for the life cycle of the devices. However, a recent Synopsis-sponsored survey conducted by the Ponemon Institute suggests healthcare delivery organizations may be equally at fault.

The report on the survey – Medical Device Security: An Industry Under Attack and Unprepared to Defend –  shows that both device manufacturers and healthcare organizations are concerned that medical device attacks will occur. 67% of medical device manufacturers and 56% of healthcare delivery organizations believe a cyberattack on a medical device at their organization is likely to occur in the next 12 months.

Even though manufacturers and HDOs are aware of the risks of cyberattacks on medical devices, and one third are aware that those attacks could have an adverse effect on patients, only 17% of device manufacturers and 15% of HDOs are taking action to reduce the risk of cyberattacks on medical devices used by their organizations.

One of the biggest challenges is incorporating security controls into the devices. 80% of device manufacturers said medical devices are very difficult to secure, with a lack of knowledge about how to secure the devices cited as a major issue along with accidental coding errors and pressure to meet product delivery deadlines.

Identifying potential vulnerabilities does not appear to be a major priority. 53% of HDOs and 43% of device manufacturers said they do not perform any medical device security tests, while just 9% of device manufacturers and 5% of HDOs conduct device security tests on an annual basis.

There is also a lack of accountability for medical device security. One third of manufacturers and HDOs said there is no one person in their organization with overall responsibility for medical device security.

The U.S. Food and Drug Administration (FDA) has been conducting workshops with device manufacturers and industry stakeholders to try to determine how medical devices can best be protected; however, the survey suggests that FDA guidance would not be sufficient in itself. Only 51% of manufacturers and 44% of HDOs said they follow current FDA guidance on mitigating medical device security risks.

Ponemon Institute Chairman and founder, Larry Ponemon, said “According to the findings of the research, attacks on devices are likely and can put patients at risk. Consequently, it is urgent that the medical device industry makes the security of its devices a high priority.”

 

Mike Ahmadi, global director of critical systems security for Synopsys’ Software Integrity Group explained the need for urgent change, saying “The industry needs to undergo a fundamental shift, building security into the software development lifecycle and across the software supply chain to ensure medical devices are not only safe, but also secure.”

The survey was conducted in two parts on 550 individuals in North America who had a direct role in the security of medical devices and/or networking equipment and mobile medical apps related to medical devices.

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