Healthcare Data Security

Healthcare Industry has Highest Number of Reported Data Breaches in 2021

Data breaches declined by 24% globally in the first 6 months of 2021, although breaches in the United States increased by 1.5% in that period according to the 2021 Mid-Year Data Breach QuickView Report from Risk-Based Security.

Risk Based Security identified 1,767 publicly reported breaches between January 1, 2021 and June 30, 2021. Across those breaches, 18.8 billion records were exposed, which represents a 32% decline from the first 6 months of 2020 when 27.8 billion records were exposed. 85% of the exposed records in the first half of 2021 occurred in just one breach at the Forex trading service FBS Markets.

The report confirms the healthcare industry continues to be targeted by cyber threat actors, with the industry having reported more data breaches than any other industry sector this year. Healthcare has been the most targeted industry or has been close to the top since at least 2017 and it does not appear that trend will be reversed any time soon. 238 healthcare data breaches were reported in the first 6 months of 2021, with finance & insurance the next most attacked sector with 194 reported incidents, followed by information with 180 data breaches.

The report shows there have been significant shifts in data breach trends in 2021. While data breaches have declined globally and have remained fairly constant in the United States, there has been a marked increase in ransomware attacks. Risk Based Security recorded 352 ransomware attacks in the first 6 months of 2021 and, if that pace continues, the number of attacks will be significantly higher than 2020.

Ransomware attacks are extremely costly in healthcare due to the long period of downtime, and without access to medical records patient safety is put at risk. This is of course known to ransomware gangs. The reliance on access to data and the high cost of downtime increases the probability of the ransom being paid.

In 2020, data breaches started to take longer to be reported and that trend has continued in 2021. This is in part due to the increase in ransomware attacks, which can take longer to investigate, but even taking that into account there were many cases when breach notifications took an unusually long time to be issued and that has started to attract attention from regulators.

“Ransomware attacks continue at an alarming pace, inflicting serious damage on the victim organizations that rely on their services,” said Inga Goddijn, Executive Vice President at Risk Based Security. “The slow pace of reporting brought on by lengthy incident investigations has not improved and attackers continue to find new opportunities to take advantage of changing circumstances.”

The majority of reported breaches (67.97%) were hacking incidents, with only 100 (5.66%) due to viruses, and just 45 email incidents (2.55%). There were 76 web breaches reported (4.30%); however, they resulted in the highest number of records being breached.

Data breaches that exposed access credentials such as email addresses and passwords have remained consistent with other years, with email addresses exposed in 40% of breaches and passwords in 33%. The majority of reported breaches in 2021 were the result of external threat actors (78.66%), with 13.75% caused by insiders. Out of the confirmed insider breaches, the majority were accidental (58.85%), with 18.52% caused by malicious insiders.

Risk Based Security also notes that breach severity is increasing. Large numbers of data breaches have been reported in 2021 that involved sensitive data, which is a particularly worrying trend.

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NSA & CISA Issue Guidance on Hardening Security and Managing Kubernetes Environments

Kubernetes is a popular open-source cloud solution for deploying and managing containerized apps.  Recently there have been several security breaches where hackers have gained access to poorly secured Kubernetes environments to steal sensitive data, deploy cryptocurrency miners, and conduct denial-of-service attacks.

This month, security researchers discovered Kubernetes clusters were being targeted by cyber actors who were exploiting misconfigured permissions for the web-facing dashboard of Argo Workflows instances. In these attacks, the computing power of Kubernetes environments were harnessed for mining cryptocurrencies. In another attack, a vulnerability in the Kubernetes API Server was being exploited to steal sensitive data.

In light of these attacks, the National Security Agency (NSA) and the Cybersecurity and Infrastructure Security Agency (CISA) have issued a 52-page technical report that includes detailed guidance on how to correctly set up and manage Kubernetes environments to make it harder for the environments to be compromised by hackers.

The report includes details of the most common threats to Kubernetes environments, including supply chain attacks, malicious external cyber actors, and insider threats. Improving defenses against supply chain attacks can be a major challenge. These can arise in the container build cycle or infrastructure acquisition. Vulnerabilities and misconfigurations of the Kubernetes architecture such as the control plane, worker nodes, and containerized applications are often exploited, while insiders with high-level privileges can easily abuse their privileges to conduct a range of attacks.

