Healthcare Cybersecurity

Hidden Backdoor Identified in 100,000 Zyxel Devices

Posted by HIPAA Journal

A vulnerability has been identified in Zyxel devices such as VPN gateways, firewalls, and access point (AP) controllers that could be exploited by threat actors to gain remote administrative access to the devices. By exploiting the vulnerability, threat actors would be able to make changes to firewall settings, allow/deny certain traffic, intercept traffic, create new VPN accounts, make internal services publicly accessible, and gain access to internal networks behind Zyxel devices. Around 100,000 Zyxel devices worldwide have the vulnerability.

Zyxel manufacturers networking equipment and its devices are popular with small to medium sized businesses and are also used by large enterprises and government agencies.

The vulnerability, tracked as CVE-2020-29583, was identified by Niels Teusink of the Dutch cybersecurity firm EYE, who discovered a hidden user account in the latest version of Zyxel firmware (4.60 patch 0).  The user account, zyfwp, which was not visible in the user interface of the products, was discovered to have a hardcoded plain-text password which Teusink found in one of the product binaries. The hardcoded administrative password was introduced in the latest version of the firmware.

Teusink was able to use the credentials to login to vulnerable devices over SSH and the web interface. Since the password is hardcoded, users of the devices are unable to change the password. An attacker could use the credentials to login remotely and compromise a vulnerable Zyxel device.

“As SSL VPN on these devices operates on the same port as the web interface, a lot of users have exposed port 443 of these devices to the internet,” said Teusink.

The vulnerability was reported to Zyxel and a patch has been released to correct the flaw. Zyxel explained that the account had been included to allow the company to deliver automatic firewall updates to connected access points through FTP.

The flaw is present in several Zyxel products including the Zyxel Advanced Threat Protection (APT) firewall, Unified Security Gateway (USG), USG Flex, and VPN version 4.60 and Zyxel AP Controllers NXC2500 and NXC5500 version 6.10.

The Multi-State Information Sharing and Analysis Center (MS-ISAC) issued an alert about the vulnerability which was rated high risk for large and medium government entities and large and medium business entities, and medium risk for small government entities and small business entities.

All users of the vulnerable products have been advised to apply the patch as soon as possible to prevent exploitation. While there have not been any reported cases of exploitation of the vulnerability in the wild, exploitation of the flaw is likely.

Affected product series Patch available in
Firewalls  
ATP series running firmware ZLD V4.60 ZLD V4.60 Patch1 in Dec. 2020
USG series running firmware ZLD V4.60 ZLD V4.60 Patch1 in Dec. 2020
USG FLEX series running firmware ZLD V4.60 ZLD V4.60 Patch1 in Dec. 2020
VPN series running firmware ZLD V4.60 ZLD V4.60 Patch1 in Dec. 2020
AP controllers

 

  
NXC2500 running firmware V6.00 through V6.10 V6.10 Patch1 on Jan. 8, 2021
NXC5500 running firmware V6.00 through V6.10 V6.10 Patch1 on Jan. 8, 2021

MS-ISAC has made the following recommendations to mitigate the threat.

  • Apply appropriate updates provided by Zyxel to vulnerable systems, immediately after appropriate testing.
  • Run all software as a non-privilege user (one without administrative privileges) to diminish the effects of a successful attack.
  • Remind users not to visit un-trusted websites or follow links provided by unknown or un-trusted sources.
  • Inform and educate users regarding the threats posed by hypertext links contained in emails or attachments especially from un-trusted sources.
  • Apply the Principle of Least Privilege to all systems and services.

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Largest Healthcare Data Breaches in 2020

Posted by HIPAA Journal

2020 was the worst ever year for healthcare industry data breaches. 616 data breaches of 500 or more records were reported to the HHS’ Office for Civil Rights. 28,756,445 healthcare records were exposed, compromised, or impermissibly disclosed in those breaches, which makes 2020 the third worst year in terms of the number of breached healthcare records.

The chart below clearly shows how healthcare industry data breaches have steadily increased over the past decade and the sharp rise in breaches in the past two years.

