Healthcare Data Security

Healthcare Data Breaches Predicted to Cost Industry $4 Billion in 2019

Posted by HIPAA Journal

A recent survey has highlighted the cost of healthcare industry data breaches, the extent to which the healthcare industry is under attack, and how often those attacks succeed.

The survey was conducted by Black Book Market Research on 2,876 security professionals at 733 provider organizations between Q4, 2018 and Q3, 2019. Respondents were asked their views on cybersecurity to identify vulnerabilities and security gaps and determine why so many of these cyberattacks are succeeding.

96% of surveyed IT professionals believed that cybercriminals are outpacing medical enterprises, which is no surprise given that 93% of healthcare organizations reported having experienced a data breach since Q3, 2016. According to the report, 57% of organizations had experienced more than five data breaches during that time period. More than half of the data breaches reported by healthcare organizations were the result of hacks and other attacks by external threat actors.

The healthcare industry is being attacked because providers and insurers hold huge quantities of sensitive and valuable information and there are often security gaps that can be easily exploited. Even though the threat of attack is so high, the industry remains highly susceptible to data breaches.

The cost of these attacks to the healthcare industry is considerable. According to the report, the cost of data breaches at hospital organizations in 2019 was $423 per record. The report predicts that, based on the current level of data breaches, they will end up costing the healthcare industry $4 billion by the end of the year. Given the current trends and the annual increases in healthcare data breaches, that figure is likely to be considerably higher in 2020.

The survey confirmed that one of the main reasons why the healthcare industry is susceptible is due to budget constraints. Legacy systems and devices are still widely used in the healthcare industry, but the cost of replacing those systems is difficult to justify when that money does not increase revenue.

Overall, investment in cybersecurity for 2020 is planned to be increased to around 6% of total IT budgets at hospital systems, but smaller practices have seen a decrease in investment in cybersecurity, especially at physician organizations where only 1% of the 2020 IT budget will be spent on cybersecurity. 90% of hospital representatives surveyed said their cybersecurity budget had not changed since 2016.

When cybersecurity solutions are purchased, in many cases purchases are made blindly. A third of surveyed hospital executives said they chose cybersecurity solutions without much vision or discernment. 92% of data security product or service decisions since 2016 were made by C-level executives without including department managers and users in the purchasing decision. Only 4% of organizations said they had a steering committee to help evaluate the impact of investment in cybersecurity.

Many healthcare organizations are also operating without a dedicated security executive. Only 21% said they had a dedicated security executive and only 6% said that individual was the Chief Information Security Officer. At physician groups with more than 10 clinicians, only 1.5% said they had a dedicated CISO. Part of the reason is a shortage of qualified staff. 21% of healthcare organizations said they have had to outsource the role and are using cybersecurity-as-a-service as a stop gap measure.

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Lack of Encryption Leads to $3 Million HIPAA Penalty for New York Medical Center

Posted by HIPAA Journal

The University of Rochester Medical Center (URMC) has paid a $3 million HIPAA penalty for the failure to encrypt mobile devices and other HIPAA violations.

URMC is one of the largest health systems in New York State with more than 26,000 employees at the Medical Center and various other components of the health system, including Strong Memorial Hospital and the School of Dentistry.

The Department of Health and Human Services’ Office for Civil Rights (OCR) launched an investigation following receipt of two breach reports from UMRC – The loss of an unencrypted flash drive and the theft of an unencrypted laptop computer in 2013 and 2017.

This was not the first time OCR had investigated URMC. An investigation was launched in 2010 following a similar breach involving a lost flash drive. In that instance, OCR provided technical compliance assistance to URMC. The latest investigation uncovered multiple violations of HIPAA Rules, including areas of noncompliance that should have been addressed after receiving technical assistance from OCR in 2010.

Under HIPAA, data encryption is not mandatory. Following a risk analysis, as part of the risk management process, covered entities must assess whether encryption is an appropriate safeguard. An alternative safeguard can be implemented in place of encryption if it provides an equivalent level of protection.

In this case, URMC had assessed risk and determined that the lack of encryption posed a high risk to the confidentiality, integrity, and availability of ePHI, yet failed to implement encryption when it was appropriate and continued to use unencrypted mobile devices that contained ePHI, in violation of 45 C.F.R. § 164.31 2(a)(2)(iv).