There are multiple ways that hackers gain access to Kubernetes environments, and while it is not possible to eliminate risk entirely, by setting up Kubernetes correctly, avoiding common misconfigurations and implementing mitigations, security can be significantly strengthened. Implementing appropriate access controls and limiting privileges can greatly reduce the risk from insider threats.

The most common way for hackers to gain access to Kubernetes is by exploiting vulnerabilities and misconfigurations. It is therefore important for security teams to conduct scans of their Kubernetes containers and pods to identify vulnerabilities and misconfigurations and ensure they are corrected, or mitigations are implemented. Periodic reviews of Kubernetes settings and regular vulnerability scans should be performed.

The NSA and CISA also recommend running containers and pods with the least privileges possible, and using network separation, firewalls, strong authentication, and log auditing. It is also important to keep on top of patching, updates, and upgrades to ensure the Kubernetes environment remains secure.

The guidance includes detailed recommendations on Kubernetes pod security, network separation and hardening, authentication and authorization, log auditing, and details best practices for application security.

The Kubernetes Hardening Guidance can be downloaded on this link (PDF).

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The Average Cost of a Healthcare Data Breach is Now $9.42 Million

IBM Security has published its 2021 Cost of a Data Breach Report, which shows data breach costs have risen once again and are now at the highest level since IBM started publishing the reports 17 years ago. There was a 10% year-over-year increase in data breach costs, with the average cost rising to $4.24 million per incident. Healthcare data breaches are the costliest, with the average cost increasing by $2 million to $9.42 million per incident. Ransomware attacks cost an average of $4.62 million per incident.

Source: IBM Security

The large year-over-year increase in data breach costs has been attributed to the drastic operational shifts due to the pandemic. With employees forced to work remotely during the pandemic, organizations had to rapidly adapt their technology. The pandemic forced 60% of organizations to move further into the cloud. Such a rapid change resulted in vulnerabilities being introduced and security often lagged behind the rapid IT changes. Remote working also hindered organizations’ ability to quickly respond to security incidents and data breaches.

According to IBM, data breaches costs were more than $1 million higher when remote work was indicated as a factor in the data breach. When remote work was a factor, the average data breach cost was $4.96 million compared to $3.89 million when remote work was not a factor. Almost 20% of organizations that reported data breaches in 2020 cited remote work as a factor, with the cost of a data breach around 15% higher when remote work was a factor.

To compile the report, IBM conducted an in-depth analysis of data breaches involving fewer than 100,000 records at 500 organizations between May 2020 and March 2021, with the survey conducted by the Ponemon Institute.

The most common root cause of data breaches in the past year were compromised credentials, which accounted for 20% of data breaches. These breaches took longer to detect and contain, with an average of 250 days compared to an overall average of 212 days.

The most common types of data exposed in data breaches were customers’ personal data such as names, email addresses, passwords, and healthcare data. 44% of all data breaches included those types of data. A data breach involving email addresses, usernames, and passwords can easily have a spiral effect, as hackers can use the compromised data in further attacks. According to the Ponemon Institute survey, 82% of individuals reuse passwords across multiple accounts.

Breaches involving customers’ personally identifiable information (PII) were more expensive than breaches involving other types of data, with a cost per record of $180 when PII was involved compared to $161 per record for other types of data.

Data breach costs were lower at companies that had implemented encryption, security analytics, and artificial intelligence-based security solutions, with these three mitigating factors resulting in data breach cost savings of between $1.25 million and $1.49 million per data breach.

Adopting a zero-trust approach to security makes it easier for organizations to deal with data breaches. Organizations with a mature zero trust strategy had an average data breach cost of $3.28 million, which was $1.76 million lower than those who had not deployed this approach at all.

“Higher data breach costs are yet another added expense for businesses in the wake of rapid technology shifts during the pandemic,” said Chris McCurdy, Vice President and General Manager, IBM Security. “While data breach costs reached a record high over the past year, the report also showed positive signs about the impact of modern security tactics, such as AI, automation and the adoption of a zero-trust approach – which may pay off in reducing the cost of these incidents further down the line.”

Security automation greatly reduces data breach costs. Organizations with a “fully deployed” security automation strategy had average breach costs of $2.90 million per incident, compared to $6.71 million at organizations that had no security automation.