The Largest Healthcare Data Breaches in 2020

When a breach occurs at a business associate of a HIPAA-covered entity, it is often the covered entity that reports the breach rather than the business associate. In 2020, a massive data breach was experienced by the cloud service provider Blackbaud Inc. Hackers gained access to its systems and stole customer fundraising databases before deploying ransomware. Blackbaud was issued with a ransom demand and a threat that the stolen data would be released publicly if the ransom was not paid. Blackbaud decided to pay the ransom to prevent the exposure of client data. Blackbaud received assurances that the stolen data was permanently deleted and not been further disclosed.

The total victim count from the Blackbaud ransomware attack may never be known, but more than 6 dozen healthcare providers have reported being affected to date and over 8 million healthcare records have potentially been compromised. That breach clearly tops the list of the largest healthcare data breaches in 2020 and ranks as one of the largest healthcare data breaches of all time.

2020’s Largest Healthcare Data Breaches

The individual entities that reported data breaches in 2020 involving more than 300,000 healthcare records are listed below. In some cases, the actual data breach occurred prior to 2020, but was only discovered and reported in 2020.

Trinity Health – 3,320,726 Individuals

At more than 3.3 million records, Trinity Health was the worst affected healthcare victim of the ransomware attack on Blackbaud Inc. The hackers potentially obtained the philanthropy database of the Livonia, Michigan-based Catholic health system, which contained patient and donor information from 2000 to 2020.

MEDNAX Services, Inc. – 1,290,670 Individuals

Sunrise, FL-based MEDNAX Services Inc, a provider of revenue cycle management and other administrative services to its affiliated physician practice groups, suffered a breach of its Office 365 environment in June 2020 after employees responded to phishing emails. The breach was extensive, involving patient and guarantor information such as Social Security numbers, driver’s license numbers, and health insurance and financial information.

Inova Health System – 1,045,270 Individuals

Virginia-based Inova Health System was also a victim of the Blackbaud ransomware attack. The hackers gained access to Blackbaud’s systems on February 7, 2020 and the breach continued until May 20, 2020. Ransomware was deployed on May 14, 2020. Inova’s fundraising database was potentially compromised which contained patient and donor information.

Magellan Health Inc. 1,013,956 Individuals

Arizona-based Magellan Health was the victim of an April 2020 ransomware attack in which the protected health information of patients was potentially compromised. The attack ended with the deployment of ransomware but started with a spear phishing email. Several of its affiliated entities were also affected by the breach.

Dental Care Alliance – 1,004,304 Individuals

Sarasota, FL-based Dental Care Alliance, LLC, a dental support organization with more than 320 affiliated dental practices across 20 states, reported a breach of its systems in December. Few details have been released about the nature of the hacking incident as the investigation is still ongoing. The breach affected many of its affiliated dental practices.

Luxottica of America Inc. – 829,454 Individuals

Luxottica of America Inc., an operator of vision care facilities across the United States and owner of the eyewear brands Ray-Ban, Oakley, and Persol, experienced a cyberattack in August 2020 which saw hackers gain access to its web-based appointment scheduling system which contained the PHI of patients of its eye care partners.

Northern Light Health – 657,392 Individuals

The Maine health system Northern Light Health was also a victim of the ransomware attack on Blackbaud Inc. The hackers potentially gained access to its fundraising database which contained patient and donor information.

Health Share of Oregon – 654,362 Individuals

In May 2020, the Medicaid coordinated care organization Health Share of Oregon reported the theft of a laptop computer from its non-emergent medical transportation vendor. The laptop was stolen in November 2019 and was not encrypted, which potentially gave the thief access to patents’ contact information, Health Share ID numbers, and Social Security numbers.

Florida Orthopaedic Institute – 640,000 Individuals

Florida Orthopaedic Institute suffered a ransomware attack in April which saw patient information on its servers encrypted. Prior to the use of ransomware, patient data may have been viewed or obtained by the hackers.

Elkhart Emergency Physicians – 550,000 Individuals

Elkhart Emergency Physicians reported a breach in May 2020 involving the improper disposal of patient records by a third-party storage vendor – Central Files Inc. Elkhart Emergency Physicians was the worst affected entity, but several other clients of the vendor were also impacted by the breach. The records had been dumped without being shredded after the storage facility permanently closed.

