Healthcare Cybersecurity

Purple Move on WiFi Security Sets Example for All Public WiFi Deployments

Posted by HIPAA Journal

Wireless networks offer many benefits to healthcare organizations. Healthcare professionals can access networks and data from any location using portable devices, without the need to plug in to the network. Many medical devices connect wirelessly to WiFi networks improving clinical workflows. However wireless networks can also introduce risks.

If any PHI is transmitted over wireless networks, HIPAA requires appropriate controls to be applied to safeguard the confidentiality, integrity and availability of PHI.

If WiFi networks lack appropriate security, unauthorized individuals could intercept WiFi packets and view sensitive data, including protected health information. Securing internal WiFi networks is therefore essential. The failure to secure WiFi networks would place an organization at risk of a HIPAA penalty.

The risk of a HIPAA violation or data breach is a real concern for healthcare organizations. Security concerns have prevented many hospitals from offering WiFi access to patients, even though offering WiFi can improve the patient experience.

Many healthcare organizations that have taken the decision to allow patients access to WiFi networks and have reduced risk by keeping WiFi access for guests totally separate from networks used by hospital staff.

While this will allow healthcare organizations to solve some security issues, guest WiFi access can be abused. WiFi networks can be used to view inappropriate material, users face a risk of malware and ransomware infections, and there is potential for man-in-the-middle attacks to occur.

Organizations can take steps to secure their WiFi networks to keep users protected and reduce security risks. A WiFi filtering solution is the typical solution to block a wide range of online threats such as phishing attacks, malware and ransomware downloads.

Purple, the intelligent spaces company, recently chose a WiFi content filtering solution to ensure its customers and clients were protected. Any users of the secured WiFi network are prevented from accessing malicious websites where malware or ransomware could be downloaded and inappropriate or illegal website content is blocked.

Purple used the WebTitan WiFi content filtering solution from TitanHQ to secure its networks and keep its customers protected. James Wood, Head of Integration at Purple said, “We take guest Wi-Fi security seriously so it was important that our customers were protected.” The decision was taken in the wake of recent cyberattacks to improve security for users.

Figures from TitanHQ show how important it is to implement a WiFi filtering solution, with 60,000 malware threats detected and blocked by the web filtering solution each day. As TitanHQ CEO Ronan Kavanagh pointed out, “Internet filtering controls provide a key layer of security, which is particularly beneficial for healthcare organizations following recent targeted attacks on the healthcare sector.”

While there is no obligation for hospitals to offer a filtered Internet service for guest users, if WiFi access is to be provided, it is now easy to secure those networks and provide a better service, including controls to prevent minors from accessing inappropriate content.

Kavanagh explained that secured, content-controlled WiFi networks are fast becoming the norm. “Content filtering for Wi-Fi will be a given in service terms over the next few years.”

If patients are to be offered free or paid internet access in hospitals, those services should include filters to prevent networks from being abused and to ensure the Internet can be accessed safely and securely.

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HIPAA Enforcement Update Provided by OCR’s Iliana Peters

Posted by HIPAA Journal

Office for Civil Rights Senior Advisor for HIPAA Compliance and Enforcement, Iliana Peters, has given an update on OCR’s enforcement activities in a recent Health Care Compliance Association ‘Compliance Perspectives’ podcast.

OCR investigates all data breaches involving the exposure of theft of more than 500 healthcare records. OCR also investigates complaints about potential HIPAA violations. Those investigations continue to reveal similar non-compliance issues. Peters said many issues come up time and time again.

Peters confirmed that cases are chosen to move on to financial settlements when they involve particularly egregious HIPAA violations, but also when they relate to aspects of HIPAA Rules that are frequently violated. The settlements send a message to healthcare organizations about specific aspects of HIPAA Rules that must be addressed.

Peters said one of the most commonly encountered problems is the failure to conduct a comprehensive, organization-wide risk assessment and ensure any vulnerabilities identified are addressed through a HIPAA-compliant risk management process. Several recent settlements have highlighted just how frequently HIPAA covered entities get risk assessments wrong, either failing to conduct them at all, not conducting them frequently enough or conducting them to the standard demanded by HIPAA.

Peters pointed out that privacy violations are occurring frequently, with many HIPAA-covered entities still unsure of the allowable uses and disclosures of PHI. OCR recently announced two settlements have been reached with covered entities that have impermissibly disclosed patients’ health information to employers and the media.

