Healthcare Data Privacy

HC3 Report Reveals Cyberattack Trends and Provides Insights to Improve Healthcare Cybersecurity

Posted by HIPAA Journal

The HHS’ Health Sector Cybersecurity Coordination Center has released a new report – Health Sector Cybersecurity: 2021 – Retrospective and 2022 Look Ahead – that provides a retrospective look at healthcare cybersecurity over the past 3 decades, detailing some of the major cyberattacks to hit the healthcare industry starting with the first-ever ransomware attack in 1989.

That incident saw Biologist Joseph Popp distribute 20,000 floppy disks at the World Health Organization AIDS conference in Stockholm. When used, the disks installed malicious code which tracked reboots. After 90 reboots, a ransom note was displayed that claimed the software lease had expired and a payment of $189 was required to regain access to the system.

The report shows how adversaries stepped up their attacks on the healthcare industry from 2014 through 2017. In 2014, Boston Children’s Hospital suffered a major distributed Denial of Service (DDoS) attack, there was a massive cyberattack on Anthem Inc. in 2015 that resulted in the unauthorized accessing of the records of 80 million health plan subscribers, Hollywood Presbyterian Medical Center paid an unheard-of ransom of $17,000 in 2016 following a ransomware attack, and the WannaCry exploits affected more than 200,000 systems in 2017.

In 2019, ransomware started to be extensively used in attacks on healthcare organizations with the Ryuk ransomware gang one of the most prolific ransomware operators. One of the gang’s attacks was conducted on a managed service provider and affected around 400 dental offices. Attacks continued, and more actors started using ransomware to extort businesses, with the attacks reaching epidemic proportions in 2020. In 2020, cybercriminals took advantage of the COVID-19 pandemic and used COVID-19 lures in their phishing attacks which continued throughout 2021. McAfee observed an average of 375 COVID-themed threats every minute in 2020.

2020 saw massive cyberattacks reported by SolarWinds, Accellion, CaptureRX, Scripps Health, and Universal Healthcare Services, with Emsisoft reporting $18.6 billion had been paid globally in ransoms to ransomware gangs, although it was estimated that the actual total was most likely closer to $75 billion.

The prolific Maze ransomware gang shut down its operation in 2020, but threats came from many other cyber actors including REvil, Avaddon, and BlackMatter. 2021 saw a massive ransomware attack on the Health Service Executive in Ireland by the Conti ransomware gang. The attack impacted 54 public hospitals and others that depended on HSE infrastructure and it took 4 months to bring all systems back online.

The report makes it clear that cyberattacks targeting healthcare organizations are nothing new. The industry has been targeted for many years and the industry will continue to be targeted for years to come. HC3 recommends healthcare organizations should continue to take steps to improve their defenses against the most common threats such as ransomware, malware, and phishing. Security teams should provide ongoing security awareness training for employees, run phishing simulation exercises to test the effectiveness of training, implement gateway/mail server filtering, blacklisting and whitelisting, and operationalize indicators of compromise.

It is also important to lock down remote access technologies, which are frequently abused to gain access to systems. Virtual Private Networks and technologies leveraging the Remote Desktop Protocol should be operationally minimized, services should be turned off if they are not used, and logs of activity should be maintained and regularly reviewed.

Vulnerability management is essential and needs to be systematic, comprehensive, and repeatable, and there must be mechanisms of enforcement. It is important to maintain situational awareness of applicable vendor updates and alerts and to develop repeatable testing, patching, and update deployment procedures.

It is important for healthcare organizations to understand the value of what the organization has to offer an adversary. That includes protected health information, which carries a high price on the black market, and intellectual property, which is often sought by foreign countries. Once assets have been identified, steps must be taken to ensure that those assets are protected.

In addition to implementing safeguards to protect against attacks, it is important to understand that there will still be a high probability of compromise and to prepare for an attack and plan and test the response in advance to ensure that the business can continue to operate.

It is also recommended that healthcare organizations consider relatively new-ish ways of thinking about defense, and to consider that adversaries are now thinking in terms of maximizing the number of victims and are targeting managed service providers and the supply chain. Healthcare organizations need to think about how they can prevent and mitigate attacks on third parties.

HC3 says situational awareness will continue to be more and more important in 2022 and beyond. There will be new threats, the tactics, techniques, and procedures of threat actors will evolve, and there will be new vulnerabilities. It is important to keep up-to-date with new threats and vulnerabilities and how they can be corrected and mitigated.

It is vital to maintain trusted defense measures and to defend against distributed attacks and other avenues of compromise. HC3 has provided several resources in the report that healthcare organizations can use to develop their defenses and block current and new attack methods.