Companies with an incident response team that had tested their incident response plan had 54.9% lower breach costs than those that had neither. The average data breach cost was $3.25 million compared to $5.71 million when neither were in place.

The cost of a data breach was $750,000 (16.6%) higher for companies that had not undergone any digital transformation due to COVID-19. Cloud-based data breach costs were lower for organizations that had adopted a hybrid cloud approach, with an average cost of $3.61 million at organizations with hybrid cloud infrastructure compared to $4.80 million for organizations with a primarily public cloud and $4.55 million for those that had adopted a private cloud approach. Data breach costs were 18.8% higher when a breach was experienced during a cloud migration project.

Organizations that were further into their cloud migration plan were able to detect and respond to data breaches far more quickly – on average 77 days more quickly for organizations that were at a mature state of their cloud modernization plan than those in the early stages.

Mega data breaches – those involving between 50 million and 65 million records – cost an average of $401 million per incident, which is more than 100 times the cost of breaches involving between 1,000 and 100,0000 records.

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Report: The State of Privacy and Security in Healthcare

2020 was a particularly bad year for the healthcare industry with record numbers of data breaches reported. Ransomware was a major threat, with Emsisoft identifying 560 ransomware attacks on healthcare providers in 2020. Those attacks cost the healthcare industry dearly. $20.8 billion was lost in downtime in 2020, according to Comparitech, which is more than twice the ransomware downtime cost to the healthcare industry in 2019.

With the healthcare industry facing such high numbers of cyberattacks, the risk of a security breach is considerable, yet many healthcare organizations are still not fully conforming with the NIST Cybersecurity Framework (NIST CSF) and the HIPAA Security Rule, according to the 2021 Annual State of Healthcare Privacy and Security Report published today by healthcare cybersecurity consulting firm CynergisTek.

To compile the reportThe State of Healthcare Privacy and Security – Maturity Paradox: New World, New Threats, New Focus – CynergisTek used annual risk assessments at 100 healthcare organizations and measured progress alongside overall NIST CSF conformance. 75% of healthcare organizations improved overall NIST conformance in 2020; however, 64% of healthcare organizations fell short of the 80% NIST conformance level considered to be the passing grade. Most of the improvements made in 2020 were only small.

As the graph below shows, 53 healthcare organizations improved NIST conformance year over year, 32 of those were considerably below the 80th percentile and 17 healthcare organizations saw NIST conformance decline year-over- year.

Year-over-Year Improvements in NIST CSF Conformance. Source: CynergisTek State of Healthcare Privacy and Security Report.

In order to improve resilience to ransomware and other cyberattacks, it is essential for healthcare organizations to improve their security posture. It will not be possible to stay one step ahead of threat actors if organizations do not take steps to improve NIST CSF and HIPAA Security Rule conformance.

While good conformance scores are a good indication of security posture, they do not necessarily reflect the extent to which healthcare organizations have reduced risk. For this year’s report, CynergisTek placed less emphasis on conformance scores and assessed the measures healthcare organizations had taken to identify which core functions of the NIST CSF appeared to be really driving long term security improvements, with the goal of identifying the best opportunities for both short- and long-term success.

The Identity function provides the foundation on which the rest of the core functions are based, but 73% of healthcare organizations were rated low performers in this function. Asset management and supply chain risk management were two of the key areas that need to be addressed. The healthcare supply chain is a universal issue and the weak link in healthcare. Many healthcare organizations struggle to validate whether or not third-party vendors meet specific security requirements. 76% of healthcare organizations failed to secure their supply chains.

The Protect function requires safeguards to be implemented to protect critical infrastructure and data. One of the main areas where organizations were falling short is protection of data using encryption. “An organization’s default for storing protected data of any kind and transmitting it should include encryption – it clearly does not”, explained CynergisTek. High performers achieved 90% conformance for protection of data at rest, whereas the rest of the sector was in the low 30th percentile.

In the Detect function, there was a major difference between high and low performers, but overall there were good levels of implementation; however, to be considered a high performer it is necessary to get the detect function substantially implemented and to ensure there is significant automation of security monitoring.

The Respond function concerns an organization’s ability to quickly implement appropriate activities when a cybersecurity event is detected, and this is an area where significant improvements need to be made. Only the highest performers are actively investigating notifications from detection systems, and only high performers were consistently and substantially mitigating incidents.