Peters explained that the healthcare industry is not doing a good job at preventing cybersecurity incidents and that warrants attention, but it is important for OCR not to just focus on the hot topics and ‘sexy’ issues. OCR is also focussed on the lack of safeguards for paper records and the failure to secure removable media.

In the case of the latter, there have been numerous instances where ePHI has been exposed as a result of the failure to use encryption. Peters pointed out that if “[a device] can walk away from your enterprise, it will walk away.” OCR has settled cases with several organizations in recent months as a result of the lack of appropriate safeguards and policies and procedures covering removable devices.

Peters explained that OCR has been working on sharing penalties or other recoveries with individuals that have been harmed by privacy violations, although that has been a challenging process as it is difficult to determine and quantify harm. OCR is working on an advanced notice of proposed rulemaking and will be seeking advice from the public on how funds should be shared.

OCR is also working on initiatives to improve privacy protections at non-HIPAA covered entities. For instance, patients are being encouraged to share their health data with research organizations and through the “All of Us” initiative. For those programs to be as successful as they should be, patients need to be sure their data will be protected. OCR is providing advice to organizations and partners to ensure that patient data are protected, even if they are collected and stored by non-HIPAA-covered entities.

Peters also spoke of dealing with Certified EHR technology and how HIPAA applies to cloud computing, malware, and ransomware.

You can listen to the Compliance Perspectives podcast via this link.

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Security Gaps Found in Virginia Medicaid Claims Processing Systems

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Last week, the Department of Health and Human Services’ Office of Inspector General released a report of an audit of Virginia Medicaid’s claims processing systems. The audit uncovered several vulnerabilities that left the data of Medicaid beneficiaries exposed. OIG investigators determined that Virginia had not secured its Medicaid data to an acceptable standard in line with Federal requirements.

The report does not detail the specific vulnerabilities OIG discovered, as that would potentially allow those flaws to be exploited, although full details of the findings of the audit have been submitted to the Department of Medical Assistance Services (DMAS) – the entity that administers and supervises the state Medicaid program. OIG has also provided several recommendations for improving the security of its information systems.

The audit involved a review of information system general controls, including conducting staff interviews, reviewing policies and procedures and conducting a vulnerability scan of network devices, servers, databases and websites.

Even though a security program had been adopted for the DMAS Medicaid Management Information System (MMIS), several vulnerabilities had not been addressed. Those vulnerabilities were allowed to persist as a result of insufficient controls over Medicaid data and systems, and a lack of oversight over its contractors to ensure sufficient security measures had been applied.

The vulnerabilities were severe in some cases, potentially allowing Medicaid data to be accessed and critical Medicaid operations to be disrupted. Together, the vulnerabilities could have compromised the integrity of the Virginia Medicaid program. However, OIG uncovered no evidence to suggest that the vulnerabilities had already been exploited.

OIG made several recommendations in various areas including the risk management process, system and information integrity controls, audit and accountability controls, system and communication protection controls and configuration management controls. OIG also recommended access and authentication controls be augmented.

Virginia concurred with all of the recommendation and has developed an action plan to implement those recommendations and correct all vulnerabilities that have yet to be addressed.

While the specific vulnerabilities discovered by OIG were not disclosed in the report, they all fall within areas that other private and public sector organizations have experienced problems with in the past.

Recent healthcare data breaches have also resulted from unaddressed vulnerabilities in similar areas. The recent WannaCry ransomware attacks have shown that vulnerabilities can all too easily be exploited by threat actors.

Healthcare organizations should therefore conduct periodic risk assessments – as required by the HIPAA Security Rule – and conduct vulnerability scans to determine whether any vulnerabilities exist. Organizations must then ensure any identified are vulnerabilities are addressed, prioritising the critical vulnerabilities that have the highest potential of being exploited and those that are likely to cause the most damage.

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Leading Cause of Healthcare Data Breaches in April was Hacking

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The monthly Breach Barometer Report from Protenus shows a significant reduction in the number of exposed healthcare records in April, with 232,060 records exposed compared to more than 1.5 million in March. The number of reported data breaches also fell from 39 to 34.

