Healthcare Cybersecurity

Massive Ransomware Attack Hits NHS: Global Warning Issued as Attacks Spread

The UK’s National Health Service (NHS) has experienced its worst ever ransomware attack, with the infection rapidly spreading to multiple NHS trusts taking computer systems out of action and forcing hospitals to cancel operations.

The attack occurred on Friday and affected as many as 40 hospital trusts, causing chaos. The NHS has been working around the clock to bring its computer systems back online and to recover encrypted data.

The massive ransomware attack involved Wanna Decryptor 2.0 ransomware or WannaCry/WanaCryptor as it is also known. There is no known decryptor.

The attackers were threatening to delete data if the ransom was not paid within 7 days, with the ransom amount set to double in three days if payment was not made. The ransom demand was reportedly $300 (£230) per infected machine. NHS Trusts saw the ransomware infection rapidly spread to all computers connected to their networks.

While the NHS was one of the early victims, the attack has spread globally with the Spanish telecoms company Telefonica also hit, along with FedEx, Universities in China, the German Rail operator and the Russian Interior Ministry. Infections are still spreading globally at an alarming pace.

Avast has reported there have been at least 57,000 worldwide infections in 100 countries. Infections are expected to grow over the next few days. This is already the largest ransomware attack in history, according to Mikki Hypponen of F-Secure.

The Department of Health and Human Services and the Department of Homeland Security have issued alerts about the threat, with the HHS saying yesterday there is evidence of the attack affecting U.S organizations.

Laura Wolf, Critical Infrastructure Lead at the HHS advised all healthcare organizations to “exercise cyber security best practices – particularly with respect to email.”

While the ransomware variant has been spread via spam email, the massive global attack is believed to have involved an exploit called ETERNALBLUE. The exploit was released by Shadow Brokers last month, after allegedly being stolen from the NSA. The exploit has been combined with a self-replicating payload that spreads without any user action required.

The exploit is for a vulnerability in Server Message Block 1.0 (SMBv1), which was patched by Microsoft in March, 2017 (MS17-010).

Any organization that has not yet installed the patch is advised to do IMMEDIATELY.

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PHI of Thousands of Patients of Bronx Lebanon Hospital Center Exposed Online

Highly sensitive medical records of thousands of patients of New York’s Bronx Lebanon Hospital Center have been exposed online. Those records were reportedly accessible for three years as a result of a misconfigured backup server.

The exposed records were uncovered by researchers at the Kromtech Security Research Center after conducting a “regular security audit of exposed rsync protocols on Shodan,” a search engine that can be used to find networked devices. Rsync backup servers are used for transferring files between computer systems and for file syncing.

The records were not encrypted nor protected with a password and could have been downloaded by any individual who knew where to look.

It is currently unclear exactly how many patient records were exposed, with initial reports indicating tens of thousands of patients may have been affected. NBC’s Mary Emily O’Hara recently reported that the breach has impacted at least 7,000 individuals.

The misconfiguration allowed the researchers to view highly sensitive information including names, addresses, medical diagnoses, health histories and highly sensitive data including HIV statuses, reports of domestic violence, sexual assaults and addiction histories.

It was not initially clear to whom the data belonged, although the records were eventually traced to the Bronx Lebanon Hospital Center, with the backup device linked to iHealth Innovations, a Louisville, KY-based IT services and records management company.

In a recent blog post, MacKeeper researcher Bob Diachenko explained that efforts were made by Kromtech to contact the owners of the data, with assistance provided by Databreaches.net. In a statement provided to databreaches.net, Diachenko confirmed there has been no improper usage of the data by the Kromtech researchers.

While the majority of data appear to relate to patients of the Bronx Lebanon Hospital Center, it is unclear at this stage whether patients of other healthcare providers have also been affected.

iHealth has confirmed that a breach has occurred and the incident has been investigated. While the investigation is ongoing, iHealth says the investigation revealed that only one individual had accessed the data – the Kromtech researcher who discovered the error.

The server has now been reconfigured to prevent further access and the investigation is continuing, with a third-party cybersecurity company called in to validate iHealth’s analysis. The breach has been reported to law enforcement and Bronx Lebanon Hospital Center is assisting with the investigation.

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Guidance on Securing Wireless Infusion Pumps Issued by NIST

The National Institute of Standards and Technology (NIST), in collaboration with the National Cybersecurity Center of Excellence (NCCoE), has released new guidance for healthcare delivery organizations on securing wireless infusion pumps to prevent unauthorized access.