The recover function identifies activities required to return to normal operations after a cybersecurity incident. While there were gaps among the high performers, conformance was generally very good, but significant improvements need to be made by low performers. Around two-thirds (66%) of healthcare organizations are underperforming in recovery planning.

CynergisTek identified several aspects of security that healthcare organizations need to focus on over the coming 12 months:

  • Improve automation of security functions
  • Validate technical controls for people and processes
  • Perform exercises and drills at the enterprise level to test all components of the business
  • Secure the supply chain
  • Look beyond the requirements of the HIPAA Rules and further enhance privacy and security measures

The researchers found notable improvements had been made in organizations’ HIPAA privacy programs in 2020, with some healthcare organizations making exceptional progress. However, there is still room for improvement. CynergisTek identified several privacy areas that should be focused on in 2021.

These measures include implementing user access monitoring tools and engaging in proactive rather than reactive monitoring, addressing defective HIPAA authorizations, preventing violations of the Minimum Necessary Rule by defining criteria to limit PHI disclosure, updating insufficient privacy policies and procedures and ensuring the new policies are implemented, and addressing inappropriate Hybrid Entity designations.

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June 2021 Healthcare Data Breach Report

For the third consecutive month, the number of reported healthcare data breaches of 500 or more records increased. June saw an 11% increase in reported breaches from the previous month with 70 data breaches of 500 or more records reported to the HHS’ Office for Civil Rights – the highest monthly total since September 2020 and well above the average of 56 breaches per month over the past year.

United States healthcare data breaches in the past 12 months

While the number of reported breaches increased, there was a substantial fall in the number of breached healthcare records, which decreased 80.24% from the previous month to 1,290,991 breached records. That equates to more than 43,000 breached records a day in June.

records Exposed in U.S. healthcare data breaches in the past 12 months

More than 40 million healthcare records have been exposed or impermissibly disclosed over the past 12 months across 674 reported breaches. On average, between July 2020 and June 2021, an average of 3,343,448 healthcare records were breached each month.

Largest Healthcare Data Breaches in June 2021

There were 19 healthcare data breaches of 10,000 or more records reported in June. Ransomware continues to pose problems for healthcare organizations, with 6 of the top 10 breaches confirmed as ransomware attacks. Several healthcare organizations reported ransomware attacks in June that occurred at third-party vendors, with the number of healthcare providers confirmed as being affected by the ransomware attacks on vendors Elekta, Netgain Technologies, and CaptureRx continuing to grow.

The largest healthcare data breach to be reported in June was a phishing attack on the medical payment billing service provider MultiPlan. A threat actor gained access to an email account containing the protected health information of 214,956 individuals.

Northwestern Memorial HealthCare and Renown Health were affected by the ransomware attack on the Swedish radiation therapy and radiosurgery solution provider Elekta Inc., That attack is known to have affected a total of 42 healthcare providers in the United States.

Name of Covered Entity Covered Entity Type Individuals Affected Breach Cause Business Associate Involvement
MultiPlan Business Associate 214,956 Phishing attack Yes
Northwestern Memorial HealthCare Healthcare Provider 201,197 Elekta ransomware attack Yes
Scripps Health Healthcare Provider 147,267 Ransomware attack No
San Juan Regional Medical Center Healthcare Provider 68,792 Unspecified hacking and data exfiltration incident No
Renown Health Healthcare Provider 65,181 Elekta ransomware attack Yes
Minnesota Community Care Healthcare Provider 64,855 Netgain ransomware attack Yes
Francisco J. Pabalan MD, INC Healthcare Provider 50,000 Hacking/IT Incident (Unknown) No
Prominence Health Plan Health Plan 45,000 Ransomware attack No
NYC Health + Hospitals Healthcare Provider 43,727 CaptureRx ransomware attack Yes
UofL Health, Inc. Healthcare Provider 42,465 Misdirected email No
Peoples Community Health Clinic Healthcare Provider 40,084 Phishing attack No
Reproductive Biology Associates, LLC and its affiliate My Egg Bank, LLC Healthcare Provider 38,000 Ransomware attack No
Hawaii Independent Physicians Association Business Associate 18,770 Phishing attack Yes
UW Medicine Healthcare Provider 18,389 Hacking/IT Incident (Unknown) Yes
Cancer Care Center Healthcare Provider 18,000 Hacking/IT Incident (Unknown) Yes
Temple University Hospital, Inc. Healthcare Provider 16,356 Hacking/IT Incident (Unknown) Yes
Walmart Inc. Healthcare Provider 14,532 Loss of paper/films No
Discovery Practice Management, Inc. Business Associate 13,611 Phishing attack Yes
Jawonio Healthcare Provider 13,313 Phishing attack No