The report offers some further good news. The time taken by healthcare organizations to report security incidents also fell last month. 66% of breaches were reported within the 60-day time period allowed by the Health Insurance Portability and Accountability Act Breach Notification Rule. While it is good news that the trend for reporting data breaches more promptly is continuing, there is still plenty of room for improvement.

Protenus reports that in April, it took an average of 51 days from the date of the breach to discovery, and an average of 59 days from the discovery of a breach to the submission of a breach report to the HHS’ Office for Civil Rights.

The data for the Protenus Breach Barometer report was supplied by Databreaches.net, which uncovered one of the worst breaches of the year to date. The theft of psychotherapy notes, substance abuse histories, health histories and the personally identifiable information of 4,229 patients of Bangor Health Center in Maine. That incident was one of 16 hacking incidents reported in April.

Hacking/IT incidents were cited as the cause of 47% of data breaches reported in April, followed by insider incidents (29%), and loss and theft of devices/PHI (15%). The cause of 9% of the breaches is currently unknown.

Hacking was the cause of the largest data breach of the month. The incident, which was reported by Harrisburg Gastroenterology, affected 93,323 individuals.

Out of the 16 hacking/IT incidents reported in April, five were related to ransomware infections and three incidents were phishing attacks. There were five breaches due to insider errors and four incidents involving insider wrongdoing.

While the majority of data breaches involved electronic protected health information, healthcare organizations must ensure appropriate controls are in place to secure physical PHI. Five of the breaches reported in April involved the theft or exposure of physical PHI.

There were two business associate data breaches in April and two reported by health plans. The majority of the breaches (79.41%) were reported by healthcare providers.

Texas was the worst affected state with 4 breaches, followed by Michigan, Ohio and New York, each with three incidents.

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Healthcare Cybersecurity Needs Immediate and Aggressive Attention, says HCIC Task Force

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Earlier this month, the Health Care Industry Cybersecurity (HCIC) Task Force issued a pre-release copy of its upcoming report on improving healthcare cybersecurity. In the report the Task Force calls for ‘immediate and aggressive attention’ to tackle growing healthcare cybersecurity threats.

The HCIC Task Force was formed by Congress to address the challenges healthcare organizations face securing and protecting against intentional and unintentional cybersecurity incidents. Those incidents are a major public health concern.

Few would argue that was not the case. Just a matter of days after the report was issued, a massive global ransomware attack occurred. While U.S healthcare organizations appear to have escaped relatively unscathed, that was not the case in the United Kingdom. More than a week after many NHS Trusts had computers encrypted by ransomware, some hospital services are still being disrupted.

The report details six imperatives for improving healthcare cybersecurity and provides a number of recommendations for the healthcare industry to improve resilience against cyberattacks.

HCIC’s 6 imperatives are:

  1. Define and streamline leadership, governance, and expectations for health care industry cybersecurity.
  2. Increase the security and resilience of medical devices and health IT.
  3. Develop the health care workforce capacity necessary to prioritize and ensure cybersecurity awareness and technical capabilities.
  4. Increase health care industry readiness through improved cybersecurity awareness and education.
  5. Identify mechanisms to protect research and development efforts and intellectual property from attacks or exposure.
  6. Improve information sharing of industry threats, weaknesses, and mitigations.

The HCIC Task Force recommends the HHS establishes a ‘cybersecurity leader’ role to oversee and guide cybersecurity efforts in the healthcare sector and suggests a new version of the National Institute of Standards and Technology (NIST) Cybersecurity Framework should be developed specifically for the healthcare industry.

The past 18 months have seen an increase in financial settlements between the HHS’ Office for Civil Rights and healthcare organizations to resolve HIPAA violations discovered during data breach investigations. However, the Task Force suggests that regulators should adopt “a more lenient approach” to security breaches that have resulted from errors to encourage the sharing of information about data breaches. If information sharing is encouraged without fear of financial repercussions, it will make it easier for the healthcare industry to learn from the mistakes of others.

To improve medical device security the Task Force is says there needs to be greater cooperation between device manufacturers and healthcare providers to inventory and secure legacy systems. Devices must also be equipped with stronger authentication controls and new strategic and architectural approaches are required to reduce the attack surface. Vendors also need to be more transparent about cybersecurity protections for the entire life cycle of medical devices.