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Poor Employee Cyber Hygiene is Putting Healthcare Cybersecurity at Risk

Posted by HIPAA Journal

There have been calls for healthcare organizations to take steps to improve security due to a major rise in hacking incidents, ransomware attacks, and vulnerability disclosures in 2021. Record numbers of healthcare data breaches were reported last year, and tens of millions of healthcare records were compromised.

Adhering to the minimum requirements of the HIPAA Security Rule and conducting risk analyses, having robust risk management practices, conducting vulnerability scans, and implementing technical safeguards such as intrusion prevention systems, next-generation firewalls, and spam filters are all important measures to improve cybersecurity and ensure HIPAA compliance, but it is also important to improve the human aspect of cybersecurity. Risky employee behaviors need to be eradicated and the workforce needs to be trained to be more security-aware and taught how to recognize common attacks that target individuals, such as phishing and social engineering.

The human aspect of cybersecurity is often one of the weakest links in the security chain, which has been highlighted by a recent study commissioned by New Zealand-based Mobile Mentor and conducted by the Austin, TX-based Center for Generational Kinetics. The aim of the study was to explore the Endpoint Ecosystem to understand how employees perceive privacy, productivity, and personal well-being in the modern workplace. The Endpoint Ecosystem is the combination of all devices, applications, and tools that are used by employees coupled with the experiences of employees using technologies.

The survey was conducted on 1,500 employees in highly regulated industries such as government, healthcare, education, and finance in the United States and Australia, and the findings are detailed in the Mobile Mentor report, The Endpoint Ecosystem – 2022 National Study.

Employees are Taking Security Risks

The survey confirmed what other studies have found – The pandemic has led to the workforce becoming much more distributed and employers have had difficulty adapting to this new way of working and ensuring security policies are implemented and enforced that are well suited to the change in how employees are working.

One of the major findings was a lack of awareness about security policies and a failure of employers to provide security awareness training to the workforce. 27% of employees said they saw security policies less than once a year and 39% said they receive security awareness training less than once a year. Healthcare and education employees were the least likely to see security policies and employees often felt they were not adequately trained to protect company data.

41% of respondents said security policies implemented by their employers restricted the way they work, and 36% of employees said they had found a way to work around security policies. The use of shadow IT – applications and services that have not been authorized by the IT department – was found to be out of control. Workers are routinely using unregulated apps and services for work activities, which can involve regulated data.  Employees commonly used services such as Gmail and Dropbox because they believe it makes them more efficient, even though the use of those services has an impact on security.

Interestingly, while remote working is viewed as a security risk, remote workers appeared to be much more tech-savvy, were more aware of security and privacy policies, and were more careful with their passwords. That said, workers are allowing family members to use their work devices – 46% of younger workers said other family members use their work devices.

The lines are getting blurred between device use for personal and work purposes. Overall, 64% of respondents said they use personal devices for work, but only 31% had a secure BYOD program.  57% of younger workers said they use work devices for personal use and 71% said they used personal devices for work. Many employers are failing to address the security risks associated with the use of personal devices for work purposes and work devices for personal use.

Poor Password Hygiene is a Major Security Risk

One of the main security risks identified in the study related to passwords. Poor password hygiene is a major security risk. 80% of cyberattacks start with a compromised password. One of the findings, mirrored by a recent IDC survey, is employees have too many passwords to remember. While password policies may be in place – and enforced – they are often circumvented. 69% of respondents said they choose passwords that are easy to remember, 29% of employees said they write down their passwords in a personal journal, and 24% said they store work passwords on their phones. While many of the security problems associated with passwords can be solved by using a password manager, only 31% of respondents used one.

The survey revealed employees are much more concerned about personal privacy than security, with healthcare employees the most concerned about protecting personal privacy. Mobile Mentor suggests that healthcare employers looking to improve security need to teach employees that privacy and security are two sides of the same coin.

“When the endpoint ecosystem works well, you have a secure, productive, and happy workforce. It’s always been important, but it became urgent over the last two years when the pandemic forced more people to work remotely, cybersecurity attacks increased, and the Great Resignation forced employers to rethink how they support their employees,” said Denis O’Shea, founder of Mobile Mentor. “Until employers prioritize the importance of each component within the Endpoint Ecosystem, their company security and employee productivity are going to be exposed to serious risk.”

The post Poor Employee Cyber Hygiene is Putting Healthcare Cybersecurity at Risk appeared first on HIPAA Journal.