Aetna ACE – 484,157 Individuals

Aetna reported a data breach in December which occurred at business associate EyeMed, which provides vision benefit services for its members. The breach occurred when an EyeMed employee responded to a phishing email, which allowed the attacker to gain access to email accounts containing PHI. Several EyeMed clients were affected by the breach.

Saint Luke’s Foundation – 360,212 Individuals

Kansas City, MO-based Saint Luke’s Foundation was also a victim of the ransomware attack on Blackbaud Inc. The hackers potentially gained access to its fundraising database which contained patient and donor information.

NorthShore University Health System – 348,746 Individuals

Evanston, IL-based NorthShore University Health System was also affected by the ransomware attack on Blackbaud Inc. The hackers potentially gained access to its fundraising database.

SCL Health Colorado – 343,493 Individuals

SCL Health Colorado was also a victim of the Blackbaud ransomware attack. The PHI of patients in its Colorado, Montana and Kansas locations was potentially accessed by the attackers.

AdventHealth – 315,811 Individuals

The Altamonte Springs, FL-based healthcare system AdventHealth was also a victim of the Blackbaud ransomware attack which saw the hackers gain access to its fundraising database.

Nuvance Health – 314,829 Individuals

Nuvance Health was a victim of the ransomware attack on Blackbaud Inc. The hackers potentially gained access to its fundraising database between February and May.

Magellan Rx Management – 314,704 Individuals

Magellan Rx Management was one of the victims of the ransomware attack on its parent company, Magellan Health, in April. The hackers potentially stole patient data prior to encrypting files.

The Baton Rouge Clinic – 308,169 Individuals

The Baton Rouge Clinic in Louisiana experienced a cyberattack in early July involving ransomware. The attackers potentially viewed or obtained patient data prior to the deployment of ransomware.

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CISA Launches SolarWinds Supply Chain Compromise Website and Free Malicious Activity Detection Tool

Posted by HIPAA Journal

The DHS’ Cybersecurity and infrastructure Security Agency has launched a website providing resources related to the ongoing cyber activities of the advanced persistent threat (APT) group responsible for compromising the SolarWinds Orion software supply chain.

The threat actors behind the attack gained access to the networks of federal, state, and local governments, critical infrastructure entities, and private sector organizations around the world. In addition to compromising the software update mechanism of SolarWinds Orion, the hackers also exploited vulnerabilities in commonly used authentication mechanisms to gain persistent access to networks.

According to Microsoft, the main goal of the attackers appears to be to gain persistent local access to networks by delivering the Sunburst/Solarigate backdoor, then pivot to victims’ cloud assets. Recently it has become clear that more than one threat group is conducting cyber espionage after the discovery of a different malware variant that was introduced through the SolarWinds Orion software update feature. Microsoft and Palo Alto Networks believe the second malware variant, named Supernova, is not associated with the group that deployed the Sunburst/Solarigate backdoor.

Several resources have already been published to help organizations assess the risk associated with the cyber activity and detect and mitigate potential breaches and eliminate the threat actors from their networks. The new website pools the resources and provides easy access to pertinent information on this global incident. The website will be regularly updated as new information becomes available as the investigations into the cyber activity continue.

The APT actor has compromised the networks of a large number of entities and is selectively choosing targets of interest for further network exploitation, but any organization that has installed the compromised software updates is at risk if corrective action is not taken.

It is important for all organizations that use SolarWinds Orion to take action to investigate for signs of compromise. As CISA explained in its latest alert, “If left unchecked, this threat actor has the resources, patience, and expertise to resist eviction from compromised networks and continue to hold affected organizations at risk.” CISA also points out that even if entities have not installed the compromised SolarWinds Orion update, that does not necessary mean they will not be affected. Their managed service providers and partners may have been compromised, which could give the APT actor access to their networks.