The Task Force calls for healthcare organizations to hire qualified cybersecurity professionals and install them in leadership positions with overall responsibility for cybersecurity. However, healthcare organizations are struggling to recruit and retain cybersecurity professionals. There is a major staff shortage and not enough CISOs to fill all of the available positions. That situation must improve.

Education on the cybersecurity risks faced by healthcare organisations needs to be improved at the C-Suite level and more tools are required to help organizations manage and assess the cybersecurity protections that have been put in place. Further academic research is also needed to identify new methods of protecting healthcare information.

One key recommendation is to provide healthcare organizations with actionable intelligence that allows them to take rapid action to respond to current threats. The Task Force says there must be greater information sharing across the healthcare industry. Threat information also needs to be packaged in a way that allows individuals with part-time cybersecurity responsibilities to quickly act on intelligence and mitigate risk.

The full report is due to be released in the next few days.

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Healthcare Organizations Reminded of HIPAA Rules Relating to Ransomware

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Following the recent WannaCry ransomware attacks, the Department of Health and Human Services has been issuing cybersecurity alerts and warnings to healthcare organizations on the threat of attack and steps that can be taken to reduce risk.

The email alerts were sent soon after the news of the attacks on the UK’s NHS first started to emerge on Friday May 12, and continued over the course of the week. The alerts provided timely and pertinent information for U.S. healthcare organizations allowing them to take rapid action to counter the threat.

While the Office for Civil Rights has previously sent monthly emails to healthcare organizations warning of new threats in its cybersecurity newsletters, the recent alerts were sent much more rapidly and frequently, with four email alerts and conference calls made with industry stakeholders alerting them to the imminent threat.

Whether this was a one off in response to a specific and imminent major threat or the HHS plans to issue more timely alerts remains to be seen. However, the rapid communication of the ransomware threat almost certainly helped many healthcare organizations take prompt action to reduce risk.

Fortunately, attacks on organizations in the United States appear to have been limited, with the Department of Homeland Security saying fewer than 10 U.S. companies have reported being attacked.

In the email alerts, healthcare organizations were reminded of the need to implement data security measures to reduce the risk of malware and ransomware attacks. OCR also issued guidance on HIPAA specific to the threat from WannaCry ransomware.

OCR reiterated that a ransomware attack that involved the encryption of patients ePHI is presumed to be a HIPAA breach, reminding covered entities to report attacks within 60 days, as is required by the HIPAA Breach Notification Rule.

OCR also advised healthcare organizations that breach reports– and patient notifications – are required if data have been compromised that have not been encrypted by the entity to NIST specifications.

In the event of a breach, covered entities were told to contact their local FBI filed office, submit details of the incident to the FBI’s Internet Crime Complaint Center and report the incident to US-CERT. OCR also emphasized that reporting ransomware attacks to other federal organizations or law enforcement bodies does not constitute a HIPAA-compliant breach report. OCR must be notified of the incident separately.

Threat intelligence sharing can prevent other organizations suffering similar attacks and OCR encourages the sharing of cyber threat information. However, the HIPAA Privacy Rule does not permit the sharing of PHI. When cyber threat information is shared with federal agencies, law enforcement, or an Information Sharing and Analysis Organization (ISAO), covered entities must ensure that PHI is not shared. Doing so would be a HIPAA violation and could result in action being taken against the organization in question.

OCR also reminded organizations that compliance with the HIPAA Security Rule helps covered entities prepare for ransomware attacks and respond appropriately if systems are compromised and data are encrypted.

Further information on HIPAA and ransomware attacks can be found in an OCR factsheet available on this link.

Healthcare organizations were also reminded that they can request and unauthenticated scan of their public IP addresses from the Department of Homeland Security.

US-CERT’s National Cybersecurity Assessment & Technical Services (NCATS) provides an objective third-party perspective on an organizations cybersecurity posture and can conduct a broad assessment scanning for known vulnerabilities at no cost to stakeholders. The service allows healthcare organizations to be proactive and take steps to reduce risk prior to exploitation by malicious individuals.  Requests can be made by emailing NCATS on NCATS_INFO@hq.dhs.gov

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Medical Device Cybersecurity Gaps Discussed at FDA Workshop

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This week, the U.S. Food and Drug Administration (FDA) is hosting a two-day workshop to identify current cybersecurity gaps that could be exploited by cybercriminals to gain access to medical devices and discuss best practices and tools that can be adopted to improve defenses against cyberattacks.

