Healthcare Cybersecurity

Critical Vulnerabilities identified in MesaLabs Laboratory Temperature Monitoring System

Five vulnerabilities have been identified in the MesaLabs AmegaView continuous monitoring system used in hospital laboratories, forensics labs, and biotech firms. Two of the flaws are critical command injection vulnerabilities with CVSS severity scores of 9.9/10 and 10/10. The vulnerabilities affect AmegaView Versions 3.0 and prior and were identified by Stephen Yackey of Securifera.

In order of severity, the vulnerabilities are as follows:

  • CVE-2021-27447 – CVSS 10/10 – Flaw due to improper neutralization of special elements used in a command, which could allow an attacker to execute arbitrary code.
  • CVE-2021-27449 – CVSS 9.9/10 – Flaw due to improper neutralization of special elements used in a command, which could allow an attacker to execute commands in the web server.
  • CVE-2021-27445 – CVSS 7.8/10 – Insecure file permissions which could be exploited to elevate privileges on the device.
  • CVE-2021-27451 – CVSS 7.3/10 – Improper authentication due to passcodes being generated by an easily reversible algorithm, which could allow an attacker to gain access to the device.
  • CVE-2021-27453 – CVSS 7.3/10 – Authentication bypass issue that could allow an attacker to gain access to the web application.

There are currently no public exploits that specifically target these vulnerabilities. Since AmegaView reaches end-of-life at the end of this year, MesaLabs has taken the decision not to release patches to correct the vulnerabilities. Instead, all users of the vulnerable products have been advised to upgrade to newer Viewpoint software compatible with AmegaView hardware.

Should this not be possible, or until it is, it is recommended to locate vulnerable products behind firewalls and to isolate them from the network and ensure they are not accessible from the Internet. If remote access is required, Virtual Private Networks (VPNs) should be required for access, and VPNs should be updated to the most current version.

Prior to implementing any new defensive measures, an impact analysis and risk assessment should be performed.

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FBI Warns of Ongoing Exploitation of Fortinet Vulnerabilities by APT Actors

The Federal Bureau of Investigation (FBI) has issued a Flash Alert warning users of Fortinet Fortigate appliances that Advanced Persistent Threat (APT) groups are targeting devices that have not been patched for three CVEs: CVE-2018-13379, CVE-2019-5591, and CVE-2020-12812.

These are not zero-day vulnerabilities, as patches have been available for some time. Many organizations have been slow to apply the patches and are now being targeted. In early April, the FBI, in conduction with the DHS’ Cybersecurity and Infrastructure Security Agency (CISA) issued a Joint Cybersecurity Advisory warning that the vulnerabilities could be exploited by threat actors to conduct data exfiltration, data encryption, and to pre-position for follow-on attacks.

In the recent Flash Alert, the FBI confirmed that an APT actor has been attempting to exploit the vulnerabilities since at least May 2021, and almost certainly exploited the vulnerabilities to gain access to a webserver hosting the domain for a U.S. municipal government. In that instance, the threat actors most likely created a new account – named elie – for conducting further malicious activities on the network.

Attacks exploiting the vulnerabilities do not appear to be targeted on any specific industry sector, instead the APT actor is simply attempting to exploit unpatched vulnerabilities. To date, victims have been in a broad range of industry sectors.

The APT actor creates new user accounts on domain controllers, servers, workstations, and the active directories. In addition to creating accounts named elie and WADGUtilityAccount, new accounts have been created to look similar to legitimate existing accounts on the network and have been specific to each victim organization.

The APT actor is known to make modifications to the Task Scheduler that may display as unrecognized scheduled tasks or ‘actions’, in particular, associated with SynchronizeTimeZone. Several tools have been used in the attacks, including Mimikatz for credential theft, MinerGate for cryptocurrency mining, WinPEAS for privilege escalation, SharpWMI for Windows Management Instrumentation, BitLocker for data encryption, and FileZilla for file transfers, with outbound FTP transfers identified over port 443.

Users of Fortigate appliances should ensure that patches are applied as soon as possible to correct the above vulnerabilities, and non FortiOS users should add key artifact files used by FortiOS to execution denylists to block any attempts to run FortiOS and its associated files.