Poor Employee Cyber Hygiene is Putting Healthcare Cybersecurity at Risk

Posted by HIPAA Journal

There have been calls for healthcare organizations to take steps to improve security due to a major rise in hacking incidents, ransomware attacks, and vulnerability disclosures in 2021. Record numbers of healthcare data breaches were reported last year, and tens of millions of healthcare records were compromised.

Adhering to the minimum requirements of the HIPAA Security Rule and conducting risk analyses, having robust risk management practices, conducting vulnerability scans, and implementing technical safeguards such as intrusion prevention systems, next-generation firewalls, and spam filters are all important measures to improve cybersecurity and ensure HIPAA compliance, but it is also important to improve the human aspect of cybersecurity. Risky employee behaviors need to be eradicated and the workforce needs to be trained to be more security-aware and taught how to recognize common attacks that target individuals, such as phishing and social engineering.

The human aspect of cybersecurity is often one of the weakest links in the security chain, which has been highlighted by a recent study commissioned by New Zealand-based Mobile Mentor and conducted by the Austin, TX-based Center for Generational Kinetics. The aim of the study was to explore the Endpoint Ecosystem to understand how employees perceive privacy, productivity, and personal well-being in the modern workplace. The Endpoint Ecosystem is the combination of all devices, applications, and tools that are used by employees coupled with the experiences of employees using technologies.

The survey was conducted on 1,500 employees in highly regulated industries such as government, healthcare, education, and finance in the United States and Australia, and the findings are detailed in the Mobile Mentor report, The Endpoint Ecosystem – 2022 National Study.

Employees are Taking Security Risks

The survey confirmed what other studies have found – The pandemic has led to the workforce becoming much more distributed and employers have had difficulty adapting to this new way of working and ensuring security policies are implemented and enforced that are well suited to the change in how employees are working.

One of the major findings was a lack of awareness about security policies and a failure of employers to provide security awareness training to the workforce. 27% of employees said they saw security policies less than once a year and 39% said they receive security awareness training less than once a year. Healthcare and education employees were the least likely to see security policies and employees often felt they were not adequately trained to protect company data.

41% of respondents said security policies implemented by their employers restricted the way they work, and 36% of employees said they had found a way to work around security policies. The use of shadow IT – applications and services that have not been authorized by the IT department – was found to be out of control. Workers are routinely using unregulated apps and services for work activities, which can involve regulated data.  Employees commonly used services such as Gmail and Dropbox because they believe it makes them more efficient, even though the use of those services has an impact on security.

Interestingly, while remote working is viewed as a security risk, remote workers appeared to be much more tech-savvy, were more aware of security and privacy policies, and were more careful with their passwords. That said, workers are allowing family members to use their work devices – 46% of younger workers said other family members use their work devices.

The lines are getting blurred between device use for personal and work purposes. Overall, 64% of respondents said they use personal devices for work, but only 31% had a secure BYOD program.  57% of younger workers said they use work devices for personal use and 71% said they used personal devices for work. Many employers are failing to address the security risks associated with the use of personal devices for work purposes and work devices for personal use.

Poor Password Hygiene is a Major Security Risk

One of the main security risks identified in the study related to passwords. Poor password hygiene is a major security risk. 80% of cyberattacks start with a compromised password. One of the findings, mirrored by a recent IDC survey, is employees have too many passwords to remember. While password policies may be in place – and enforced – they are often circumvented. 69% of respondents said they choose passwords that are easy to remember, 29% of employees said they write down their passwords in a personal journal, and 24% said they store work passwords on their phones. While many of the security problems associated with passwords can be solved by using a password manager, only 31% of respondents used one.

The survey revealed employees are much more concerned about personal privacy than security, with healthcare employees the most concerned about protecting personal privacy. Mobile Mentor suggests that healthcare employers looking to improve security need to teach employees that privacy and security are two sides of the same coin.

“When the endpoint ecosystem works well, you have a secure, productive, and happy workforce. It’s always been important, but it became urgent over the last two years when the pandemic forced more people to work remotely, cybersecurity attacks increased, and the Great Resignation forced employers to rethink how they support their employees,” said Denis O’Shea, founder of Mobile Mentor. “Until employers prioritize the importance of each component within the Endpoint Ecosystem, their company security and employee productivity are going to be exposed to serious risk.”

The post Poor Employee Cyber Hygiene is Putting Healthcare Cybersecurity at Risk appeared first on HIPAA Journal.

OCR Director Encourages HIPAA-Regulated Entities to Strengthen Their Cybersecurity Posture

Posted by HIPAA Journal

In a recent blog post, Director of the HHS’ Office for Civil Rights, Lisa J. Pino, urged HIPAA-regulated entities to take steps to strengthen their cybersecurity posture in 2022 in light of the increase in cyberattacks on the healthcare industry.