This is the third time the FDA has held such a workshop on medical device security and it comes at an appropriate time. The recent WannaCry ransomware attacks resulted in Siemens, Bayer and other manufacturers’ devices having data encrypted.

Cyberattacks on medical devices have potential to cause considerable harm to patients. Cybercriminals could also target medical devices to obtain sensitive information on patients or use the devices to launch attacks on healthcare networks.

This week, the attacks only resulted in data being encrypted. Bayer reported that both of the healthcare organizations that were affected were able to recover data and restore the functionality of their medical devices within 24 hours. The medical devices were not specifically targeted and the aim of the attacks was to encrypt data rather than steal information or cause patients to be harmed. That may not always be the case.

Studies have been conducted that demonstrated a theoretical risk of medical devices being hacked, and while the risk of cyberattacks on medical devices is likely to be low, this week’s incidents have clearly demonstrated that attacks are not only theoretical.

Medical devices now have the functionality to connect to healthcare networks and pass data directly to EHR systems, making them an attractive target for cybercriminals, even more so given the relative lack of security controls in place.

While there have been no reports of cyberattacks on medical devices being conducted that resulted in patients coming to harm, action does need to be taken now to ensure attacks cannot easily occur in the future. As the functionality of medical devices improves and new Smart devices come to market, the risk of cyberattacks is only ever likely to increase.

Progress is being made to improve medical device cybersecurity. Last week, the National Institute of Standards and Technology (NIST) issued new guidance for healthcare providers on securing wireless infusion pumps to prevent unauthorized access. However more needs to be done by manufacturers of the devices to improve security, something that the FDA is attempting to tackle.

At the workshop, the FDA, researchers and industry representatives discussed the challenges of securing medical devices and the possible tools and best practices that can be adopted to improve resilience against cyberattacks to prevent unauthorized access.

Many of the issues that were highlighted by the recent WannaCry attacks were raised at the meeting, including how to secure devices for their entire lifecycle, when the support for software on which the devices run often stops during the product lifecycle.

The workshop is continuing today with the discussions ongoing. A report on the outcome of the workshop will be published later this year.

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WannaCry Ransomware Encrypted Hospital Medical Devices

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The WannaCry ransomware attacks on NHS hospitals in the UK have been widely publicized, but the extent to which U.S. healthcare organizations were affected is unclear. However, news has emerged that WannaCry ransomware has been installed on hospital systems and succeeded in encrypted medical device data.

The ransomware targeted older Windows versions and more recent operating systems that had not been updated with the MS17-010 patch that addressed the exploited vulnerability in Server Message Block 1.0 (SMBv1). The attacks claimed more than 200,000 victims around the globe.

So far, two healthcare organizations in the United States have confirmed they experienced a WannaCry ransomware attack that affected Bayer MedRad devices. The devices are power injector systems used to monitor contrast agents administered to improve the quality of imaging scans, such as MRIs.

Bayer told Forbes, “If a hospital’s network is compromised, this may affect Bayer’s Windows-based devices connected to that network.” In both cases that were reported to Bayer, the issue was resolved within 24 hours and systems were brought back online.

Bayer is not the only device manufacturer that was affected by the ransomware attacks. According to HITRUST, reports were received from healthcare organisations that had Siemens devices encrypted by the ransomware. Siemens has not publicly confirmed that was the case with U.S hospitals, only that the company had been working with the NHS to help resolve the attacks.

HITRUST has been issuing updated information on the WannaCry ransomware attacks and confirmed that evidence has been uncovered suggesting other unnamed medical devices were impacted, in addition to Siemens and Bayer devices.

HITRUST also said indicators of compromise were confirmed via the HITRUST Enhanced IOC program well in advance of the attacks on Friday, pointing out that organizations that had already applied HITRUST CSF controls related to End Point protection and patch management would have appropriately addressed the threat – specifically Control References “09.j Controls Against Malicious Code” and “10.m Control of Technical Vulnerabilities.”

HITRUST also said organizations that leveraged the HITRUST CyberAid program have not been affected by the recent WannaCry ransomware attacks.

While the attacks using Friday’s WannaCry ransomware variant were halted after a researcher identified a kill switch, researcher Matt Suiche identified a second variant that referenced a different domain. He registered that domain and prevented attacks with the second variant, mostly in Russia.