Causes of June 2021 Healthcare Data Breaches

Hacking/IT incidents dominated the breach reports in June 2021, with ransomware attacks accounting for a large percentage of those breaches. There were 58 reported hacking/IT incidents, in which the protected health information of 1,190,867 individuals was exposed or compromised – 92.24% of all breached records in June. The mean breach size was 20,532 records and the median breach size was 2,938 records.

Causes of June 2021 Healthcare data breaches

There were 9 unauthorized access/disclosure incidents reported that involved the impermissible disclosure of the PHI of 81,764 individuals. The mean breach size was 9,085 records and the median breach size was 5,509 records.

There was one incident reported involving the loss of paperwork containing the PHI of 14,532 individuals, one portable electronic device theft affecting 1,166 patients, and 1 incident involving the improper disposal of 2,662 physical records.

42 hacking incidents involved PHI stored on network servers, most of which were data access and exfiltration incidents involving ransomware. There were 19 email security breaches involving PHI stored in email accounts, most of which were phishing incidents.

Location of breached PHI in June 2021 data breaches

Covered Entities Reporting Data Breaches in June

The breach reports show healthcare providers were the worst affected covered entity type with 53 data breaches. 9 breaches were reported by health plans, and 8 by business associates of HIPAA covered entities. HIPAA-covered entities often report breaches at third party vendors, which can mask the extent to which business associates are being targeted by hackers. Adjusted figures taking this into account show the extent to which business associates are suffering data breaches. There were 36 data breaches reported that involved business associates, as shown in the pie chart below.

June 2021 healthcare data breaches by covered entity type

June 2021 Healthcare Data Breaches by State

There were large healthcare data breaches reported by HIPAA covered entities and business associates based in 32 states. California was the worst affected state with 8 reported breaches, followed by New York with 6.

State No. Data Breaches
California 8
New York 6
Illinois, Pennsylvania, Washington 4
Georgia, New Jersey, Ohio, Oregon, Texas 3
Arkansas, Kentucky, Michigan, Mississippi, Nevada, Tennessee, Wisconsin 2
Alaska, Arizona, Colorado, Connecticut, Florida, Hawaii, Iowa, Maryland, Massachusetts, Minnesota, Montana, New Mexico, Oklahoma, Rhode Island, South Carolina 1

HIPAA Enforcement Activity in June 2021

The HHS’ Office for Civil Rights announced one HIPAA enforcement action in June under its HIPAA Right of Access enforcement initiative. The Diabetes, Endocrinology & Lipidology Center, Inc. in Martinsburg, West Virginia was ordered to pay a financial penalty of $5,000 to resolve its HIPAA Right of Access case and agreed to adopt a robust corrective action plan to ensure that patients will be provided with timely access to their medical records. There were no confirmed HIPAA enforcement actions by state Attorneys General in June.

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Kaseya KSA Supply Chain Attack Sees REvil Ransomware Sent to 1,000+ Companies

A Kaseya KSA supply chain attack has affected dozens of its managed service provider (MSP) clients and saw REvil ransomware pushed out to MSPs and their customers. Kaseya is an American software company that develops software for managing networks, systems, and information technology infrastructure. The software is used to provide services to more than 40,000 organizations worldwide.

The REvil ransomware gang gained access to Kaseya’s systems, compromised the Kaseya’s VSA remote monitoring and management tool, and used the software update feature to install ransomware. The Kaseya VSA tool is used by MSPs to monitor and manage their infrastructure.

It is not clear when the ransomware gang gained access to Kaseya’s systems, but ransomware was pushed out to customers when the software updated on Friday July 2. The attack was timed to coincide with the July 4th holiday weekend in the United States, when staffing levels were much lower and there was less chance of the attack being detected and blocked before the ransomware payload was deployed.