OCR’s investigation confirmed that the ePHI of 43 patients was contained on the stolen laptop and as a result of the theft, that information was impermissibly disclosed – 45 C.F.R. §164.502(a). OCR also determined that URMC had failed to conduct a comprehensive, organization-wide risk analysis – 45 C.F.R. § 164.308(a)(1)(ii)(A) – that included all risks to the confidentiality, integrity, and availability of ePHI, and covered ePHI stored on the lost and stolen devices.

Risks had not been sufficiently managed and reduced to reasonable and acceptable level – 45 C.F.R. §164.308(a)(l)(ii)(B) – and policies and procedures governing the receipt and removal of hardware and electronic media in and out of its facilities had not been implemented – 45 C.F.R. § 163.310(d).

In addition to the $3,000,000 financial penalty, URMC is required to adopt a robust corrective action plan to address all aspects of noncompliance identified by OCR. URMC’s compliance efforts over the next two years will be scrutinized by OCR to ensure continuing compliance.

“Because theft and loss are constant threats, failing to encrypt mobile devices needlessly puts patient health information at risk,” said OCR Director Roger Severino. “When covered entities are warned of their deficiencies, but fail to fix the problem, they will be held fully responsible for their neglect.”

This is the sixth financial penalty of 2019 that OCR has issued to resolve violations of the Health Insurance Portability and Accountability Act and it is the fourth enforcement action to cite a risk analysis failure.

The risk analysis is one of the most important elements of HIPAA compliance and a risk analysis failure is the most common HIPAA violation cited in OCRs enforcement actions.

OCR has released a risk assessment tool to help covered entities and business associates comply with this aspect of HIPAA. Further information on the HHS risk assessment tool is available on this page.

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Common Office 365 Mistakes Made by Healthcare Organizations

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An Office 365 phishing campaign has been running over the past few weeks that uses voicemail messages as a lure to get users to disclose their Office 365 credentials. Further information on the campaign is detailed below along with some of the most common Office 365 mistakes that increase the risk of a costly data breach and HIPAA penalty.

Office 365 Voicemail Phishing Scam

The Office 365 voicemail phishing scam was detected by researchers at McAfee. The campaign has been running for several weeks and targets middle management and executives at high profile companies. A wide range of industries have been attacked, including healthcare, although the majority of attacks have been on companies in the service, IT services, and retail sectors.

The emails appear to have been sent by Microsoft and alert users to a new voicemail message. The emails include the caller’s telephone number, the date of the call, the duration of the voicemail message, and a reference number. The emails appear to be automated messages and tell the recipient that immediate attention is required to access the message.

The phishing emails include an HTML attachment which will play a short excerpt from the voicemail message if opened. Users will then be redirected to a spoofed Office 365 web page where they must enter their Office 365 credentials to listen to the full message. If credentials are entered, they will be captured by the attacker. Users are then redirected to the Office.com website. No voicemail message will be played.

This is not the first time that voicemail and missed call notifications have been used as a lure in phishing attacks, but the inclusion of audio recordings in phishing emails is unusual. The partial voicemail recording comes from an embedded .wav file in the HTML attachment.

McAfee reports that three different phishing kits are being used to generate the spoofed Microsoft Office 365 websites, which suggests three different threat groups are using this ploy.

While there are red flags that should alert security-aware employees that this is a scam, unfamiliarity with this type of phishing scam and the inclusion of Microsoft logos and carbon-copy Office 365 login windows may be enough to convince users that the voicemail notifications are genuine.

Common Office 365 Mistakes to Avoid and HIPAA Best Practices

This is just the latest of several recent phishing campaigns targeting Office 365 users and attacks on Office 365 users are increasing. Listed below are some steps that can be taken to reduce risk along with some of the common Office 365 mistakes that are made which can increase the risk of account compromises, data breaches and HIPAA penalties.

Consider Using a Third-Party Anti-Phishing Solution on Top of Office 365

Office 365 incorporates anti-spam and anti-phishing protections as standard through Microsoft Exchange Online Protection (EOP). While this control is effective at blocking spam email (99%) and known malware (100%), it doesn’t perform so well at stopping phishing emails and zero-day threats. Microsoft is improving its anti-phishing controls but EOP is unlikely to provide a sufficiently high level of protection for healthcare organizations that are extensively targeted by cybercriminals.