Since exploitation may have already occurred, system administrators should review domain controllers, servers, workstations, and active directories for new or unrecognized user accounts and Task Scheduler should be reviewed for any unrecognized scheduled tasks. The FBI also recommends manually reviewing operating system defined or recognized scheduled tasks for unrecognized “actions.” Antivirus logs should also be reviewed for indications that they were unexpectedly turned off.

Further mitigations to deal with the threat are detailed in the Flash Alert, a copy of which is available from the American Hospital Association on this link.

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SolarWinds Orion Hackers Targeting U.S. Organizations with New Spear Phishing Campaign

Microsoft has discovered a large-scale spear phishing campaign being conducted by the Russian Advanced Persistent Threat (APT) group behind the SolarWinds Orion supply chain attack.

The spear phishing campaign has been active since at least January 2021 and the APT group, tracked by Microsoft as Nobelium. The APT group has been experimenting and has trialed various delivery techniques, including leveraging the Google Firebase platform to deliver a malicious ISO file via HTML email attachments that deliver a variety of malware payloads.

Nobelium escalated the campaign on May 25, 2021 when it started using the Constant Contact mass-mailing service to distribute messages to targets in a wide range of industry verticals. The latest campaign targeted around 3,000 individual accounts across 150 organizations, most of which were in the United States. Each target had its own unique infrastructure and tooling, which has helped the group stay under the radar.

The attackers gained access to the Constant Contact account of the U.S. Agency for International Development (USAID) and delivered spear phishing messages under the guise of a USAID Special Alert. The messages have a reply-to address on the usaid.gov domain and were sent from the in.constantcontact.com domain.

Example Phishing email. Source: Microsoft

The messages claimed “Donald Trump has published new documents on election fraud”, with the messages including a button to click to view the documents. If the recipient clicks the link in the email, they are directed to the legitimate Constant Contact service, and then redirected to a URL under the control of Nobelium that delivers a malicious ISO file. Within the ISO file are a decoy document, a .lnk shortcut that executes a Cobalt Strike Beacon loader, and a malicious DLL file that is a Cobalt Strike Beacon loader and backdoor dubbed NativeZone by Microsoft.

Once the payloads are deployed, Nobelium gains persistent access to compromised systems and can subsequently complete further objectives such as lateral movement, data exfiltration, and the delivery of additional malware.

A previous campaign in May also used the combination of HTML and ISO files, which dropped a .NET first-stage implant – TrojanDownloader:MSIL/BoomBox – that was used for reconnaissance and to download additional malicious payloads from Dropbox.

The phishing campaign is being investigated by the Cybersecurity and Infrastructure Security Agency (CISA) and the Federal Bureau of Investigation (FBI). Constant Contact issued a statement confirming that the account credentials of one of its customers were compromised. “This is an isolated incident, and we have temporarily disabled the impacted accounts while we work in cooperation with our customer, who is working with law enforcement,” said Constant Contact.

Microsoft has warned that the tactics, techniques, and procedures used by Nobelium have had a high rate of evolution. “It is anticipated that additional activity may be carried out by the group using an evolving set of tactics,” warned Microsoft.

Microsoft has published Indicators of Compromise (IoCs) and has suggested several mitigations that can reduce the impact of this threat, including the use of antivirus software, enabling network protection to prevent applications or users from accessing malicious domains, and implementing multi-factor authentication to prevent the use of compromised credentials.

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Healthcare Organizations Facing Higher Cyber Insurance Costs for Less Coverage

The number of cyberattacks now being reported is higher than ever before. A couple of years ago, healthcare cyberattacks were being reported at a rate of one per day, but in 2021, there have been months where attacks have been reported at twice that rate.

The severity of cyberattacks has also increased and the cost of responding to and recovering from cyberattacks is now much higher. The likelihood of a serious cyberattack occurring and the high costs of remediating such an attack have prompted many healthcare organizations to take out a cyber insurance policy to cover the cost.

The Government Accountability Office (GAO) has recently published a study of the cyber insurance market as required by the National Defense Authorization Act for Fiscal Year 2021. GAO conducted the study of the cyber insurance market to identify key trends and the challenges faced by insurers and the options available to address them.

GAO studied cyber insurance policies, reports on cyber risk and cyber insurance from researchers, think tanks, and the insurance industry, and interviews were conducted with treasury officials and two industry associations representing cyber insurance providers, an organization providing policy language services to insurers, and one large cyber insurance provider.