Fast Response Limited Extent of the Attack

The fast response of Kaseya limited the extent of the attack. Over the weekend, Kaseya’s chief executive, Fred Voccola, said the software update was pushed out to around 40 customers and only affected on-premise customers who were running their own data centers and that its cloud-based services were not affected. The number of affected customers is now thought to be closer to 60.

Many of the victims were MSPs. In addition to their systems being encrypted, ransomware code was pushed out to their clients. More than 1,000 MSP clients are known to have been affected and had REvil ransomware installed. Sophos has reported that it is aware of 70 MSPs that have been affected, along with around 350 companies that use their services.

Kaseya has been issuing regular updates since the attack. In a Sunday morning update, Kaseya said there had been no further compromises since the Saturday evening report which suggests the measures implemented following the discovery of the attack have been successful. While no further ransomware attacks are believed to be occurring, the victim count will undoubtedly grow over the coming days.

When the attack was detected, Kaseya shut down its hosted and SaaS VSA servers and told all customers to switch off their own VSA servers while the attack was mitigated. Customers have been told to keep the servers switched off until further notice. Kaseya is working closely with CISA, the FBI, and cybersecurity forensics firms to investigate the incident and to determine the extent of the attack.

“Our security, support R&D, communications, and customer teams continue to work around the clock in all geographies through the weekend to resolve the issue and restore our customers to service,” said Kaseya in a July 4, 2021, statement about the attack. “We are in the process of formulating a staged return to service of our SaaS server farms with restricted functionality and a higher security posture (estimated in the next 24–48 hours but that is subject to change) on a geographic basis. More details on both the limitations, security posture changes, and time frame will be in the next communique later today.”

Supply chain attacks such as this can have a huge impact globally. Attackers compromise one company, then gain access to the networks of thousands of others, as was the case with the SolarWinds Orion supply chain attack in 2020. In that attack, malware was distributed through the software update mechanism which gave the attackers access to the systems of around 18,000 companies that received the update.

Kaseya Was Developing Patches for the Exploited Vulnerabilities

The REvil ransomware gang gained access to Kaseya’s systems by exploiting recently discovered vulnerabilities that had been reported to Kaseya by the Dutch Institute for Vulnerability Disclosure (DIVD). Those vulnerabilities had not been publicly disclosed and Kaseya was in the process of developing patches to correct the vulnerabilities when the REvil gang struck.

“Unfortunately, we were beaten by REvil in the final sprint, as they could exploit the vulnerabilities before customers could even patch,” said Victor Gevers, chairman of DIVD.

Kaseya said patches are being developed to correct the flaws and will be released as soon as possible.

One of the Largest Ransomware Attacks to Date

The REvil gang is believed to operate out of Eastern Europe or Russia and is one of the most prolific ransomware-as-a-service operations. Recent attacks conducted by the gang include JBS Foods, computer giant Acer, Pan-Asian retail giant Dairy Farm, UK clothing company French Connection (FCUK), French pharmaceutical company Pierre Fabre, and Brazilian healthcare company Grupo Fleury to name but a few. The latest attack is one of the largest ransomware attacks ever seen.

The gang is known to exfiltrate data prior to file encryption and demands payment of a ransom for the keys to decrypt encrypted files and to prevent the exposure or sale of data stolen in the attack. It is currently unclear if these attacks involved data theft.

Businesses and organizations affected by the latest attack have been issued with ransom demands ranging from $50,000 to $5 million according to Sophos malware analyst Mark Loman and Emsisoft CTO Fabian Wosar. The REvil gang has asked for a payment of $70 million to supply a universal decryptor that will unlock all systems that have been encrypted in the attack.

“On Friday (02.07.2021) we launched an attack on MSP providers. More than a million systems were infected. If anyone wants to negotiate about universal decryptor – our price is 70,000,000$ in BTC and we will publish publicly decryptor that decrypts files of all victims, so everyone will be able to recover from attack in less than an hour,” wrote the gang on its data leak site.

“We have been advised by our outside experts, that customers who experienced ransomware and receive a communication from the attackers should not click on any links - they may be weaponized,” said Kaseya.