The website includes a link to a free tool that has been released by CISA for detecting unusual and potentially malicious activity in Azure/Microsoft Office 365 environments. The new tool provides a narrowly focused view of activity related to the identity- and authentication-based attacks that have been observed across a wide range of sectors following the deployment of the Sunburst/Solarigate backdoor.

The tool – named Sparrow – can be used to narrow down large data sets of investigation modules and telemetry to provide information specific to the attacks on federated identity sources and applications.

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NIST Releases Final Guidance on Securing the Picture Archiving and Communication System (PACS) Ecosystem

Posted by HIPAA Journal

The National Cybersecurity Center of Excellence (NCCoE) at the National Institute of Standards and Technology (NIST) has released final guidance for healthcare delivery organizations on securing the Picture Archiving and Communication System (PACS) ecosystem.

PACS is a medical imaging technology that is used to securely store and digitally transmit medical images such as MRIs, CT scans, and X-rays and associated clinical reports and is ubiquitous in healthcare. These systems eliminate the need to store, send, and receive medical images manually, and assist healthcare delivery organizations by allowing the images to be securely and cheaply stored offsite in the cloud. PACS allows medical images to be easily retrieved using PACS software from any location.

PACS is a system that by design cannot operate in isolation. In healthcare delivery organizations, PACS is usually integrated into highly complex environments and interfaces with many interconnected systems. The complexity of those environments means securing the PACS ecosystem can be a major challenge and it is easy for cybersecurity risks to be introduced that could easily compromise the confidentiality, integrity, and availability of the PACS ecosystem, protected health information (PHI), and any systems to which PACS connects.

In September 2019, a ProPublica report found 187 unprotected servers that were used to store and retrieve medical images. Those servers stored the medical images and associated PHI of more than 5 million patients in the United States. In some cases, the images could be accessed using a standard web browser and viewed using free-to-download software.

This year, the analyst team at CyberAngel scanned approximately 4.3 billion IP addresses worldwide and found 2,140 unprotected servers across 67 countries. Those servers were found to contain more than 45 million medical images. The images had up to 200 lines of metadata that included personally identifiable information and protected health information. According to the CyberAngel “Full Body Exposure” report, those images could be accessed via the Internet with a standard web browser. In some instances, login portals were present, but accepted blank username and password fields.

NIST released draft guidance on securing the PACS ecosystem shortly after the ProPublica report was published to help healthcare delivery organizations identify cybersecurity risks associated with PACS and implement stronger security controls while minimizing the impact and availability to PACS and other components.

The final version of the guidance includes a comprehensive set of cybersecurity standards and best practices to adopt to improve the security of the PACS ecosystem, with the guidance covering asset management, access control, user identification and authentication, data security, security continuous monitoring, and response planning, recovery, and restoration.

“The final practice guide, which in addition to incorporating feedback from the public and other stakeholders, builds on the draft guide by adding remote storage capabilities into the PACS architecture. This effort offers a more comprehensive security solution that more closely mirrors real-world HDO networking environments,” explained NIST.

This practice guide can be used by HIPAA covered entities and their business associates to implement current cybersecurity standards and best practices to reduce their cybersecurity risk, while maintaining the performance and usability of PACS

NIST Cybersecurity Special Publication 1800-24, Securing Picture Archiving and Communication System (PACS): Cybersecurity for the Healthcare Sector is available on this link.

The guidance was developed by NIST/NCCoE in collaboration with Cisco, Clearwater Compliance, DigiCert, Forescout, Hyland, Microsoft, Philips, Symantec, TDI Technologies, Tempered Networks, Tripwire, Virtua Labs, and Zingbox.

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FBI Warns of DoppelPaymer Ransomware Attacks Targeting Critical Infrastructure

Posted by HIPAA Journal

The Federal Bureau of Investigation (FBI) has issued a private industry notification warning of an increase in DoppelPaymer ransomware activity and a change in tactics by the threat actors to pressure victims into paying.

DoppelPaymer ransomware first emerged in the summer of 2019 and has since been used in attacks on a range of verticals including healthcare, education, and the emergency services. The ransomware is believed to be operated by the Evil Corp (TA505) threat group, which was behind Locky ransomware and the Dridex banking Trojan.