GAO found the number of insurance clients that hold a cyber insurance policy has increased from 26% in 2016 to 47% in 2020 – an increase of more than 60%. As demand for cyber insurance has increased, so too have insurance premiums. The increase in attack frequency and severity has seen insurance premiums increase dramatically. According to the study, more than half of cyber insurance clients saw their insurance premiums increase by between 10% and 30% in late 2020.

Insurance costs have increased, but coverage has decreased. In certain industry sectors, including healthcare and education, insurers have reduced coverage limits, meaning victims of cyberattacks often have to cover part of the cost themselves.

Many insurers have stopped including coverage for cyberattacks within their existing policies and instead now offer policies specific to cyber risk, but there have been several challenges in creating these policies. Without access to comprehensive, high quality data on losses due to cyberattacks, the insurance industry has found it difficult to price policies appropriately. Industry stakeholders have suggested federal and state governments and industries should collect and share data on incident response, which will help the insurance industry develop better insurance products and price them accordingly.

There have also been problems with the definitions used and what exactly is covered by a cyber insurance policy. For instance, many policies cover cyberterrorism, but it is unclear exactly what cyberterrorism includes. Industry stakeholders have called for better definitions of cyberattacks to be developed to help both insurers and their clients understand exactly what is covered by insurance policies.

GAO found that many businesses, especially smaller businesses, are underestimating their cyber risks and the amount of insurance coverage they need. Researchers also identified many businesses that have failed to take out a policy as they have not understood the magnitude of risks they face, and do not see the value in cyber insurance as they do not believe it will cover the cost of a cyberattack because there are too many exclusions. Better definitions of cyberattacks and exactly what is covered could help these businesses take out the coverage they need.

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FBI Warns of Ongoing Conti Ransomware Attacks on Healthcare Organizations and First Responders

The Federal Bureau of Investigation (FBI) has issued a TLP:WHITE Flash notice about ongoing Conti ransomware attacks targeting healthcare and first responder networks. According to the FBI, the Conti ransomware gang has attacked 16 healthcare and first responder organizations in the United States.

In addition to healthcare providers, the gang has attempted ransomware attacks on 911 dispatch centers, emergency medical services, law enforcement agencies and municipalities. The gang is known to have conducted attacks on 400 organizations worldwide, including a recent attack on the Health Service Executive (HSE) and Department of Health (DoH) in Ireland. To date, the gang has claimed 290 victims in the United States.

Conti ransomware is believed to be operated by the Russian cybercrime group Wizard Spider and is a ransomware-as-a-service (RaaS) operation. The threat group is known for attacking large organizations and issuing huge ransom demands, which have been as high as $25 million. The ransom demand set for each victim based on the extent of the encryption and the perceived ability of the victim to pay.

As is common now with ransomware attacks, the Conti ransomware gang exfiltrates sensitive data prior to file encryption and threatens to sell or publish the data if the ransom is not paid. Victims are given 8 days to make payment, although if attempts have not been made by the victims to get in touch with the gang, contact is often made using Voice Over Internet Protocol (VOIP) services or encrypted email such as ProtonMail after 2-8 days to pressure victims into paying.

Attacks usually start with phishing emails that include weaponized hyperlinks or email attachments or the use of stolen Remote Desktop Protocol (RDP) credentials. Prior to the disruption of the Emotet botnet, the attackers used malicious Word documents with embedded PowerShell scripts, first to stage Cobalt Strike and then to deploy the Emotet Trojan onto the network, which allowed the threat group to deliver their ransomware payload. The group has also been known to use the TrickBot Trojan in their attacks. The time from the initial compromise to the deployment of ransomware is usually between 4 days and 3 weeks, with the ransomware payload often delivered using dynamic link libraries (DLLs).

The threat group uses living-off-the-land techniques to escalate privileges and move laterally within networks, such as Sysinternals and Mimikatz. After encrypting files, the gang often remains in the network and beacons out using Anchor DNS. Remote access tools used by the gang beacon out to domestic and international VPS infrastructure over posts 80, 443, 8443, with port 53 often used for persistence. Indicators of attacks in progress include the creation of new accounts and the installation of tools such as Sysinternals, along with disabled detection and constant HTTP and DNS beacons.