President Biden Orders Federal Investigation

After learning of the attack, U.S. President Joe Biden ordered federal intelligence agencies to investigate the incident, stating on Saturday that it was unclear who was responsible for the attack. President Biden spoke with Vladamir Putin at the June 16 Geneva summit and urged him to crack down on cybercriminal gangs operating out of Russia and warned of consequences should the ransomware attacks continue. “The initial thinking was it was not the Russian government but we’re not sure yet,” President Biden told reporters on a Saturday visit to Michigan. He also confirmed the U.S. would respond if it is determined Russia was to blame for the attack.

CISA Issues Guidance for MSPs and MSP Customers Affected by the Kaseya VSA Supply Chain Attack

Kaseya issued a Compromise Detection Tool on July 3, 2021, which was rolled out to around 900 customers. The tool can be used to quickly determine if a customer’s VSA server has been compromised in the attack. The U.S. Cybersecurity and Infrastructure Security Agency is urging all Kaseya MSP customers to download and run the Compromise Detection Tool as soon as possible.

Kaseya MSP customers have also been advised to enable and enforce multi-factor authentication on every single account and, as far as is possible, to enable and enforce MFA for customer-facing services.

CISA also says MSPs should “implement allowlisting to limit communication with remote monitoring and management (RMM) capabilities to known IP address pairs, and/or place administrative interfaces of RMM behind a virtual private network (VPN) or a firewall on a dedicated administrative network.”

MSP customers affected by the attack have been advised to implement cybersecurity best practices, especially MSP customers who do not currently have their RMM service running due to the Kaseya attack. CISA recommends the following measures:

  • Ensure backups are up to date and stored in an easily retrievable location that is air-gapped from the organizational network;
  • Revert to a manual patch management process that follows vendor remediation guidance, including the installation of new patches as soon as they become available;
  • Implement:
    • Multi-factor authentication; and
    • Principle of least privilege on key network resources admin accounts.

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HHS: Take Action Now to Secure Vulnerable PACS Servers

The HHS’ Health Sector Cybersecurity Coordination Center (HC3) has issued a TLP:White Alert warning about vulnerabilities in the Picture Archiving Communication Systems (PACS) used by hospitals, clinics, small healthcare practices, and research institutions for sharing patient data and medical images.

The HC3 Sector Alert warns that PACS vulnerabilities are exposing sensitive patient data and placing systems at risk of compromise. Vulnerable Internet-exposed PACS servers can easily be identified and compromised by hackers, threatening not just the PACS servers but also any systems to which those servers connect.

PACS was initially developed to help with the transition from analog to digital storage of medical images. PACS servers receive medical images from medical imaging systems such as magnetic resonance imaging (MRI), computed tomography (CT), radiography, and ultrasound and store the images digitally using the Digital Imaging and Communications in Medicine (DICOM) format. DICOM is now three decades old and was discovered to have vulnerabilities that could easily be exploited.

The vulnerabilities were first described by security researchers in September 2019, who showed it is possible for the flaws to be exploited to gain access to medical images and patient data. Thousands of vulnerable PACS were identified worldwide, with a second study several months later uncovering even more PACS that were exposed to the Internet and vulnerable to attack.

In June 2021, a study by ProPublica revealed millions of medical images have been exposed via the Internet via vulnerable PACS. 130 health systems were found to have exposed around 8.5 million case studies involving more than 2 million patients, with more than 275 million medical images from their examinations placed at risk along with any associated protected health information. Exposed protected health information included patient names, examination dates, images, physician names, dates of birth, procedure types, procedure locations, and Social Security numbers.

Successful exploitation of the vulnerabilities could result in an attacker obtaining sensitive data, but it would also be possible to exploit vulnerabilities in the DICOM protocol to install malicious code, manipulate diagnoses, falsify scans, sabotage research, or install malware. Once access to PACS systems is gained, an attacker could move laterally and spread to other parts of the network undetected.

The main issue is PACS servers have been exposed to the Internet without applying basic security principles. These include:

  • Checking and validating connections to ensure the systems can only be accessed by authorized individuals.
  • Configuring the systems in accordance with manufacturer documentation.
  • Restricting network access to vulnerable systems and ensuring, where possible, that they are not accessible over the Internet.
  • Placing PACS systems behind firewalls, whenever possible.
  • Ensuring a Virtual Private Network (VPN) must be used to access PACS systems remotely.
  • Ensuring traffic between Internet connected systems and physicians/patients is encrypted by enabling HTTPS.
  • Ensuring default passwords are changed to strong, unique passwords.
  • Closing all unused ports on affected systems.
  • Where possible, discontinuing or limiting the use of third-party software on affected systems to decrease the attack surface.
  • Ensuring patches are applied promptly.
  • Logging and monitoring all network traffic attempting to reach vulnerable systems.