Like many human-operated ransomware operations, the threat group exfiltrates data prior to the encryption of files and uses the stolen data as leverage to get the ransom paid. While victims may be able to recover encrypted files from backups, the threat of the public release or sale of stolen data is sufficient to get them to pay the ransom demand.

The threat group is known for demanding large ransom payments, often as high as seven figures. The gang is also believed to have been the first to start cold calling victims to pressure them into paying; a tactic that has now been adopted by several ransomware gangs including Ryuk, Conti, and Sekhmet.

The DoppelPaymer gang has been calling victims since at least February 2020 to issue threats if payment is not made, such as the public release of stolen data, sale of stolen data, and even threats of violence. In one case, a call was made using a spoofed U.S. number by an individual claiming to be in North Korea who threatened to send an individual to an employee’s home if the ransom was not paid. Subsequently, calls were made to several of the individual’s relatives.

The FBI explained in the alert that several attacks have been conducted in recent months that have caused significant disruption to critical services. Many healthcare providers have been attacked causing disruption to patient services. One attack on a hospital in Germany resulted in patients being redirected to alternative facilities, with one patient dying before treatment could be provided. Law enforcement officials later determined that the patient would likely have died due to poor health irrespective of the attack and the FBI notes that when the threat group was notified that lives were being put at risk, the extortion attempt was withdrawn, and the digital decryption keys were provided without charge.

Another attack on a large U.S. healthcare provider in July 2019 saw 13 servers impacted by the attack. While the ransom was not paid and files were recovered from backups, the recovery process took several weeks. In September 2020, the ransomware gang attacked a 911 dispatch center which prevented the county from accessing its computer-aided dispatch (CAD) system. In a separate attack on a different country, servers were encrypted that prevented access to systems used for emergency dispatch, patrol, jail, and the payroll departments. A U.S. city was attacked in the summer of 2020 causing major disruption to emergency services, the police department, and government functions.

Ransomware attacks on healthcare organizations have increased as the year has gone on, with Kroll reporting a 75% increase in attacks on healthcare providers in October 2020. Ransom payments are similarly increasing. Beazley has reported ransom demands in attacks on its clients doubled in the first 6 months of 2020, while Coveware reported the average ransom demand rose to $234,000 in the third quarter of 2020, up 31% from Q2.

The advice of the FBI is never to pay ransom demands unless there is no alternative, as payment does not guarantee the recovery of files or prevent data exposure. Payment of the ransom also encourages the attackers to conduct further attacks and incentivizes others to get involved in ransomware operations.

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NSA Warns of Authentication Mechanism Abuse to Gain Access to Cloud Resources

Posted by HIPAA Journal

The U.S. National Security Agency (NSA) has issued an alert that warns about two hacking techniques that are currently being used by threat groups to gain access to cloud resources containing protected data. These techniques abuse authentication mechanisms and allow attackers to steal credentials and maintain persistent access to networks.

These techniques have been used by the threat actors who compromised SolarWinds Orion platform. The hackers behind the attacks have yet to be identified, but some evidence has emerged that suggest this is a nation state attack by a Russian threat group, possibly APT29 (Cozy Bear). Secretary of State Mike Pompeo said in a radio interview on Friday that “now we can say pretty clearly that it was the Russians that engaged in this activity,” although on Saturday President Trump downplayed the attack and suggested there is a possibility China is responsible, although President Trump is largely alone in having that viewpoint.

The SolarWinds Orion platform supply chain attack was used to push malware out to customers through the SolarWinds software update mechanism, but that is one of several methods currently being used to compromise public and private sector organizations and government agencies.

“Initial access can be established through a number of means, including known and unknown vulnerabilities,” explained the NSA in its alert. “The recent SolarWinds Orion code compromise is one serious example of how on-premises systems can be compromised, leading to abuse of federated authentication and malicious cloud access.”

Once initial access had been gained, through the SolarWinds compromise for example, the techniques described in the alert are used to gain additional privileges through the forging of credentials to maintain persistent access. The NSA has provided guidance on how to detect attacks and mitigate against them, regardless of how the initial access is gained. The NSA notes that these tactics are not new and have been used by threat actors since at least 2017 and continue to be effective.