The FBI does not recommend paying ransoms as payment does not guarantee the recovery of files nor the sale or publication of stolen data. The FBI has requested all victims of Conti ransomware attacks share information about the attacks with the FBI including boundary logs showing communications to and from foreign IP addresses, Bitcoin wallet information, decryptor files and/or benign samples of encrypted files.

The FBI has published several mitigations that can be implemented to harden defenses against Conti and other ransomware attacks.  These include:

  • Regularly back up data, test backups, and store backups on air-gapped devices.
  • Retain multiple copies of sensitive and proprietary data on servers that are physically separate and cannot be accessed from the systems where data resides.
  • Implement network segmentation.
  • Use multi-factor authentication.
  • Patch and update systems, software, and firmware promptly.
  • Use strong passwords and regularly change passwords for network systems and accounts.
  • Disable hyperlinks in inbound email.
  • Add email banners to all inbound emails from external sources.
  • Conduct regular user account audits for accounts with administrative privileges.
  • Only use secure networks and avoid public Wi-Fi networks.
  • Use a VPN for remote access.
  • Ensure all members of the workforce are provided with regular security awareness training.

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U.S Advances 5 Bills to Improve Cyber Defenses of SLTT Governments and Critical Infrastructure Entities

In the wake of the SolarWinds Supply chain attack, ransomware attack on Colonial Pipeline, and President Biden’s cybersecurity executive order, the U.S. House Committee on Homeland Security has cleared five bipartisan bills that seek to address cybersecurity and improve the defenses of state, local, tribal, and territorial (SLTT) governments and critical infrastructure entities.

The cyberattack on Colonial Pipeline forced the company to shut down its 5,500-mile fuel pipeline that delivers 45% of the fuel required by the East Coast. In order to speed up recovery and minimize disruption, Colonial Pipeline’s CEO Joseph Blount authorized the payment of a $4.4 million ransom to the DarkSide ransomware gang; however, even though the ransom was paid, the fuel pipeline remained shut down for 5 days, causing major disruption to fuel supplies.

These attacks have highlighted major vulnerabilities in cybersecurity defenses which need to be addressed to improve national security.

The five bipartisan cybersecurity bills advanced this week are:

  • The Pipeline Security Act (H.R. 3243)
  • The State and Local Cybersecurity Improvement Act (H.R. 3138)
  • The Cybersecurity Vulnerability Remediation Act (H.R. 2980)
  • The CISA Cyber Exercise Act (H.R. 3223)
  • The Domains Critical to Homeland Security Act (H.R. 3264)

The Pipeline Security Act (H.R. 3243), introduced by Congressman Emanuel Cleaver (D-MO), had previously been introduced two years ago but failed to gain traction. The main purpose of the reintroduced bill is to codify the role of the Transportation Safety Administration (TSA) in securing the nation’s natural gas and oil infrastructure to guard pipeline systems against cyberattacks, terrorist attacks, and other threats.

The State and Local Cybersecurity Improvement Act (H.R. 3138), introduced by Congresswoman Yvette D. Clarke (D-NY), authorizes the creation of a new $500 million grant program that will provide funds to SLTT governments to help them secure their networks from ransomware and other types of cyberattacks.

The Cybersecurity Vulnerability Remediation Act (H.R. 2980), introduced by Congresswoman Sheila Jackson Lee (D-TX), gives the DHS’ Cybersecurity and Infrastructure Security (CISA) Agency the authority to assist critical infrastructure owners and operators in developing mitigation strategies to protect against known, critical vulnerabilities.

The CISA Cyber Exercise Act (H.R. 3223), introduced by Congresswoman Elissa Slotkin (D-MI), creates a National Cyber Exercise program within CISA that will ensure more frequent testing of preparedness and resilience to cyberattacks on critical infrastructure.

The Domains Critical to Homeland Security Act (H.R. 3264), introduced by Ranking Member John Katko (R-NY), gives the DHS the authority conduct research and development into supply chain risks for critical domains of the United States economy, and send the results to Congress.

A further two bills were introduced that tackle non-cybersecurity issues – the DHS Blue Campaign Enhancement Act (H.R. 2795) and the DHS Medical Countermeasures Act” (H.R. 3263) – which strengthen DHS’ human trafficking prevention efforts and DHS’ medical countermeasures following chemical, biological, radiological, nuclear, or explosive attacks, disease outbreaks and pandemics.