2021 was a particularly bad year for healthcare organizations, with the number of reported healthcare data breaches reaching record levels. 714 healthcare data breaches of 500 or more records were reported to the HHS’ Office for Civil Rights in 2021 and more than 45 million records were breached.

The breach reports were dominated by hacking and other IT incidents that resulted in the exposure or theft of the healthcare data of more than 43 million individuals. In 2021, hackers took advantage of healthcare organizations dealing with the COVID-19 pandemic and conducted several attacks that had a direct impact on patient care and resulted in canceled surgeries, medical examinations, and other services as a result of IT systems being taken offline and network access being disabled.

Pino also drew attention to the critical vulnerability identified in the Java-based logging utility Log4J, which has been incorporated into many healthcare applications. The vulnerability was discovered in December 2021 and cybercriminals and other threat groups were quick to exploit it to gain access to servers and networks for a range of malicious purposes.

The vulnerabilities and data breaches show how important it is for healthcare organizations to be vigilant to threats and take prompt action when new risks to the confidentiality, integrity, and availability of protected health information are identified. “With these risks in mind, I would like to call on covered entities and business associates to strengthen your organization’s cyber posture in 2022,” said Pino.

Pino said OCR investigations and audits have uncovered many cases of noncompliance with the risk analysis and risk management requirements of the HIPAA Rules. “All too often, we see that risk analyses only cover the electronic health record.  I cannot underscore enough the importance of enterprise-wide risk analysis.  Risk management strategies need to be comprehensive in scope,” explained Pino. “You should fully understand where all electronic protected health information (ePHI) exists across your organization – from software, to connected devices, legacy systems, and elsewhere across your network.”

OCR’s investigations of data breaches in 2020 showed multiple areas where HIPAA-regulated entities need to take steps to improve compliance with the standards of the HIPAA Security Rule, especially in the following areas:

  • Risk analysis
  • Risk management
  • Information system activity review
  • Audit controls
  • Security awareness and training
  • Authentication

Pino made several recommendations, including reviewing risk management policies and procedures, ensuring data are regularly backed up (and testing backups to ensure data recovery is possible), conducting regular vulnerability scans, patching and updating software and operating systems promptly, training the workforce how to recognize phishing scams and other common attacks, and practicing good cyber hygiene.

“We owe it to our patients, and industry, to improve our cybersecurity posture in 2022 so that health information is private and secure”, concluded Pino, who also drew attention to resources that have been made available by CISA and the Office for Civil Rights to help protect against common threats to ePHI.

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NCCoE Releases Final Version of NIST Securing Telehealth Remote Patient Monitoring Ecosystem Guidance

Posted by HIPAA Journal

The National Cybersecurity Center of Excellence (NCCoE) has published the final version of NIST guidance on Securing Telehealth Remote Patient Monitoring Ecosystem (SP 1800-30).

Healthcare delivery organizations have been increasingly adopting telehealth and remote patient monitoring (RPM) systems to improve the care they provide to patients while reducing costs. Patient monitoring systems have traditionally only been used in healthcare facilities but there are advantages to using these solutions in patients’ homes. Many patients prefer to receive care at home, the cost of receiving that care is reduced, and healthcare delivery organizations benefit from freeing up bed space and being able to treat more patients.

While there are advantages to be gained from the provision of virtual care and the remote monitoring of patients in their homes, telehealth and RPM systems can introduce vulnerabilities that could put sensitive patient data at risk and if RPM systems are not adequately protected, they could be vulnerable to cyberattacks that could disrupt patient monitoring services.

Special Publication 1800-30 was developed by NCCoE in collaboration with healthcare, technology, and telehealth partners to form a reference architecture that demonstrates how a standard-based approach can be adopted along with commercially available cybersecurity tools to improve privacy and security for the telehealth and RCM ecosystem.

The project team at NCCoE performed a risk assessment based on the NIST Risk Management Framework on a representative RPM ecosystem in a laboratory environment. The NIST Cybersecurity Framework was applied along with guidance based on medical device standards, and the team demonstrated how healthcare delivery organizations can implement a solution to enhance privacy and better secure their telehealth RPM ecosystem.

SP 1800-30 explains how healthcare delivery organizations can identify cybersecurity risks associated with telehealth and RPM solutions, use the NIST Privacy Framework to broaden their understanding of privacy risks, and apply cybersecurity and privacy controls. How-To guides are provided that include detailed instructions for installing and configuring the products used to build NCCoE’s example solution. NCCoE used solutions from AccuHealth and Vivify, but the principles can be applied to other solutions.