The techniques described in the alert involve the use of compromised authentication tokens and abuse of compromised system administration accounts in Microsoft Azure and other cloud platforms once a local network has been compromised.

The first technique involves compromising an on-premises federated identity provider or single sign-on (SSO) system. These systems allow organizations to use the authentication system they already own to grant access to resources, including cloud services. These systems use cryptographically signed automated messages – assertions – which are shared via Security Assertion Markup Language (SAML) to show that users have been authenticated. Threat actors are abusing the authentication mechanism to gain illicit access to a wide range of assets owned by organizations.

The attackers either steal credentials or private keys from the SSO system that allow them to sign assertions and impersonate a legitimate user and gain sufficient privileges to create their own keys and identities, as well as their own SSO system. The second approach involves compromising admin accounts to assign credentials to cloud application services, after which the attackers call for the application’s credentials to gain automated access to cloud resources.

The NSA has warned that threat actors are continuing to exploit the recently disclosed command injection vulnerability in VMware products (CVE-2020-4006). In one case cited by the NSA exploitation of this vulnerability allowed initial local network access to be gained, rather than the SolarWinds method. The techniques described in the alert were then used to gain access to cloud resources. A patch has been released to correct the flaw affecting VMware products. The patch should be applied as soon as possible. Users of SolarWinds Orion should follow the previously published mitigations.

These attack methods to gain access to cloud resources do not exploit vulnerabilities in cloud infrastructure, federated identity management, the SAML protocol, or on-premises and cloud identity services, instead they abuse trust in the federated identity system.

“The security of identity federation in any cloud environment directly depends on trust in the on-premises components that perform authentication, assign privileges, and sign SAML tokens. If any of these components is compromised, then the trust in the federated identity system can be abused for unauthorized access,” said the NSA.

To prevent the new techniques from being successfully used to gain access to cloud resources, the NSA recommends the following:

  • Lock down SSO configuration and service principle usage
  • Harden systems running on-premises identity and federation services
  • Monitor logs for suspicious tokens that do not match the organization’s baseline for SAML tokens.
  • Audit tokens to detect anomalies
  • Examine logs for suspicious use of service principles
  • Look for unexpected trust relationships that have been added to Azure Active Directory

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OCR HIPAA Audits Industry Report Identifies Common Areas of Noncompliance with the HIPAA Rules

Posted by HIPAA Journal

The Department of Health and Human Services’ Office for Civil Rights has published its 2016-2017 HIPAA Audits Industry Report, highlighting areas where HIPAA-covered entities and their business associates are complying or failing to comply with the requirements of the Health Insurance Portability and Accountability Act.

The Health Information Technology for Economic and Clinical Health (HITECH) Act requires the HHS to conduct periodic audits of HIPAA covered entities and business associates to assess compliance with the HIPAA Rules. Between 2016 and 2017, the HHS conducted its second phase of compliance audits on 166 covered entities and 41 business associates to assess compliance with certain provisions of the HIPAA Privacy, Security, and Breach Notification Rules.

The 2016/2017 HIPAA compliance audits were conducted on a geographically representative, broad cross-section of covered entities and business associates and consisted of desk audits – remote reviews of HIPAA documentation – rather than on-site audits. All entities have since been notified of the findings of their individual audits.

The 2016-2017 HIPAA Audits Industry Report details the overall findings of the audits, including key aspects of HIPAA compliance that are proving problematic for covered entities and business associates.

In the report, OCR gives each audited entity a rating based on their level of compliance with each specific provision of the HIPAA Rules under assessment. A rating of 1 indicates the covered entity or business associate was fully compliant with the goals and objectives of the selected standards and implementation specifications. A rating of 2 means the entity substantially met the criteria and maintained adequate policies and procedures and could supply documentation or other evidence of compliance.