Infusion pumps, and many other medical devices, used to interact only with the patient and healthcare provider; however, advances in technology have improved functionality and now the devices can interact with a much wider range of healthcare systems and networks.  The additional functionality of the devices has allowed vulnerabilities to be introduced that could be easily exploited to cause patients to come to harm.

Wireless infusion pumps are of particular concern. Vulnerabilities could be exploited by malicious actors allowing drug doses to be altered, the functioning of the infusion pumps to be changed or patients’ protected health information to be accessed.  Typically, the devices have poor cybersecurity protections in place to prevent unauthorized access.

The risks introduced by the devices have been widely reported in recent years. While no cyberattacks are known to have resulted in patients coming to harm, there is considerable potential for malicious actors to hack the devices unless action is taken to improve device security.

The 246-page guidance on securing wireless infusion pumps was written following collaboration with a wide range of security companies following a January 2016 request submitted in the federal register.

NIST and NCCoE conducted questionnaire-based risk assessments to analyze risk factors and signed a Cooperative Research and Development Agreement with B. Braun Medical Inc, Baxter Healthcare Corporation, Becton, Dickinson and Company, Cisco, Clearwater Compliance, DigiCert, Hospira Inc., Intercede, MDISS, PFP Cybersecurity, Ramparts, Smiths Medical, Symantec Corporation, TDi Technologies, Inc., and The MITRE Corporation, all of which helped to develop an example solution.

The guidance offers best practices that can be adopted to improve the security of wireless infusion pumps, mitigate vulnerabilities and protect against threats. The document includes a list of potential vulnerabilities and a questionnaire-based risk assessment that can be used by healthcare organizations to identify risks. The risk assessment maps security characteristics to HIPAA Security Rule requirements and available cybersecurity standards.

“Based on our risk assessment findings, we apply security controls to the pump’s ecosystem to create a ‘defense-in-depth’ solution for protecting infusion pumps and their surrounding systems against various risk factors,” explained NIST in the guidance.

Several commercially available technologies and tools are available to healthcare organizations that allow them to plug vulnerabilities and make it harder for unauthorized individuals to gain access to the devices, some of which have been detailed in the report along with product installation guides and suggested configurations.

NIST says, “Ultimately, we show how biomedical, networking, and cybersecurity engineers and IT professionals can securely configure and deploy wireless infusion pumps to reduce cybersecurity risk.”

The guidance on securing wireless infusion pumps (NIST Special Publication 1800-8) can be downloaded on this link.

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Security Breach Highlights Need for Patient Portals to be Pen Tested

A range of safeguards must be implemented to ensure networks and EHRs are protected. Encryption should be considered to prevent the loss or theft of devices from exposing the ePHI of patients. However, it is important for healthcare organizations also check their patient portals for potential vulnerabilities and implement safeguards to prevent unauthorized disclosures of sensitive information.

The failure to implement appropriate safeguards on web-based applications can easily result in unauthorized disclosures of patients PHI, as was recently demonstrated at True Health Diagnostics.

The Frisco, TX-based healthcare services company offers testing for a wide range of diseases and genetic abnormalities, with test information available to patient via a web portal. The web portal allows patients to obtain their test results quickly. Patients are required to register and can only access their records if they first log in to the portal.

However, a flaw on the web portal allowed patients to access not only their own test results, but the test results and PHI of other patients. The website flaw was discovered by a Las Vegas IT consultant called Troy Mursch, who alerted Brian Krebs to the vulnerability last week.

Mursch discovered that after logging into the patient porta, he was able to access health records and medical test results of other patients. Mursch accessed his own test results, which were uploaded to the portal in PDF form but, by changing a digit in the URL, was able to view the medical information of other patients.

True Health Diagnostics used sequential numbers on their PDF files, which makes it easy for the URL to be altered and for other patients records to be viewed via a web browser. While the portal required users to be logged in to view test results, there appear to have been no controls in place to prevent a logged in user from accessing the records of other patients.

Krebs alerted True Health Diagnostics to the flaw and the web portal was immediately taken offline while the issue was resolved. The issue has now been fixed and the portal is now back online. An investigation has now been launched to determine whether any patient health information was accessed by unauthorized individuals. Should that be the case, patients will be notified.

In this case, the incident was identified and reported quickly, allowing rapid action to be taken to secure the records. However, Mursch noted that his test results from two years ago also appeared to have been numbered in the same manner, suggesting patient records could have been exposed for a number of years.