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Ransomware Gangs Adopt Triple Extortion Tactics

Following on from the DarkSide ransomware attack on Colonial Pipeline, several ransomware threat actors have ceased activity or have implemented rules that their affiliates must follow, including banning all attacks on critical infrastructure firms, healthcare organizations, and government organizations.  Some popular hacking forums are distancing themselves from ransomware and have banned ransomware groups from advertising their RaaS programs. However, there are many threat actors conducting attacks and not all are curbing their activities. It remains to be seen whether there will be any reduction in attacks, even in the short term.

So far in 2021, attacks have been occurring at record levels, with the healthcare and utility sectors the most targeted. An analysis of attacks by Check Point Research found that since the start of April 2021, ransomware attacks have been occurring at a rate of around 1,000 per week, with a 21% increase in impacted organizations in the first trimester of 2021 and 7% more in April.

The number of attacked organizations is up 102% from the corresponding period in 2020 and in April 2021, an average of 109 ransomware attacks were reported by healthcare organizations every week, with 59 attacks per week on the utilities sector and 34 in legal/insurance. Ransom payments have also increased and are up 171% from the same time last year, with the average payment now $310,000.

Since early 2020, ransomware threat groups have been using double extortion tactics to increase the probability of victims paying the ransom. Instead of simply encrypting files and demanding payment for the keys to decrypt data, prior to data encryption, the attackers exfiltrate any sensitive data they can find. Threats are then issued to publish the data if payment is not made.

Now, a new tactic has been detected by researchers at Check Point – triple extortion attacks. As with the double extortion tactics of breaching a healthcare network, exfiltrating data, and demanding a ransom for the keys to decrypt files and prevent the sale or publication of stolen data on leak sites, some threat groups are also targeting individuals whose data has been stolen. They too are issued with a ransom demand to prevent their personal and health data from being sold or put in the public domain.

This tactic has been observed since late 2020 and has continued to gain traction in 2021, with the first known case affecting the Vastaamo Clinic in Finland in October 2020. In that case, the attackers stole large amounts of data and issued ransom demands to the clinic and patients, with the latter including a threat to publish their psychotherapy notes if they failed to pay to prevent the data leak.

While the REvil ransomware operation did not issue demands for payment from individuals, their tactics have included contacting individuals by telephone to alert them to the attack to pile on the pressure on the breached entity to pay up.

“We can only assume that creative thinking and a wise analysis of the complex scenario of double extortion ransomware attacks have led to the development of the third extortion technique,” explained Check Point Research. “Third-party victims, such as company clients, external colleagues and service providers, are heavily influenced, and damaged by data breaches caused by these ransomware attacks, even if their network resources are not targeted directly… Such victims are a natural target for extortion, and might be on the ransomware groups’ radar from now on.”

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CISA Issues Guidance on Evicting Adversaries from Networks Following SolarWinds Attacks

The Cybersecurity and Infrastructure Security Agency (CISA) has published guidance on evicting threat actors from networks compromised in the SolarWinds Orion supply chain attacks and, including subsequent compromises of Active Directory and M365 environments.

The attacks have been attributed to threat actors tied to the Russian Foreign Intelligence Service (SVR). After gaining network access through the update mechanism of SolarWinds Orion, the threat actor selected targets of interest for further compromise and bypassed multi-factor authentication methods and moved laterally into Microsoft 365 environments by compromising federated identity solutions. Most of the targets selected for further compromise were government departments and agencies and critical infrastructure organizations, although private sector organizations may also have experienced more extensive compromises.

The guidance applies to evicting adversaries from on-premises and cloud environments and includes a 3-phase remediation plan. CISA notes that malicious compromises are unique to each victim, so careful consideration must be given to each of the steps and the guidance then applied to the unique environment of each breached entity to ensure success.

All three phases are required to fully evict an adversary from either on-premises or cloud environments, so shortcuts should not be taken. The failure to follow all steps could result in substantial, long-term undetected Advanced Persistent Threat (APT) activity, prolonged theft of data, and erosion of public trust in victims’ networks.

The guidance provides the plan for evicting adversaries from a network, but does not provide specific details on how the required actions should be taken.