The final guidance and How-To guides can be downloaded from NCCoE here.

Image Source: J. Stoughton/NIST

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January 2022 Healthcare Data Breach Report

Posted by HIPAA Journal

50 healthcare data breaches of 500 or more records were reported to the HHS’ Office for Civil Rights (OCR) in January 2022. January was the second successive month where the number of reported data breaches fell, although 38.9% more breaches were reported last month than in January 2020.

Healthcare data breaches over the past 12 months to January 2022

The protected health information of 2,304,607 individuals was exposed or impermissibly disclosed across those 50 breaches – 22% fewer records than December 2021, and well below the 12-month average of 3.51 million records a month. 726 data breaches of 500 or more records were reported to OCR in the 12 months from February 2021 to January 2022, and 42,175,121 records were breached across those 726 incidents.

Healthcare records breached in the past 12 months to January 2022

 

Largest Healthcare Data Breaches in January 2022

18 healthcare data breaches of 10,000 or more records were reported to the HHS’ Office for Civil Rights in January 2022, including one major data breach that affected more than 1.35 million Broward Health patients.

Name of Covered Entity State Covered Entity Type Individuals Affected Type of Breach Location of Breached Information Breach Cause
North Broward Hospital District d/b/a Broward Health FL Healthcare Provider 1,351,431 Hacking/IT Incident Network Server Unspecified hacking and data theft incident
Medical Review Institute of America UT Business Associate 134,571 Hacking/IT Incident Network Server Ransomware attack
Medical Healthcare Solutions, Inc. MA Business Associate 133,997 Hacking/IT Incident Network Server Ransomware attack
Ravkoo FL Healthcare Provider 105,000 Hacking/IT Incident Other Cyberattack on cloud prescription portal
TTEC Healthcare Solutions CO Business Associate 86,305 Hacking/IT Incident Network Server Ransomware attack
Advocates, Inc. MA Healthcare Provider 68,236 Hacking/IT Incident Network Server Unspecified hacking and data theft incident
iRise Florida Spine and Joint Institute, LLC FL Healthcare Provider 61,595 Hacking/IT Incident Email Email accounts accessed by unauthorized individuals
Suncoast Skin Solutions FL Healthcare Provider 57,730 Hacking/IT Incident Network Server Ransomware attack
Hospital Authority of Valdosta and Lowndes County Georgia GA Healthcare Provider 41,692 Unauthorized Access/Disclosure Desktop Computer Unauthorized access and PHI theft by former employee
Family Christian Health Center IL Healthcare Provider 31,000 Hacking/IT Incident Network Server Ransomware attack
Lakeshore Bone & Joint Institute, PC IN Healthcare Provider 23,627 Hacking/IT Incident Email Email account accessed by unauthorized individual
South City Hospital MO Healthcare Provider 21,601 Theft Network Server, Other Burglary
Pace Center for Girls FL Healthcare Provider 18,300 Unauthorized Access/Disclosure Network Server Unspecified hacking and data theft incident
County of Kings, a political subdivision of the State of California CA Healthcare Provider 16,590 Hacking/IT Incident Network Server Misconfigured web server
Philadelphia FIGHT Community Health Centers PA Healthcare Provider 15,000 Hacking/IT Incident Network Server Unspecified hacking incident
Catholic Hospice, Inc. FL Healthcare Provider 14,986 Hacking/IT Incident Email Email accounts accessed by unauthorized individuals
Houston Area Community Services, Inc. d/b/a Avenue 360 Health and Wellness TX Healthcare Provider 12,186 Hacking/IT Incident Email Email accounts accessed by unauthorized individuals
Spencer Gifts LLC Health and Welfare Benefit Plan NJ Health Plan 10,023 Hacking/IT Incident Network Server Unspecified hacking and data theft incident

Causes of January 2022 Healthcare Data Breaches

Hacking incidents continue to dominate the breach reports and accounted for 76% of the month’s data breaches and 95.57% of the month’s breached records. The average breach size was 57,962 records and the median breach size was 6,174 records. The largest healthcare data breach of the month resulted in the theft of the protected health information of more than 1.35 million patients of Broward Health in Florida. A hacker gained access to the Broward Health network via a third-party medical provider that had been given access rights to Broward Health’s systems.