This incident should serve as a warning to covered entities that have implemented patient portals to ensure appropriate safeguards have been implemented to prevent unauthorized disclosures of PHI. Any web-based interface should be thoroughly checked, using penetration tests, to determine whether vulnerabilities exist. If a solution is purchased from a third party firm, a covered entity should determine the extent to which the system has been tested and should also consider verifying no vulnerabilities exist by conducting penetration tests.

OCR has taken action against covered entities in the past for the failure to secure PHI accessible via web-based interfaces, including a $1.7 million settlement with WellPoint and a $100,000 settlement with Phoenix Cardiac Surgery.

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Patient-Physician Texting to Be Covered at AMA Annual Meeting

Text messages are a quick and easy method of communication, although for healthcare professionals the use of SMS messages carries considerable privacy risks. While text messages can be used to communicate quickly with members of a care team, the inclusion of any protected health information (PHI) or personally identifiable information (PII) violates HIPAA Rules.

SMS texts are unencrypted, potentially allowing unauthorized individuals to access the messages and view the contents. SMS messages may also be stored on the servers of service providers. Those messages may remain on unsecured servers indefinitely.

Copies of SMS texts can remain on the sender’s and recipients phone. In the event that either the sender or recipient’s phone is lost or stolen, PHI/PII in messages may be exposed. With SMS messages, there are no HIPAA-compliant controls to verify the identity of the recipient or for the recipient to verify the identity of the sender.

The lack of safeguards in place to ensure the confidentiality and integrity of PHI and limited authentication controls means the sending of any PHI/PII over the SMS network is a violation of the HIPAA Security Rule.

Technology has advanced considerably in recent years and numerous secure text messaging platforms are now available that incorporate all of the necessary privacy, security, authentication controls required by HIPAA. By using such a platform to send messages securely, healthcare professionals can communicate quickly, easily, and securely without risking a HIPAA violation.

While those secure messaging platforms satisfy HIPAA requirements, the platforms have yet to be approved by the Joint Commission for texting patient care orders. While the ban on texting orders was temporarily lifted, it was soon put back in place over fears of patient safety. The use of secure texting platforms was also thought to place an increased and unnecessary burden on nurses required to enter texted information into EHRs.

Due to the ease of communication via text messages, many healthcare organizations allow physicians to communicate with patients via text. Patients may even prefer to use SMS messages rather than logging into patient portals or calling their healthcare providers.

As with text messages between healthcare professionals, the sending of PHI or PII via SMS to patients is also covered by HIPAA Rules. Any communications with patients via SMS have potential to risk the exposure of PHI and physicians and other healthcare professionals must exercise extreme caution.

Even with the potential privacy risks, the use of text messages for communicating with patients is increasing. This has prompted the American Medical Association (AMA) to discuss the issues surrounding the use of SMS messages and HIPAA-compliant texting platforms at next month’s AMA House of Delegates annual meeting.

The AMA has already issued guidance for healthcare providers on the use of email, although guidance on the use of text messages has not yet been issued. Current guidance is therefore expected to be expanded after the meeting to cover the use of text messaging between patients and physicians to help healthcare providers avoid privacy – and HIPAA – violations.

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180,000 Patient Records Dumped Online by The Dark Overlord

It is a nightmare scenario far worse than a ransomware attack. A hacker infiltrates your network, steals patient data and then threatens to publish those data if you do not pay a ransom.

That is the modus operandi of TheDarkOverlord, who conducted numerous attacks on healthcare organizations over the past few months. Sizable ransom demands were issued – which TDO referred to as ‘modest’ – with threats issued to sell or publish the data if the victims refused to pay or ignored the requests. Many healthcare organizations chose not to pay up.

TDO has now made good on his/her promise and has published the data of more than 180,000 patients online, several months after the attacks occurred.

Aesthetic Dentistry of New York City, OC Gastrocare of Anaheim, CA, and Tampa Bay Surgery Center in Tampa, FL have all had highly sensitive patient data published online last week . The data of 3,496 patients of Aesthetic Dentistry, 34,100 patients of OC Gastrocare, and 134,000 patients of Tampa Bay Surgery Center can now be freely downloaded. A link to the website where the data were dumped was sent out by TDO on Twitter last week.

At least nine healthcare organizations are known to have been attacked by TDO last year according to databreaches.net, which has been tracking the TDO attacks.