A rating of 3 means the entity minimally addressed the audited requirements and had made some attempt to comply, although had failed to comply fully or had misunderstood the HIPAA requirements. A rating of 4 means the entity made negligible efforts to comply, such as supplying policies and procedures for review that were copied directly from an association template or providing poor or generic documentation as evidence of training.  A rating of 5 means OCR was not provided with evidence of a serious attempt to comply with the HIPAA Rules.

The table below summarizes the audit results on key provisions of the HIPAA Rules. The blue and red figures indicate the most common rating in each category, with blue corresponding to mostly ratings of 1 or 2 (compliant) and red indicating implementation was inadequate, negligible, or absent.

The table clearly shows that most audited entities largely failed to successfully implement the HIPAA Rules requirements.

OCR 2016-2017 HIPAA Audits Industry ReportMost covered entities complied with the requirement of the Breach Notification Rule to send timely notifications in the event of a data breach. HIPAA requires those notifications to be sent within 60 days of the discovery of a data breach; however, most covered entities failed to include all the required information in their breach notifications.The audits revealed widespread compliance with the requirement to create and prominently post a Notice of Privacy Practices on their website. The Notice of Privacy Practices gives a clear, user friendly explanation of individuals’ rights with respect to their personal health information and details the organization’s privacy practices. However, most audited entities failed to include all the required content in their Notice of Privacy Practices.

The individual right of access is an important provision of the HIPAA Privacy Rule. Individuals have the right to obtain and inspect their health information. Most covered entities failed to properly implement the requirements of the HIPAA Right of Access, which includes providing access to or a copy of the PHI held within 30 days of receiving a request and only charging a reasonable cost-based fee for access.

The first phase of HIPAA compliance audits conducted by OCR in 2012 revealed widespread noncompliance with the requirement to conduct a comprehensive, organization-wide risk analysis to identify vulnerabilities and risks to the confidentiality, integrity, and availability of protected health information. In its enforcement activities over the past 11 years, a risk analysis failure is the most commonly cited HIPAA violation.

HIPAA covered entities are still failing in this important provision of the HIPAA Security Rule, with the latest round of audits revealing most audited entities failed to implement the HIPAA Security Rule requirements for risk analysis and risk management.

“The audit results confirm the wisdom of OCR’s increased enforcement focus on hacking and OCR’s Right of Access initiative,” said OCR Director Roger Severino. “We will continue our HIPAA enforcement initiatives until health care entities get serious about identifying security risks to health information in their custody and fulfilling their duty to provide patients with timely and reasonable, cost-based access to their medical records.”

You can view the full 2016-2017 HIPAA Audits Industry Report on this link: https://www.hhs.gov/sites/default/files/hipaa-audits-industry-report.pdf.

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House Passes Bill Calling for HHS to Recognize Adoption of Cybersecurity Best Practices When Making Regulatory Determinations

Posted by HIPAA Journal

A new bill (HR 7988) has been passed by the House Energy and Commerce Committee which seeks to amend the HITECH Act to require the Department of Health and Human Services to recognize whether cybersecurity best practices have been adopted by HIPAA-covered entities and business associates when making certain determinations, such as financial penalties following security breaches or for other regulatory purposes.

The HIPAA Safe Harbor Bill, if signed into law, would reward covered entities and business associates that have met cybersecurity practices through reduced financial penalties and shorter compliance audits. The legislation calls for the HHS Secretary to consider whether the entity has adequately demonstrated recognized security practices have been in place for no less than 12 months, which may mitigate financial penalties, result in an early, favorable termination of an audit, or mitigate other remedies which may otherwise have been agreed with respect to resolving potential HIPAA Security Rule violations.

The bill defines ‘Recognized Security Practices’ as “standards, guidelines, best practices, methodologies, procedures, and processes developed under section 2(c)(15) of the National Institute of Standards and Technology Act, the approaches promulgated under section 405(d) of the Cybersecurity Act of 2015, and other programs and processes that address cybersecurity and that are developed, recognized, or promulgated through regulations under other statutory authorities.”

The bill also confirms that its aim is to reduce potential sanctions, penalties, and the length of audits when cybersecurity best practices are followed, and not to give the HHS the authority to increase audit lengths, fines, and penalties when an entity is discovered not to be in compliance with recognized security standards.