Microsoft’s anti-phishing protections are better in Advanced Threat Protection (APT), although this solution cannot identify zero-day threats, does not include sandboxing for analyzing malicious attachments, and email impersonation protection is limited. For advanced protection against phishing and zero-day threats, consider layering a third-party anti-phishing solution on top of Office 365.

Implement Multi-Factor Authentication

A third-party solution will block more threats, but some will still be delivered to inboxes. The Verizon Data Breach Investigations Report revealed 30% of employees open phishing emails and 12% click links in those messages. Security awareness training for employees is mandatory under HIPAA and can help to reduce susceptibility to phishing attacks, but additional anti-phishing measures are required to reduce risk to a reasonable and acceptable level. One of the most effective measures is multi-factor authentication. It is not infallible, but it will help to ensure that compromised credentials cannot be used to access Office 365 email accounts.

Check DHS Advice Prior to Migrating from On-Premises Mail Services to Office 365

There are risks and vulnerabilities that must be mitigated when migrating from on-premises mail services to Office 365. The DHS’ Cybersecurity and Infrastructure Security Agency has issued best practices that should be followed. Check this advice before handling your own migrations or using a third-party service.

Ensure Logging is Configured and Review Email Logs Regularly

HIPAA requires logs to be created of system activity and ePHI access attempts, including the activities of authorized users. Those logs must also be reviewed regularly and checked for signs of unauthorized access and suspicious employee behavior.

Ensure Your Emails are Encrypted

Email encryption will prevent messages containing ePHI from being intercepted in transit. Email encryption is a requirement of HIPAA if messages containing ePHI are sent outside your organization.

Make Sure You Read Your Business Associate Agreement

Just because you have obtained a signed business associate agreement from Microsoft it does not mean your email is HIPAA-compliant. Make sure you read the terms in the BAA, check your set up is correct, and you are aware of your responsibilities for securing Office 365 and you are using Office 365 in a HIPAA compliant manner.

Backup and Use Email Archiving

In the event of disaster, it is essential that you can recover your email data. Your Office 365 environment must therefore be backed up and emails containing ePHI and HIPAA-related documents must be retained for a period of 6 years. An archiving solution – from Microsoft or a third-party – is the best way of retaining emails as archives can be searched and emails quickly recovered when they are required, such for legal discovery or a compliance audit.

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HHS Releases Updated HIPAA Security Risk Assessment Tool

Posted by HIPAA Journal

The HHS has updated its HIPAA Security Risk Assessment Tool and has added several new features that have been requested by users to improve usability.

The HIPAA Security Risk Assessment Tool was developed by the HHS Office of the National Coordinator for Health Information Technology (ONC) in collaboration with the HHS’ Office for Civil Rights.

The Security Risk Assessment Tool can help small to medium sized healthcare organizations conduct a comprehensive, organization-wide risk assessment to identify all risks to the confidentiality, integrity, and availability of protected health information (PHI).

By using the tool, healthcare organizations will be able to identify and assess risks and vulnerabilities and use that information to improve their defenses against malware, ransomware, viruses, botnets and other types of cyberattack.

The risk assessment is a foundational element of compliance with the Health Insurance Portability Act Security Rule. By conducting a risk assessment, healthcare organizations can identify areas where PHI may be at risk. Any risks can then be assessed, prioritized, and reduced to a reasonable and acceptable level.

Since its initial release, the tool has been updated several times to improve usability and add additional functions. The latest version of the Risk Assessment Tool – Version 3.1 – has been released to coincide with National Cybersecurity Awareness Month and includes several user-requested improvements:

  • Threat and vulnerability validation
  • Incorporation of NIST Cybersecurity Framework references
  • Improved asset and vendor management
  • Question flagging and a new Flagged Report
  • Ability to export Detailed Reports to Excel
  • Fixes for several reported bugs to improve stability

The tool can be downloaded from the HHS for Windows devices, although the latest version is not available for Mac OS.

The HHS points out that the tool is only as useful as the work that goes into conducting and documenting a risk assessment. Use of the tool does not guarantee compliance with the risk assessment requirements of the HIPAA Security Rule and will only help HIPAA-covered entities and their business associates conduct periodic risk assessments.

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Report Suggests Augmented Security Following a Data Breach Contributes to Increase in Patient Mortality Rate

Posted by HIPAA Journal

Healthcare data breaches lead to a reduction in the quality of care provided to patients, according to a study recently published in Health Services Research.