HC3 says there are still several PACS servers that are currently visible and vulnerable. All healthcare organizations have been advised to review their inventory to determine if they are running any PACS servers and to take the steps outlined in the guidance to ensure those systems are secured.

The Department of Homeland Security has produced a list of GE Healthcare PACS that are known to have vulnerabilities that need to be addressed. The list is not all-inclusive so security measures should be assessed for all PACS servers, regardless of whether there are known vulnerabilities.

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CISA Releases Ransomware Readiness Assessment Audit Tool

The U.S. Cybersecurity and Infrastructure Security Agency (CISA) has launched a new tool that can be used by organizations to assess how well they are equipped to defend and recover from a ransomware attack.

The threat from ransomware has gown significantly over the past year. The Verizon Data Breach Investigations Report shows 10% of cyberattacks now involve the use of ransomware, with SonicWall reporting a 62% global increase in ransomware attacks since 2019 and a 158% spike in attacks in North America during the same period. BlackFog predicts loses due to ransomware attacks will increase to $6 trillion in 2021, up from $3 trillion in 2015.

The Ransomware Readiness Assessment (RRA) audit module has been added to CISA’s Cyber Security Evaluation Tool (CSET). CSET is a desktop software tool that guides network defenders through a step-by-step process of assessing their cybersecurity practices for both their information technology (IT) and operational technology (OT) networks. CSET can be used to perform a comprehensive evaluation of an organization’s cybersecurity posture using recognized government and industry standards and recommendations.

The RRA can be used to evaluate cybersecurity defenses specifically relating to ransomware. CISA says the RRA tool has been developed for organizations at all levels of cybersecurity maturity and will allow network defenders to evaluate their defenses against recognized standards and best practice recommendations in a systematic, disciplined, and repeatable manner.

The RRA guides asset owners and operators through a systematic process to evaluate cybersecurity practices against ransomware threats and provides an analysis dashboard with graphs and tables displaying the results of the assessment, both in summarized and detailed form.

The RRA tool is available through CSET, which should first be downloaded and correctly installed. The installation file and instructions on installing CSET and starting the ransomware readiness assessment is available on GitHub on this link.

CISA is urging all organizations to install the CSET tool and conduct a Ransomware Readiness Assessment to evaluate their cybersecurity defenses.

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CISA Publishes Catalog of Cybersecurity Bad Practices That Must Be Eradicated

The DHS’ Cybersecurity and Infrastructure Security Agency (CISA) has published a new resource that lists cybersecurity bad practices that are exceptionally dangerous and significantly increase risk to critical infrastructure.

There are many published resources that provide information about cybersecurity best practices that should be adopted to improve security, but CISA felt an additional perspective was required as it is equally, if not more, important to ensure that bad cybersecurity practices are eliminated. “Ending the most egregious risks requires organizations to make a concerted effort to stop bad practices,” explained CISA.

CISA is urging leaders of all organizations to engage in urgent conversations to address technology bad practices, especially organizations that support national critical functions.

One of the foundational elements of risk management is “focus on the critical few”, explained CISA Executive Assistant Director Eric Goldstein in a blog post announcing the launch of the new website resource. Organizations may have limited resources to identify and mitigate risks, but eliminating cybersecurity bad practices is an essential element of every organization’s strategic approach to security. “Addressing bad practices is not a substitute for implementing best practices, but it provides a rubric for prioritization and a helpful answer to the question of ‘what to do first’,” said Goldstein.

The new resource was created following cyberattacks on critical infrastructure which demonstrated the impact they can have on critical government functions and how they pose a threat to security, national economic security, and/or national public health and safety.

The CISA Bad Practices catalog will grow over time, but currently lists two cybersecurity bad practices that are exceptionally risky: The use of unsupported software that has reached end-of-life and the continued use of known, fixed, and default passwords and credentials in service of Critical Infrastructure and National Critical Functions.

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