Any attempt to evict an adversary from the network requires a pre-eviction phase, an eviction phase, and a post-eviction phase. The pre-eviction phase is concerned with confirming tactics, techniques, and procedures (TTTPs) associated with the attacks and fully investigating the true scope of compromise. During the remediation process, steps will be taken to improve security and build more resilient networks; however, the eviction process is complex, time-consuming, and will require business networks to be disconnected from the Internet for 3-5 days.

A thorough risk assessment must be conducted prior to any eviction attempt to understand the potential impacts on critical business functions. There will likely be disruption to business operations, so it is essential that the remediation efforts are properly planned, the impact on the business is fully understood, and appropriate resources are made available to limit disruption.

After completing all eviction steps, entities enter into the post-eviction phase which involves confirming the adversary has been evicted. This phase includes integrating detection mechanisms, configuring endpoint forensics and detection solutions for aggressive collection, and maintaining vigilance, with steps taken over the 60 days after completing the eviction phase.

“In the hours, days, and weeks after the network’s internet connection is restored, the agency’s detection capability will be important in verifying that all threat actor activity within the enterprise has stopped,” explained CISA. “Extended vigilance is necessary because this threat actor has demonstrated extreme patience with follow-on activity.”

CISA’s Eviction Guidance for Networks Affected by the SolarWinds and Active Directory/M365 Compromise can be found on this link.

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April 2021 Healthcare Data Breach Report

April was another particularly bad month for healthcare data breaches with 62 reported breaches of 500 or – the same number as March 2021. That is more than 2 reported healthcare data breaches every day, and well over the 12-month average of 51 breaches per month.

Healthcare data breaches in the past 12 months

High numbers of healthcare records continue to be exposed each month. Across the 62 breaches, 2,583,117 healthcare records were exposed or compromised; however, it is below the 12-month average of 2,867,243 breached records per month. 34.4 million healthcare records have now been breached in the past 12 months, 11.2 million of which were breached in 2021.

Healthcare records breached in the past 12 months

Largest Healthcare Data Breaches Reported in April 2021

There were 19 reported data breaches in April that involved more than 10,000 records, including 7 that involved more than 100,000 records with all but one of the top 10 data breaches due to hacking incidents.

Ransomware attacks continue to occur at high levels, with many of the reported attacks affecting business associates of HPAA-covered entities. These incidents, which include attacks on Netgain Technologies, Accellion, and CaptureRX, have affected multiple healthcare provider clients.

The majority of ransomware attacks now involve data theft prior to file encryption, with the stolen data used as leverage to get breach victims to pay. Large quantities of data are stolen in the attacks. The top three data breaches of the month all involved the use of ransomware and involved 1.3 million healthcare records.

There has been some positive news this month. In the wake of the ransomware attack on Colonial Pipeline, multiple ransomware gangs appear to have ceased operations and at least two have now taken the decision not to attack healthcare organizations. This news should naturally be taken with a large pinch of salt, as similar promises were made by certain ransomware gangs at the start of the pandemic and attacks continued at high levels.

Name of Covered Entity Covered Entity Type Business Associate Involvement Individuals Affected Type of Breach Reported Cause of Breach
Trinity Health Business Associate Yes 586,869 Hacking/IT Incident Ransomware (Accellion)
Bricker & Eckler LLP Business Associate Yes 420,532 Hacking/IT Incident Ransomware
Health Center Partners of Southern California Business Associate Yes 293,516 Hacking/IT Incident Ransomware (Netgain Technologies)
Total Health Care Inc. Health Plan No 221,454 Hacking/IT Incident Phishing
Wyoming Department of Health Health Plan No 164,010 Unauthorized Access/Disclosure Exposure of PHI over Internet
Home Medical Equipment Holdco, LLC Healthcare Provider No 153,013 Hacking/IT Incident Phishing
Health Aid of Ohio, Inc. Healthcare Provider No 141,149 Hacking/IT Incident Unspecified hacking and data exfiltration attack
Woodholme Gastroenterology Healthcare Provider No 50,000 Hacking/IT Incident Unspecified hacking and data exfiltration attack
Neighborhood Healthcare Healthcare Provider Yes 45,200 Hacking/IT Incident Ransomware (Netgain Technologies)
Crystal Lake Clinic PC Healthcare Provider No 37,331 Hacking/IT Incident Not confirmed
RiverSpring Health Plans Health Plan No 31,195 Hacking/IT Incident Phishing
Middletown Medical Imaging Healthcare Provider No 29,945 Hacking/IT Incident Exposure of PHI over Internet
St. John’s Well Child and Family Center, Inc. Healthcare Provider No 29,030 Hacking/IT Incident Unspecified hacking and data exfiltration attack
MailMyPrescriptions.com Pharmacy Corporation Healthcare Provider No 24,037 Hacking/IT Incident Phishing
Squirrel Hill Health Center Healthcare Provider No 23,869 Hacking/IT Incident Malware
Eastern Shore Rural Health System Inc. Healthcare Provider Yes 23,282 Unauthorized Access/Disclosure Not confirmed
Faxton St. Luke’s Healthcare Healthcare Provider Yes 17,656 Hacking/IT Incident Ransomware (CaptureRX)
Midwest Transplant Network, Inc. Healthcare Provider No 17,580 Hacking/IT Incident Ransomware
Baptist Health Arkansas Healthcare Provider Yes 16,765 Hacking/IT Incident Hacking of business associate (Foley & Lardner, LLP)