Researchers analyzed data from Medicare Compare which details quality measures at hospitals. Data from 2012-2016 was analyzed and compared with data from the HHS’ Office for Civil Rights on data breaches of more than 500 records over the same period. The researchers analyzed data on 3,025 Medicare-certified hospitals, 311 of which had experienced a data breach.

According to the study, the time it took from a patient arriving at the hospital to an electrocardiogram being performed increased by up to 2.7 minutes at hospitals that had experienced a data breach. A ransomware attack that prevents clinicians from accessing patient data will limit their ability to provide essential medical services to patients, so a delay in conducting tests and obtaining the results is to be expected. However, the delays were found to continue for months and years after an cyberattack was experienced.

The study showed that 3-4 years after a breach had occurred there were still delays in providing electrocardiograms to patients. The waiting time for an electrocardiograms to patients was found to be up to 2 minutes longer than before the breach occurred.

Hospitals that experienced a data breach also saw an increase in the 30‐day acute myocardial infarction mortality rate. The mortality rate at breached hospitals increased by as much as 0.36%.

The increase in mortality rate has not been attributed to the cyberattack itself, as recovery is usually possible without a few days to a few weeks after a cyberattack. The researchers suggest the delays in providing medical services following a cyberattack is due to the steps hospitals have taken to improve the security of their systems and better protect patient data, along with the increased HHS oversight that occurs after a data breach is experienced. These factors can result in a deterioration in the timeliness of care and patient outcomes.

Following a cyberattack, hospitals augment their security controls to prevent further cyberattacks from succeeding. Those measures include multi-factor authentication, stronger passwords, and other security enhancements. While these additional measures improve the security posture of hospitals and make breaches less likely to occur in the future, they can also impede clinicians.

“Over the past few years, overall improvements in AMI treatment have resulted in the 30‐day AMI mortality rate decreasing about 0.4 percentage points annually from 2012 to 2014,” wrote the researchers. “A 0.23‐0.36 percentage point increase in 30‐day AMI mortality rate after a breach effectively erases a year’s worth of improvement in the mortality rate.”

The researchers suggest hospitals should carefully evaluate the security measures they implement to prevent further breaches to ensure they do not unduly impede clinicians and negatively affect patient outcomes.

The study – Data breach remediation efforts and their implications for hospital quality – was published in the October edition of Health Services Research: DOI: 10.1111/1475-6773.13203.

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Slew of HIPAA Violations Leads to $2.15 Million Civil Monetary Penalty for Jackson Health System

Posted by HIPAA Journal

The Department of Health and Human Services’ Office for Civil Rights has imposed a $2.15 million civil monetary penalty against the Miami, FL-based nonprofit academic medical system, Jackson Health System (JHS), for a slew of violations of HIPAA Privacy Rule, Security Rule, and Breach Notification Rule.

In July 2015, OCR became aware of several media reports in which the PHI of a patient was impermissibly disclosed. The individual was a well-known NFL football player. Photographs of an operating room display board and schedule had also been shared on social media by a reporter. OCR launched an investigation in October 2015 and opened a compliance review in relation to the impermissible disclosure.

JHS investigated and submitted a report confirming a photograph was taken in which two patients PHI was visible, including the PHI of a well-known person in the community. The internal investigation revealed an employee had been accessing patient information without authorization since 2011. During that time, the employee had accessed the records of 24,188 patients without any legitimate work reason for doing so and had been selling that information.

HIPAA requires covered entities to implement policies and procedures to prevent, contain, and correct security violations – 45 C.F.R. § 164.308(a)(l) – however, before risks can be managed and reduced to a reasonable and acceptable level, a covered entity must conduct a comprehensive risk analysis – 45 C.F .R. §164.308(a)(l)(ii){A) – to ensure that all risks to the confidentiality, integrity, and availability of PHI are identified.

On several occasions, OCR requested documentation on risk analyses at JHS. JHS supplied documentation on internal assessments from 2009, 2012, and 2013, and risk analyses conducted by third parties in 2014, 2015, 2016, and 2017.

OCR discovered that prior to 2017, JHS had erroneously marked several aspects of the HIPAA Security Rule as non-applicable in the risk analyses. A risk analysis failure occurred in 2014 as it had failed to cover all ePHI and did not identify all risks to ePHI contained within JHS systems. JHS had also failed to provide documentation confirming measures had been implemented to reduce all risk to ePHI to a reasonable and appropriate level, even though recommendations had been made by the company that performed the 2014 risk analysis.