Causes of January 2022 Healthcare Data Breaches

Ransomware is still being extensively used in cyberattacks on healthcare organizations. 5 of the month’s top 10 data breaches were reported as ransomware attacks, with several others likely to have involved ransomware. Ransomware attacks have become highly sophisticated, with the attackers using a variety of methods to gain access to healthcare networks. CISA, the FBI, and the NSA recently issued a joint threat brief warning about the increased risk of ransomware attacks on critical infrastructure firms and provided mitigations that can be implemented to improve resilience to ransomware attacks.

Phishing attacks are also common. 12 of the month’s data breaches involved compromised email accounts. Combatting phishing attacks requires a combination of email security solutions and end user training. While HIPAA does not specify anti-phishing training for employees, HIPAA-regulated entities should go beyond the requirements of HIPAA and ensure the workforce receives regular security awareness training, including instruction on how to identify phishing emails. When combined with phishing simulation exercises, susceptibility to phishing attacks can be significantly reduced.

There were 11 unauthorized access/disclosure incidents reported to OCR in January, across which the protected health information of 80,456 individuals was impermissibly accessed or disclosed. One of the incidents reported in January involved the theft of the protected health information of 41,692 patients by a former employee. That individual was arrested and charged in connection to the incident. The average size of these breaches was 7,314 records, and the median breach size was 1,125 records. There was also one theft incident reported – a burglary – involving the theft of a network server that contained the protected health information of 21,601 patients.

January 2022 healthcare data breaches - location of breached PHI

Data Breaches by HIPAA-Regulated Entity Type

Data breaches were reported by 31 healthcare providers, 6 health plans, and 13 business associates in January; however, a further 5 breaches occurred at business associates but were reported by the HIPAA-covered entity. The pie chart below shows the adjusted figures for where the data breach occurred.

January 2022 healthcare data breaches by HIPAA-regulated entity type

Healthcare Data Breaches by State

Healthcare data breaches were reported by HIPAA-regulated entities in 22 states, with Florida the worst affected with 7 data breaches.

State Number of Reported Data Breaches
Florida 7
Pennsylvania 6
California 4
Illinois, Massachusetts, New Jersey & New York 3
Colorado, Georgia, Ohio, Tennessee, Texas, & Utah 2
Arkansas, Connecticut, Idaho, Indiana, Minnesota, Missouri, Oklahoma, South Carolina, & Wisconsin 1

HIPAA Enforcement in January 2022

There were no HIPAA enforcement actions announced by the HHS’ Office for Civil Rights or state attorneys general in January 2022.

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Bipartisan Legislation Introduced to Modernize Health Data Privacy Laws

Posted by HIPAA Journal

Healthcare privacy laws in the United States are due an update to bring them into the modern age to ensure individually identifiable health information is protected no matter how it is collected and shared. The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule is now more than 2 decades old, and while the Department of Health and Human Services (HHS) has proposed updates to the HIPAA Privacy Rule that are due to be finalized this year, even if the proposed HIPAA Privacy Rule changes are signed into law, there will still be regulatory gaps that place health data at risk.

The use of technology for healthcare and health information has grown in a way that could not be envisaged when the Privacy Rule was signed into law. Health information is now being collected by health apps and other technologies, and individuals’ sensitive health information is being shared with and sold by technology companies. The HIPAA Privacy and Security Rules introduced requirements to ensure the privacy and security of health data, but HIPAA only applies to HIPAA-covered entities – healthcare providers, health plans, and healthcare clearinghouses – and their business associates. Some of the emerging technologies now being used to record, store, and transmit health data are not covered by HIPAA and its protections and safeguards do not apply. Further, the proposed updates to the HIPAA Privacy Rule will make it easier for individuals to access their health data and direct covered entities to send that information to unregulated personal health applications.

New bipartisan legislation has now been introduced that aims to start the process of identifying and closing the current privacy gaps associated with emerging technologies to ensure health data are better protected, including health data that are not currently protected by HIPAA. The Health Data Use and Privacy Commission Act was introduced by Sens. Bill Cassidy (R-LA) and Tammy Baldwin (D-WI) and aims to set up a new commission that will be tasked with analyzing current federal and state laws covering health data privacy and make recommendations for improvements to cover the current technology landscape.

“As a doctor, the potential of new technology to improve patient care seems limitless. But Americans must be able to trust that their personal health data is protected if this technology can meet its full potential,” said Dr. Cassidy. “HIPAA must be updated for the modern day. This legislation starts this process on a pathway to make sure it is done right.”

The Comptroller General is tasked with appointing committee members who will be required to submit their report, conclusions, and recommendations to Congress and the President within 6 months. The commission will be required to assess current privacy laws and determine their effectiveness and limitations, any potential threats to individual health privacy and legitimate business and policy interests, and the purposes for which the sharing of health data is appropriate and beneficial to consumers.