Causes of April 2021 Healthcare Data Breaches

Hacking/IT incidents, which include malware and ransomware attacks, dominated the breach reports in April 2021 and accounted for 67.74% of all reported breaches (42 incidents). These incidents involved 85.93% of all breached records in April. The mean breach size was 52,851 records and the median breach size was 6,563 records.

There were 17 incidents classed as unauthorized access/disclosures involving 358,870 records – 13.89% of all records breached in April. The mean breach size was 21,110 records and the median breach size was 2,704 records.

Loss and theft incidents continue but only at very low levels. There were just two reported cases of theft of devices containing PHI and one loss incident reported. 4,500 records were breached in these 3 incidents.

April 2021 Healthcare Data Breach  causes

Network server incidents, most of which involved ransomware or malware, have overtaken phishing as the main cause of healthcare data breaches, although it should be noted that phishing emails are often the root cause of many ransomware attacks. There were 19 reported incidents involving PHI in email accounts, the majority of which were due to phishing or other forms of credential theft. One of the largest reported breaches in April was due to phishing and resulted in the exposure and potential theft of the PHI of 221,454 individuals.

April 2021 Healthcare Data Breaches - location of PHI

According to the Verizon 2021 Data Breach Investigations Report, phishing attacks increased globally by 11% in 2020 and ransomware attacks increased by 6%. The report shows insider breaches in healthcare have continued to fall and are now not even in the top three breach causes. In 2020, 61% of healthcare data breaches were due to external threat actors and 39% were caused by insiders.

April 2021 Healthcare Data Breaches by Covered Entity Type

Healthcare providers were the worst affected covered entity with 30 data breaches of 500 or more records reported by the provider and a further 13 reported by a vendor. Business associate data breaches continue to be reported at high levels. There were 24 breaches involving business associates, with 10 of those breaches reported by the covered entity. 9 branches were reported by health plans in April, with one breach affecting a health plan reported by its business associate.

States Affected by Healthcare Data Breaches

HIPAA-covered entities and business associates based in 28 states reported breaches of protected health information in April. California was the worst affected state with 7 breaches reported followed by Michigan and Texas with 5 breaches. Florida, New York, and Wisconsin had 4 breaches, and there were 3 reported breaches in Massachusetts and Ohio.

Wyoming, the least populated U.S. state, only had one reported breach, but it affected a quarter of state residents.

State No. Reported Data Breaches
California 7
Michigan and Texas 5
Florida, New York, & Wisconsin 4
Massachusetts & Ohio 3
Georgia, Illinois, Minnesota, Missouri, New Mexico, Pennsylvania, and Vermont 2
Alabama, Arkansas, Colorado, Kansas, Maryland, Montana, North Carolina, New Hampshire, New Jersey, Oregon, Tennessee, Virginia, & Wyoming 1

HIPAA Enforcement Activity in April 2021

It has been a busy year of HIPAA enforcement by the HHS’ Office for Civil Rights with 6 financial penalties imposed to resolve violations of the HIPAA Rules; however, there were no new settlements or civil monetary penalties announced in April, nor any enforcement actions by state Attorneys General.

 

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