Similar risk analysis failures occurred in 2015. Some sections of the risk analysis conducted by a third party had not been completed, the risk analysis failed to cover all ePHI, and documentation could not be supplied confirming risk management efforts had taken place. It was a similar story in 2016, and the 2017 risk analysis was not comprehensive.

OCR investigators also discovered reviews of information system activity such as audit logs had not been regularly reviewed, in violation of 45 C.F.R. § 164.308(l)(ii)(D).

OCR also determined that between July 22, 2013 and January 27, 2016, policies and procedures had not been implemented to prevent, detect, contain, and correct security violations. The HIPAA Privacy Rule had also been violated, as reasonable efforts were not made to limit certain employees’ access to PHI, which had led to unauthorized access and impermissible disclosures. Access to PHI was also not limited to the minimum necessary information, in violation of 45 C.F.R. §164.308(a)(4) and 45 C.F.R. § 164.514(d).

On multiple occasions employees had accessed records without authorization when there was no treatment relationship with a patient, and also after a treatment relationship had come to an end.

JHS had also violated the HIPAA Breach Notification Rule by failing to report a breach within 60 days of discovery in violation of 45 C.F.R. § 164.408(b). The loss of boxes of files in 2013 was not reported for 160 days. JHS also admitted that it did not have policies in place covering PHI breaches prior to October 2013.

OCR attempted to resolve the HIPAA violations via informal means, but JHS failed to comply, which led to OCR issuing a Notice of Proposed Determination. JHS waived its right to a hearing and OCR issued a Notice of Final Determination, which was not contested and JHS paid the full financial penalty of $2,154,000.

“OCR’s investigation revealed a HIPAA compliance program that had been in disarray for a number of years,” explained OCR Director Roger Severino. “This hospital system’s compliance program failed to detect and stop an employee who stole and sold thousands of patient records; lost patient files without notifying OCR as required by law; and failed to properly secure PHI that was leaked to the media.”

This is the second financial penalty for a HIPAA covered entity to be announced this month and the fifth penalty to be issued in 2019. Earlier this month, Elite Dental Associates settled its HIPAA case with OCR for $10,000 following disclosures of patients’ PHI on the Yelp review site.

Settlements were also agreed with Bayfront Health St Petersburg ($85,000), Medical Informatics Engineering ($100,000), and Touchstone Medical Imaging ($3,000,000) earlier in the year.

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76% of SMBs Have Experienced a Data Breach in the Past Year

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A recent survey conducted by the Ponemon Institute on behalf of Keeper Security has revealed 76% of small and medium sized businesses in the United States have experienced a data breach in the past 12 months.

The survey was conducted on 2,391 IT and IT security professionals in the United States, United Kingdom, and Western Europe for Keeper Security’s 2109 Global State of Cybersecurity report.

The survey revealed SMBs in the United States are more extensively targeted than in other countries. Globally, 66% of SMBs have experienced a data breach in the past year. The frequency of attacks has also increased. Since 2016, the number of cyberattacks on SMBs has risen by 20%. 69% of respondents said cyberattacks have become much more targeted.

The main methods used by cybercriminals to attack SMBs are phishing and social engineering, which were behind 57% of SMB cyberattacks in the past 12 months. 30% of attacks involved other forms of credential theft, and 33% of breaches were due to compromised or stolen devices. 70% of surveyed SMBs said they had experienced incidents in past 12 months in which employee passwords were either lost or stolen.

The root causes of most breaches differed from country to country. In Scandinavia, Austria, Germany, and Switzerland, phishing and social engineering attacks were the most common causes of data breaches, whereas in the United States, United Kingdom, Belgium, Netherlands, and Luxembourg breaches were most commonly due to employee negligence.

63% of respondents globally and 69% in the United States said a data breaches had resulted in the loss or theft of sensitive information, which is 50% higher than in 2016.

Many businesses have implemented an intrusion detection system to prevent and detect breaches, yet 69% of businesses reported that at least one attack had circumvented that system.

There has been a major rise in the use of mobile devices by SMBs and those devices are often used to access business-critical applications. 48% of respondents said they use mobile devices for that purpose and the same number said they do so even though it poses a security risk.

It is important for strong passwords to be set to reduce the potential for password guessing or brute force attacks. While many businesses had password policies in place, 54% said they had no visibility into the password practices of their employees.