Kaspersky Lab’s Costin Raiu said another version has been identified, with this one lacking the kill switch. While that version is spreading, it appears not to be capable of encrypting files as the ransomware component is corrupted.

What should be of particular concern, not just for healthcare organizations but all businesses, is a threat issued by Shadow Brokers – the group that released the ETERNALBLUE exploit used in Friday’s attacks. Shadow Brokers plans to release further exploits in a similar fashion on a monthly basis, including exploits for vulnerabilities in Windows 10.

Ransomware and other malware attacks on the same scale as WannaCry could become frequent events, highlighting the importance of updating software and applying patches promptly.

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WannaCrypt Ransomware Attacks Stopped, But Only Briefly

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The global WannaCrypt ransomware attacks that hit NHS Trusts in the UK hard on Friday have spread to the United States, affecting many U.S. organizations, including FedEx. Figures this morning indicate there were more than 200,000 successful attacks spread across 150 countries over the weekend.

Fortunately, the variant of the ransomware used in the weekend attacks has been neutralized. On Saturday afternoon, a blogger and security researcher in the UK identified a kill switch and was able to prevent the ransomware from claiming more victims.

While investigating the worm element of the ransomware campaign, the researcher ‘Malware Tech’ found a reference to a domain in the code. That domain had not been registered, so Malware Tech purchased and registered the domain. Doing so stopped the ransomware from encrypting files.

The ransomware performs a domain check prior to encrypting files. If the ransomware is able to connect with the domain in the code, the ransomware exists and does not encrypt any files. If the connection fails, the ransomware continues and starts encrypting files. The purpose of this check is believed to be an attempt to avoid analysis by security researchers.

The good news is that by registering the domain the ransomware attacks have been thwarted. The bad news is that while the version of the ransomware used in Friday’s attacks has been neutralized, a new version of the ransomware – without the kill switch – has reportedly been released already. Heimdal Security said a new version – a Uiwix strain – does not feature the kill switch.

Other security researchers have yet to confirm whether the new variant exists, but even if no new version has been released, it is only a matter of time before that happens.

WannaCrypt Ransomware Attacks Spread Like WildFire

The WannaCrypt ransomware attacks started in Europe with the NHS hit particularly hard. 61 NHS Trusts experienced ransomware infections, which spread rapidly through their networks encrypting all vulnerable devices. The attacks resulted in data being encrypted and computer and telephone systems being taken out of action. Hospitals were forced to cancel operations while IT teams worked around the clock to restore encrypted data. The NHS is still experiencing major disruptions to services.

The attacks took advantage of a vulnerability that was patched by Microsoft on March 13, 2017. Many organizations failed to install the update, even though the vulnerability was categorized as critical and an exploit for the vulnerability was released online last month.

Unfortunately for many organizations, the NHS included, the patch could not be applied to unsupported Windows versions such as Windows XP. Many hospitals still have computers running on the outdated Windows version, even though Microsoft stopped issuing patches on April 8, 2014. Many of the attacks affected older versions of Windows that could not be patched. Microsoft said in a recent blog post that the attacks were not performed on computers running Windows 10.

Microsoft Takes Unusual Step of Issuing a Patch for Unsupported Windows Versions

In response to the WannaCrypt ransomware attacks, Microsoft has taken a highly unusual step of issuing a patch for Windows XP, even though the operating system has not been supported for more than 3 years. The patch also addresses the vulnerability in Windows 8 and Windows Server 2003. Microsoft said in a blog post on the WannaCrypt ransomware attacks that “This decision was made based on an assessment of this situation, with the principle of protecting our customer ecosystem overall, firmly in mind.” Healthcare organizations should ensure the patch is applied promptly to prevent future attacks using the exploit.

Microsoft may have issued an emergency patch for unsupported Windows versions, although other vulnerabilities remain unpatched and could potentially be exploited. Any healthcare organization still using Windows XP or other unsupported software is therefore taking a big risk. Continued use of unsupported software is a recipe for disaster as well as a potential HIPAA violation.

Useful Links on the WannaCrypt Ransomware Attacks

US-CERT Ransomware Alert

FBI Indicators Associated With WannaCrypt Ransomware

HHS Update: International Cyber Threat to Healthcare Organizations

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