The commission is required to report on whether further federal legislation is necessary and, if current privacy laws need to be updated, provide suggestions on the best ways to reform, streamline, harmonize, unify, or augment current laws and regulations relating to individual health privacy. Those recommendations could involve updates to HIPAA to cover a broader range of entities or new state or federal legislation covering health data. If updates are recommended, the commission will be required to provide details of the likely costs, burdens, and potential unintended consequences, and whether there is a threat to health outcomes if privacy rules are too stringent.

“I am excited to introduce the bipartisan Health Data Use and Privacy Commission Act to help inform how we can modernize health care privacy laws and regulations to give Americans peace of mind that their personal health information is safe, while ensuring that we have the tools we need to advance high-quality care.”

The Health Data Use and Privacy Commission Act has attracted support from a dozen medical associations and technology vendors, including the Federation of American Hospitals, College of Cardiology, National Multiple Sclerosis Society, Association of Clinical Research Organizations, Epic Systems, and IBM.

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RI Attorney General Subpoenas RIPTA and UnitedHealthcare Over 22,000-Record Data Breach

Posted by HIPAA Journal

The Rhode Island Attorney General is investigating UnitedHealthcare and the Rhode Island Public Transit Authority (RIPTA) over a cyberattack and data breach that resulted in hackers gaining access to RIPTA’s network that contained the sensitive personal and protected health information of up to 22,000 individuals.

The Office of the Rhode Island Attorney General was notified about the security breach on December 23, 2021. RIPTA said it discovered and blocked a cyberattack on August 5, 2021, with its investigation confirming the hackers gained access to its network on August 3, 2021. Files stored on the compromised part of its network included extensive information on its employees, including names, dates of birth, Social Security numbers, and health plan ID numbers, along with the sensitive information of thousands of state employees who had never worked at RIPTA.

RIPTA reported the breach to the HHS’ Office for Civil Rights as affecting 5,015 individuals but said in its breach notice that the incident had resulted in the exposure of the personal data of 17,378 individuals. The difference in the numbers was due to UnitedHealthcare, RIPTA’s previous health insurance provider, providing RIPTA with files containing the data of non-RIPTA employees.  In total, up to 22,000 individuals had their sensitive data stolen in the attack. The files were stored on RIPTA’s servers and were not encrypted and the hackers exfiltrated approximately 40,000 files from RIPTA’s systems.

RIPTA sent notification letters to affected individuals, including those that had no association with RIPTA, triggering a barrage of complaints to the Office for the Attorney General questioning why their personal data had been compromised in a breach at RIPTA when they had never had any association with the quasi-public agency. The delay in issuing notification letters was due to each of those 40,000 files having to be manually searched, which was a labor-intensive and time-consuming process. RIPTA said only a small number of people were involved in the document review to prevent sensitive data from being further exposed.

On Monday this week, RIPTA administrators testified under oath at a Senate oversight committee hearing about the incident. RIPTA Chief Legal Counsel Steven Colantuono said at the hearing, “We don’t believe that anyone did anything wrong on our end, but we are still investigating it.”

RIPTA Director Scott Avedisian confirmed that reports downloaded by RIPTA from a UnitedHealthcare portal between 2015 and 2020 were ‘filtered files’, and the data unrelated to RIPTA was supposed to remain hidden. While not confirmed, the description suggests the downloaded files were Excel spreadsheets with certain rows hidden. The secure links to access the files on the portal were emailed to RIPTA by UnitedHealthcare.

At the hearing, officials at the state Department of Information Technology confirmed there is a statewide policy requiring the encryption of sensitive data such as personally identifiable information, personal health information, and federal tax information; however, RIPTA is not one of the agencies or quasi-state agencies assisted or supported by the Department of Information Technology, so RIPTA is not required to comply with the state’s encryption policy.

UnitedHealthcare’s VP of external affairs was scheduled to appear at the hearing but backed out after initially agreeing to appear. UnitedHealthcare said it is investigating the breach to determine what went wrong. At this stage, there is no listing of a breach at UnitedHealthcare on the HHS’ Office for Civil Rights breach portal.

In addition to the investigation by the Rhode Island Attorney General, Colantuono said there will also be a federal investigation and discussions are currently being had between the Department of Justice and the HHS’ Office for Civil Rights to determine which of the two agencies will be conducting the investigation. There is also the possibility of legal action being taken against UnitedHealthcare and RIPTA by state employees affected by the data breach.

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Technologies Supporting Telehealth are Placing Healthcare Data at Risk

Posted by HIPAA Journal

A new report from Kaspersky indicates the massive increase in telehealth has placed healthcare data at risk. Vulnerabilities have been found in the technologies that support telemedicine, many of which have not yet been addressed.