Some of those organizations have had their patient data listed for sale on the darknet marketplace, TheRealDeal. TDO claimed last year that buyers had been found for some of the stolen data. It is unclear whether attempts were made to sell the 180,000 patient records and no buyers could be found, hence the publication of the data.

None of the organizations impacted by the latest data dump have submitted breach reports to the Department of Health and Human Services’ Office for Civil Rights, although some of the other victims of TDO have issued breach reports to OCR and have notified their patients.

Extortion attempts – either using ransomware or threats of publication of data – have now become commonplace. The FBI recommends never paying a ransom demand as it only encourages further attacks. There is also no guarantee that payment of the ransom demand will see decryption keys issued or stolen data permanently and securely deleted.

It is likely that many patients whose data are stolen would also feel the same way about payment of the ransom demand. However, regardless of whether a ransom is paid, patients should be notified and allowed to take precautions to protect their identities and financial accounts. Failure to notify patients of such a data breach would be a violation of HIPAA Rules, and could see the organization in question issued with a sizable fine for non-compliance.

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NIST Small Business Cybersecurity Act of 2017 Approved by SST Committee

Cybercriminals may not be targeting small healthcare practices to the same extent as large health systems, but as the OCR’s data breach portal shows, cyberattacks on small healthcare organizations occur frequently.

When cyberattacks occur they can be catastrophic for small businesses. Figures from the National Cybersecurity Alliance suggest 60% of small businesses cease trading within 6 months of experiencing a cyberattack. Faced with the financial burden of resolving a data breach, it is no surprise that so many businesses fail to make it through the next six months.

In order to prevent cyberattacks and keep sensitive health data secure, small healthcare organizations must effectively manage cybersecurity risks. However, many cybersecurity resources and security frameworks have been developed for medium to large sized businesses. Smaller organizations typically lack the necessary resources to be able to implement highly effective cybersecurity defenses and few have skilled cybersecurity staff to monitor and manage cybersecurity risks.

NIST has developed a cybersecurity framework to help organizations protect critical infrastructure, and while adoption of the framework can be advantageous for many businesses, for smaller organizations the demands are too great.

Late last year, NIST released a new guide specifically to help small businesses improve their cybersecurity posture. The guide was based on the NIST Framework for Improving Critical Infrastructure Cybersecurity and outlined best practices and standards and explained how an information security program can be implemented that balanced security with the capabilities of small businesses. Now further guidance for small businesses will be issued, following the approval of new legislation by the U.S. House Committee on Science, Space, and Technology last week.

The NIST Small Business Cybersecurity Act of 2017 calls for the National Institute of Standards and Technology to provide small to medium sized businesses with new guidance to allow them to reduce cybersecurity risk.

The NIST Small Business Cybersecurity Act requires NIST to develop clear and concise guidelines and make available appropriate tools, best practices, standards and methodologies to help small businesses identify, assess, manage and reduce cybersecurity risks. Those tools and guidelines will be based on the NIST Framework for Improving Critical Infrastructure Cybersecurity.

The new act does not make it mandatory for small businesses to access and follow the new guidance and best practices, although using the new resources will help small businesses effectively manage risk and prevent data breaches. The guidance and best practices, when completed, will be made available through the NIST website.

According to Chairman Lamar Smith (R-Texas), “The NIST Small Business Cybersecurity Act will help ensure that our small businesses have the information they need to protect themselves from cyber-attacks.”

Due to a squeeze on spending at NIST, the costs of developing the new resources and guidelines will have to be found from its existing budget. NIST has been given a year to develop and release the new guidance and resources.

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NCCIC Warns of Highly Sophisticated Campaign Delivering Multiple Malware Variants

Homeland Security’s National Cybersecurity and Communications Integration Center (NCCIC) has issued an alert about an emerging sophisticated campaign affecting multiple industry sectors.

The attacks have been occurring for at least a year, with threat actors using stolen administrative credentials and certificates to install multiple malware variants on critical systems. A successful attack gives the threat actors full access to systems and data, while the methods used allow the attackers to avoid detection by conventional security solutions.

While many organizations have been attacked, one of the main targets has been IT service providers. Gaining access to their systems has allowed the actors to conduct attacks on their clients and gain access to their environments. The method of attack allows the actors to bypass conventional monitoring and detection tools and, in many cases, results in the attackers gaining full access to networks and stored data.