The bill easily passed the house vote and is expected to pass the Senate vote next week. The bill has received considerable support from many health IT industry stakeholder groups, including HITRUST. HITRUST believes the legislation will help to improve the cybersecurity posture of the healthcare industry, will encourage healthcare organizations to take a more proactive approach to HIPAA compliance, and will ensure entities that have achieved HITRUST Cybersecurity Standard Framework (CSF) Certification are recognized for their proactive approach to protecting healthcare data.

The bill also has the backing of the Healthcare and Public Health Sector Coordinating Council (HSCC), which believes the legislation will act as a positive incentive for health providers to increase investment in cybersecurity for the benefit of regulatory compliance and patient safety.

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CISA: SolarWinds Orion Software Under Active Attack

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The Cybersecurity and Infrastructure Security Agency (CISA) has issued a warning that sophisticated hackers are actively exploiting SolarWinds Orion IT monitoring and management software.

The cyberattack, which is ongoing, is believed to be the work of a highly sophisticated, evasive, nation state hacking group who created a Trojanized version of Orion software that has been used to deploy a backdoor into customers’ systems dubbed SUNBURST.

The supply chain attack has impacted around 18,000 customers, who are understood to have downloaded the Trojanized version of SolarWinds Orion and the SUNBURST backdoor. SolarWinds Orion is used by large public and private organizations and government agencies.

SolarWinds customers include all five branches of the U.S. military, the Pentagon, State Department, NASA and National Security Agency. Its solutions are also used by 425 of the 500 largest publicly traded U.S. companies. The US Treasury, US National Telecommunications and Information Administration (NTIA), and Department of Homeland Security are known to have been attacked. The campaign was first detected by the cybersecurity company FireEye, which was also attacked as part of this campaign.

The attacks started in spring 2020 when the first malicious versions of the Orion software were introduced. The hackers are believed to have been present in compromised networks since then. The malware is evasive, which is why it has taken so long to detect the threat. “The malware masquerades its network traffic as the Orion Improvement Program (OIP) protocol and stores reconnaissance results within legitimate plugin configuration files allowing it to blend in with legitimate SolarWinds activity,” according to FireEye. Once the backdoor has been installed, the attackers move laterally and steal data.

“We believe that this vulnerability is the result of a highly-sophisticated, targeted, and manual supply chain attack by a nation-state,” said Kevin Thompson, SolarWinds President and CEO.

The hackers gained access to SolarWinds’ software development environment and inserted the backdoor code into its library in SolarWinds Orion Platform software versions 2019.4 HF 5 through 2020.2.1 HF 1, which were released between March 2020 and June 2020.

CISA issued an Emergency Directive ordering all federal civilian agencies to take immediate action to block any attack in progress by immediately disconnecting or powering down SolarWinds Orion products, versions 2019.4 through 2020.2.1 HF1, from their networks. The agencies have also been prohibited from “(re)joining the Windows host OS to the enterprise domain.”

All customers have been advised to immediately upgrade their SolarWinds Orion software to Orion Platform version 2020.2.1 HF 1. A second hotfix – 2020.2.1 HF 2 – is due to be released on Tuesday and will replace the compromised component and implement other additional security enhancements.

If it is not possible to immediately upgrade, guidelines have been released by SolarWinds for securing the Orion Platform. Organizations should also scan for signs of compromise. The signatures of the backdoor are being added to antivirus engines, and Microsoft has confirmed that all its antivirus products now detect the backdoor and users have been advised to run a full scan.

SolarWinds is working closely with FireEye, the Federal Bureau of Investigation, and the intelligence community to investigate the attacks. SolarWinds is also working with Microsoft to remove an attack vector that leads to the compromise of targets’ Microsoft Office 365 productivity tools.

It is currently unclear which group is responsible for the attack; although the Washington Post claims to have spoken to sources who confirmed the attack was the work of the Russian nation state hacking group APT29 (Cozy Bear). A spokesperson for the Kremlin said Russia had nothing to do with the attacks, stating “Russia does not conduct offensive operations in the cyber domain.”

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