Massive Increase in the Use of Telehealth

The COVID-19 pandemic has led to an increase in virtual visits, with healthcare providers increasing access to telehealth care to help curb infections and cut costs. Virtual visits are conducted via the telephone, video-conferencing apps, and other platforms, and a host of new technologies and products such as wearable devices for measuring vital signs, implanted sensors, and cloud services are also being used to support telehealth.

Data from McKinsey shows telemedicine usage has increased by 38% since before the emergence of SARS-Cov-2 and COVID-19, and the CDC reports that between June 26, 2020, and November 6, 2020, around 30% of all consultations with doctors were taking place virtually.  Kaspersky says that its own data indicate 91% of healthcare providers around the world have implemented the technology to give them telehealth capabilities.

Telehealth has literally been a lifesaver during the pandemic; however, the use of new technologies is not without risk. Many of the products and services now being used to support telehealth include a variety of third-party components that have not been verified as having the necessary safeguards to ensure the confidentiality, integrity, and availability of healthcare data, and they are potentially putting patient information is at risk.

Kaspersky hypothesized that the rapid digitalization of medical services and the wealth of sensitive and valuable patient data collected, stored, or transmitted by these new healthcare technologies has not gone unnoticed and cybercriminals, who are looking to exploit vulnerabilities. A study was devised to explore the security landscape of telehealth in 2020 and 2021 to determine the extent to which healthcare data is being put at risk.

Analysis of Telehealth Applications and Related Technology

In the summer of 2021, Kaspersky conducted an analysis of 50 of the most popular applications that were being used to provide telehealth services to identify vulnerabilities that could potentially be exploited to gain access to patient data, and checked for the presence of malicious code used to mimic those applications or steal data from them. No vulnerabilities were identified in the 50 applications, although that does not mean vulnerabilities do not exist, only that they have not been found by researchers. Deeper analyses of those apps may uncover vulnerabilities.

“In the absence of centralized quality control of telehealth at the application level, their security can significantly vary from product to product,” suggests Kaspersky. “Another unfortunate fact is that smaller companies, like start-ups, simply do not have enough hands and resources to control the quality and safety of their applications. Accordingly, such applications may contain many vulnerabilities currently unknown to the public that cybercriminals can find and use.”

The researchers then looked at wearable devices and sensors, which are often used in conjunction with telemedicine, specifically, the most commonly used protocol for transferring data from wearable devices and sensors – MQTT..

Kaspersky notes in its report – Telehealth: A New Frontier in Medicine- and Security – that MQTT does not require authentication for data transfers, and even if authentication is implemented, data are transferred in plain text with no encryption, which means MQTT is susceptible to man-in-the-middle (MITM) attacks to gain access to the transferred data. If a device is exposed to the Internet, data transfers via MQTT could easily be intercepted.

According to Kaspersky, between 2016 and 2021, 87 vulnerabilities have been identified in MQTT, and 57 of those vulnerabilities were rated critical or high-severity. Many of those vulnerabilities have still not been patched.

Kaspersky reports that the most common wearable device platform, Qualcomm Snapdragon Wearable, is riddled with vulnerabilities. Since the platform was launched in 2020, more than 400 bugs have been detected, many of which have yet to be patched. Multiple vulnerabilities have also been identified in other vendors’ wearable devices.

Cybercriminals Are Looking to Exploit Vulnerabilities to Access Patient Data

Kaspersky warns that cybercriminals are increasingly using medical themes in their phishing campaigns. Between June 2021 and December 2021, more than 150,000 phishing attacks were detected that used medical themes as lures, and as the digitization of healthcare increases, that trend is only likely to continue to increase.

Telehealth is likely to continue to be used to provide care to patients for years to come and there have been calls for the telehealth flexibilities introduced in response to the pandemic to be made permanent. It is therefore vital for app developers and manufacturers of wearable devices, as well as the healthcare organizations that use them, to be aware of the security risks associated with the technology.

Developers need to be aware of vulnerabilities that could be exploited to gain access to patient data and should implement appropriate safeguards to keep data protected. Users of telehealth services, especially frontline workers who have a say in the platforms and devices used for telehealth, should study the security of each application or product and take steps to secure their accounts with strong passwords, multifactor authentication.

“We expected that 2021 would be a year of greater collaboration between the medical sector and IT security specialists,” said Kaspersky. “In some ways, our expectations were met, but the explosive growth of telehealth has brought new challenges to this collaboration which have yet to be solved.”

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