NCCIC is still investigating the campaign so full information is not yet available, although an advance warning has been issued to allow organizations to search for signs of a potential system compromise and take appropriate action to mitigate risk.

While multiple tactics, techniques and procedures are used in the campaign, credentials primarily are stolen using malware. Those credentials are then used to gain access to business environments. Once access has been gained, the attackers use PowerShell for reconnaissance, to assess business networks and move laterally within those networks.

Communication with the C2 uses RC4 cipher communications over port 443; however, the domains frequently change IP address, with domains commonly spoofed to make them appear as Windows update sites and other legitimate domains.

While many malware variants are used by the threat actors two of the most common variants are the REDLEAVES remote administration Trojan (RAT) and the sophisticated Remote Access Tool (RAT) PLUGX/SOGU, both of which are executed via DLL side-loading.

REDLEAVES is capable of passing a range of information about the user’s system and allows the attackers to run commands on the infected system. PLUGX provides the attackers with complete C2 capabilities including the ability to take screenshots and silently download files with all C2 communications encrypted to prevent detection.

NCCIC has compiled and published indicators of compromise (IOCs) to allow organizations to identify intrusions and malware infections. Organizations have been advised to continuously analyse their systems for those IOCs via their normal intrusion detection systems.

It may not be possible for organizations to prevent their systems from being attacked, but if appropriate defences are put in place it will make it much harder for the threat actors to infiltrate systems and operate undetected. NCCIC says no single set of defensive techniques will avert malicious activity; however, adopting a multi-layered approach to security will allow organizations to construct an effective barrier to prevent attacks.

IOCs, details of the attack methods and suggested mitigations are available for download from NCCIC on this link.

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Majority of Organizations Failing to Protect Against Mobile Device Security Breaches

A recent report published by Dimensional Research has highlighted the growing threat of mobile device security breaches and how little organizations are doing to mitigate risk.

Cybercriminals may view employees as one of the weakest links in the security chain, but mobile devices are similarly viewed as an easy way of gaining access to data and corporate networks.

According to the report, the threat of mobile cyberattacks in growing. Two out of ten companies have already experienced a mobile device cyberattack, although in many cases, organizations are not even aware that a cyberattack on a mobile device has occurred.

The survey, which was conducted on 410 security professionals, found that two thirds of respondents were doubtful they would be able to prevent a cyberattack on mobile devices and 51% believed the risk of data theft/loss via mobile devices was equal to or greater than the risk of data theft/loss from PCs and laptops. Yet, a third of respondents said they did not adequately protect mobile devices.

94% of respondents said cyberattacks on mobile devices will become more frequent while 79% said the already difficult task of securing mobile devices will become harder.

A broad range of attack methods are used to gain access to mobile devices and the networks and accounts to which they connect. Malware infections are most common cause of mobile device security breaches, being involved in 58% of attacks. Text message phishing attacks were reported by 54% of organizations as were man-in-the-middle attacks and connections to malicious Wi-Fi networks. Intercepted calls and text messages (43%) and keylogging and credential theft (41%) made up the top five attack methods.

Even though mobile device security breaches are occurring with increasing frequency, 38% of companies have yet to implement a dedicated mobile device security solution.

Virtually all staff members carry mobile phones at work. Many employees use them for work communications and to access sensitive data. While laptop computers are frequently lost or stolen and are often protected, the risk of mobile devices being lost or stolen is greater yet the devices are poorly protected.

When asked about the reasons why a mobile device security solution was not used, a lack of budget (53%) and shortage of resources (41%) were the primary reasons. For 37% of respondents, the perceived risk of a data breach or security incident did not justify the cost a dedicated security solution. However, 62% of companies are aware of the increasing risk of mobile device security breaches and are dedicating more funds to securing mobile devices.

Since the devices are likely to store far less data than desktops, the perceived cost of a mobile device breach may be lower. However, the survey revealed that IT security professionals did not believe that to be the case. 37% of respondents said a mobile data breach would likely cost the company more than $100,000 to resolve, with 23% expecting the cost to be in excess of $500,000.

David Gehringer, Principal at Dimensional Research said, “The research consistently revealed that the overall focus and preparedness of security for mobile devices is severely lacking,” and pointed out that “security professionals identified the risk of mobile devices, but focus and resources assignment seem to be waiting for actual catastrophes to validate the need to properly prepare their defenses.”

As we have already seen on countless occasions, such a strategy can prove costly. That cost is likely to be much higher than the cost of implementing a security solution to protect mobile devices.

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