There is also a lack of oversight of third parties with whom sensitive data is shared. 70% of respondents said they did not maintain a comprehensive record of the third parties with whom sensitive data was shared. Unless that information is recorded, it is impossible to conduct comprehensive assessments to determine whether business associates are implementing appropriate controls to keep confidential information secure.

45% of SMBs believed they cybersecurity defenses were ineffective at mitigating cyberattack and 39% said they had no incident response procedures in place to deal with data breaches when they occurred. Given the lack of incident response plans it is no surprise that only 26% of respondents said they had managed to decrease their response time to cyberattacks. 39% said their response times had increased.

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Sensitive Data of Millions of Patients Discovered to Be Freely Accessible Over the Internet

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The sensitive health information of millions of patients has been exposed over the internet as a result of the failure of nine companies to secure their medical databases.

The exposed patient data was discovered by security researchers at WizeCase. The research team, led by Avishai Efrat, used publicly available tools to search for exposed data that could be accessed without the need for any usernames or passwords. The firm then offers to help those organizations fix their data leaks and better secure their data.

In all cases, the researchers attempted to contact the healthcare organizations concerned to advise them about the misconfigured databases to allow steps to be taken to secure the data and prevent unauthorized access, but in several cases no response was received.

The researchers contacted databreaches.net and received assistance in contacting the companies concerned. When no response was received, the researchers contacted local authorities and hosting companies for assistance. Several attempts were made to get the data secured over the space of a month before the decision was taken to go public and name the companies concerned to spur them into taking action.

The databases belonged to healthcare organizations in Brazil, Canada, France, Nigeria, Saudi Arabia, two in China, and two in the United States. Seven of the nine exposed databases were on public facing Elasticsearch servers and two were misconfigured MongoDB databases.

The databases contained a range of sensitive information including names, addresses, contact telephone numbers, email addresses, dates of birth, tax ID numbers, insurance details, employer details, occupations, diagnoses, details of medical complaints, prescription information, HIV test results, pregnancy status, lab test results, Social Security numbers, and other types of personal and health information.

The two U.S. databases belonged to DeepThink Health – formerly Jintel Health – and VScript. DeepThink Health has developed a precision intelligence platform that captures and structures clinical and genomic datasets and analyzes the data to enable precision medicine. The 2.7GB Elasticsearch database contacted approximately 700,000 records. Those records contained the names and contact information of medical personnel, medical observations including details of the stages and types of cancers of patients, and cancer treatment information.

VScript is a pharmacy software firm. The researchers found an Elasticsearch server hosting 81MB of data of around 800 patients and a GoogleAPI bucket containing thousands of images of prescriptions along with the names, contact information, and dates of birth of the patients who had received them.

VScript was one of the companies that did not respond to either WizeCase or databreaches.net emails and phone calls. Databreaches.net also reached out to Google about the exposed data, but the data remained accessible even after Google had made contact. Databreaches.net notes that it is unclear whether the data belonged to VScript. The database may have been the responsibility of one of its vendors.

The other databases were owned by BioSoft in Brazil, ClearDent in Canada, the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS), Stella Prism in Saudi Arabia, Tsinghua University Clinical Medical College and Sichuan Lianhao Technology Group Co., Ltd in China, and Essibox, the French division of the international ophthalmic optics group Essilor.

“Technology is moving at a fast pace and the security systems don’t seem like they can keep up. This is especially troubling when dealing with a company that is supposed to protect sensitive user data,” explained WizeCase in a recent blog post. “Since some of these databases were created and maintained by third party companies, it is possible that the patients concerned are unaware that their data is being held and used by these companies.”

The exposure of sensitive medical data places patients at risk of blackmail, identity theft, and fraud, but many may never learn that their sensitive information has been exposed. The WizeCase researchers may not be the only individuals to have discovered the databases. It is possible that multiple individuals have stolen the databases and are using them for nefarious purposes.

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September 2019 Healthcare Data Breach Report

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September saw 36 healthcare data breaches of more than 500 records reported to the Department of Health and Human Services’ Office for Civil Rights, which represents a 26.53% decrease in breaches from the previous month.

1,957,168 healthcare records were compromised in those breaches, an increase of 168.11% from August. The large number of breached records is largely down to four reported incidents, each of which involved hundreds of thousands of healthcare records. Three of those incidents have been confirmed as ransomware attacks.

Largest Healthcare Data Breaches in September 2019

The largest breach of the month was due to a ransomware attack on Jacksonville, FL-based North Florida OB-GYN, part of Women’s Care of Florida. 528,188 healthcare records were potentially compromised as a result of the attack. Sarrell Dental also experienced a ransomware attack in which the records of 391,472 patients of its Alabama clinics were encrypted. 320,000 records of patients of Premier Family Medical in Utah were also potentially compromised in a ransomware attack. The University of Puerto Rico reported a network server hacking incident involving 439,753 records of Intramural Practice Plan members. The exact nature of the breach is unclear.

Those four breaches accounted for 85.80% of the healthcare records breached in September.

Name of Covered Entity Covered Entity Type Individuals Affected Type of Breach Location of Breached Information
Women’s Care Florida, LLC Healthcare Provider 528188 Hacking/IT Incident Network Server
Intramural Practice Plan – Medical Sciences Campus – University of Puerto Rico Healthcare Provider 439753 Hacking/IT Incident Network Server
Sarrell Dental Healthcare Provider 391472 Hacking/IT Incident Network Server
Premier Family Medical Healthcare Provider 320000 Hacking/IT Incident Network Server
Magellan Healthcare Business Associate 55637 Hacking/IT Incident Email
CHI Health Orthopedics Clinic -Lakeside Healthcare Provider 48000 Hacking/IT Incident Desktop Computer, Electronic Medical Record, Network Server
Kilgore Vision Center Healthcare Provider 40000 Hacking/IT Incident Network Server
Peoples Injury Network Northwest Healthcare Provider 27000 Hacking/IT Incident Network Server
Sweetser Healthcare Provider 22000 Hacking/IT Incident Email
Perfect Teeth Yale, P.C. Healthcare Provider 15000 Loss Other Portable Electronic Device

Causes of September 2019 Healthcare Data Breaches

Hacking/IT incidents dominated the breach reports in September with 24 incidents reported. There were 9 unauthorized access/disclosure incidents and three cases of loss/theft of physical and electronic records.

1,917,657 healthcare records were compromised in the 24 hacking/IT incidents which accounted for 97.98% of breached records in September. The mean breach size was 958,829 records and the median breach size was 5,255 records.

Unauthorized access/disclosure incidents in September accounted for 1% or 19,741 breached records. The mean breach size was 2,193 records and the median breach size was 998 records. There were two reported theft incidents involving 4,770 physical and electronic records and a single loss incident involving 15,000 records stored on a portable electronic device.

Location of Breached Protected Health Information

Phishing continues to be a major problem area for the healthcare industry. In September, 44.44% of all breaches – 16 incidents – involved PHI stored in email accounts. There were 13 network server incidents, a large percentage of which were ransomware attacks.

September 2019 Healthcare Data Breaches by Covered Entity Type

28 data breaches were reported by healthcare providers in September, four incidents were reported by health plans/health insurers, and four incidents were reported by business associates of HIPAA covered entities. A further four breaches had some business associate involvement but were reported by the covered entity.

States Affected by September 2019 Healthcare Data Breaches

September’s data breaches were reported by entities in 23 states and Puerto Rico. California, Maryland, and Washington were the worst affected with three breaches each. There were two breaches reported by entities based in Arkansas, Arizona, Colorado, Georgia, Indiana, and South Carolina, and one breach was reported in each of Alabama, Florida, Iowa, Illinois, Maine, Michigan, Nebraska, New Jersey, Ohio, Oklahoma, Tennessee, Texas, Utah, West Virginia, and Puerto Rico.

HIPAA Enforcement Activity in September 2019

In September 2019, the HHS’ Office for Civil Rights announced its third HIPAA violation penalty of the year. Bayfront Health St Petersburg in Florida was issued with an $85,000 financial penalty for the failure to provide a patient with a copy of her child’s fetal heart monitor records within a reasonable time frame. It took 9 months and multiple attempts by the patient before she was provided with the records.

This month, OCR Director Roger Severino gave an update on OCR’s main enforcement priorities and confirmed that noncompliance with the HIPAA right of access is still a major focus for OCR. Further financial penalties can be expected over the coming weeks and months for healthcare organizations that fail to provide individuals with copies of their health information within a reasonable time frame and at a reasonable cost.

There were no financial penalties issued by state attorneys general in September over HIPAA violations.

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