Healthcare Data Security

OCR Reminds Covered Entities Not to Overlook Physical Security Controls

Posted by HIPAA Journal

The Department of Health and Human Services’ Office for Civil Rights (OCR) has reminded covered entities that HIPAA not only requires technical controls to be implemented to ensure the confidentiality, integrity, and availability of protected health information, but also appropriate physical security controls.

Physical controls are often the simplest and cheapest forms of protection to keep PHI private and confidential, yet these security controls are often overlooked. Some physical security controls cost nothing – such as ensuring portable electronic devices (laptop computers, portable storage devices, and pen drives) are locked away when they are not in use.

While this is a very basic form of security, it is one of the most effective ways of preventing theft and one that can prove incredibly costly if overlooked. OCR draws attention to a 2015 HIPAA breach settlement with Lahey Hospital and Medical Center. An unencrypted laptop computer was stolen from the Tufts Medical School affiliated teaching hospital resulting in the exposure 599 patients’ ePHI.

The laptop computer was used in connection with a computerized tomography (CT) scanner. The laptop was in an unlocked treatment room off an inner corridor of the radiology department. Lahey Hospital settled the case for $850,000. A high price to pay for failing to implement a free physical security control.

In 2014, QCA Health Plan agreed to settle potential HIPAA violations with OCR for $250,000. QCA Health plan failed to implement physical safeguards for all workstations to restrict access to ePHI to authorized users only. In that case, the workstation was an unencrypted laptop computer that was stolen from the vehicle of an employee.

In 2012, Massachusetts Eye and Ear Infirmary (MEEI) settled a HIPAA violation case with OCR for $1.5 million. This was another case of an unencrypted laptop computer being stolen that resulted in the impermissible disclosure of ePHI.

In 2016, OCR settled potential HIPAA violations with Feinstein Institute for Medical Research for $3.9 million. Feinstein Institute had failed to physically secure a laptop computer containing the ePHI of 13,000 patients. The device was also stolen from the vehicle of an employee.

In July 2016, University of Mississippi Medical Center settled a case with OCR for $2,750,000. An unencrypted laptop computer containing the ePHI of an estimated 10,000 patients was stolen from its Medical Intensive Care unit.

HIPAA requires covered entities and their business associates to implement “physical safeguards for all workstations that access ePHI to restrict access to authorized users.” Workstations include desktop computers, laptops, and other computing devices including portable storage devices, smartphones, and tablets.

It is up to HIPAA-covered entities and their business associates to decide on the most appropriate physical security controls to implement, which should be based on their risk analyses and risk management process.

Common physical security controls used to secure electronic devices and ePHI include:

  • Positioning desks to ensure screens cannot be easily viewed by anyone other than the user of a workstation
  • Privacy screens to prevent shoulder surfing
  • Cable locks to prevent electronic devices containing ePHI from being stolen
  • The use of security cameras to deter theft of electronic devices and physical PHI
  • Use of signage to remind employees about the need to use physical security controls
  • Use of port and device locks to prevent CD/DVD drives and USB connections from being used on workstations to copy ePHI and install unauthorized software.

The importance of preventing the use of USB drives by staff was highlighted in a recent study by Dtex Systems into insider threats. While the study was not conducted specifically on healthcare organizations, it did reveal that 90% of the risk assessments conducted on its customers and prospective customers revealed employees were transferring data to unencrypted USB devices.

As OCR explained in its May 2018 cybersecurity newsletter, “While the latest security solutions to combat new threats and vulnerabilities get much deserved attention, appropriate physical security controls are often overlooked.  Yet physical security controls remain essential and often cost-effective components of an organization’s overall information security program.”

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Lack of Visibility into Employee Activity Leaves Organizations Vulnerable to Data Breaches

Posted by HIPAA Journal

The 2018 Insider Threat Intelligence Report from Dtex Systems shows how a lack of visibility into employee activities is preventing security teams from acting on serious data security threats.

The report is based on data gathered from risk assessments performed on the firm’s customers and prospective customers. Those risk assessments highlighted just how common it is for employees to attempt to bypass security controls, download shadow IT, and violate company policies.

If your risk assessment has identified employees attempting to bypass security controls, you are not alone. According to the Dtex Systems report, 60% of risk assessments uncovered attempts by employees to bypass an organization’s security controls, use of private and anonymous browsers, or cases where employees had researched how to bypass security controls.

In most cases, employees are attempting to bypass security controls to gain access to websites that breach acceptable internet usage policies – such as adult content, gaming, and gambling sites, and to access P2P file sharing websites. 67% of companies discovered inappropriate Internet use. It is also common for employees to try to download shadow IT to make their jobs easier – use of tools such as Dontsleep, Caffeine, WireShark, or SnippingTool is common, even though those programs are prohibited.

While there may not be any malicious intent, these actions jeopardize security and could easily result in the accidental disclosure of sensitive information or malware infections. Programs such as open VPN tools and CCleaner are also commonly downloaded – both of which are an indicator of employees attempting to cover their tracks, potentially to hide malicious activities.

72% of risk assessments determined at least some employees were using high-risk applications or hacking tools and 90% of risk assessments showed employees were transferring data to unencrypted USB devices. 78% of companies also discovered company data that were publicly accessible online due to mistakes made by employees.

The 2018 Verizon Data Breach Investigations Report showed almost a third of the 2,216 confirmed breaches were caused by insiders and insider data breaches are far more common in the healthcare industry. Typically, in any given month, more healthcare industry data breaches are caused by insiders than breaches caused by external threat actors.

While technological controls can be implemented to improve security, it is important not to neglect the human element. Security awareness training shows employees how certain behaviors can easily result in a data breach; however, employees are often aware that certain actions increase risk, yet they still engage in risky activities. Many employees do not think that their actions will result in a data breach and carry on taking risks. They rely on IT teams to address cybersecurity and take no personal responsibility for helping to keep their company’s systems and data secure.

Security teams can take steps to reduce risk, but unless they have visibility into what their employees are doing they will not know the extent of risk taking by employees are could remain blind to these potentially dangerous activities.

Unfortunately, no single solution can be used to protect against insider threats. Only by using a range of solutions will healthcare organizations be able to tackle the problem of insider data breaches.

In addition to performing regular risk analyses to identify potential threats, Dtex Systems suggests the use of Security Information and Event Management (SIEM), user behavior analytics, and data loss prevention technologies. Additionally, employee monitoring solutions and user behavior intelligence are required to highlight abnormal activities and suspicious behavior. Such solutions will help security teams identify insider threats and take action before they lead to a data breach.

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DMARC Still Not Widely Adopted by Healthcare Organizations

Posted by HIPAA Journal

By adopting the Domain-based Message Authentication, Reporting and Conformance (DMARC) Standard, healthcare organizations can detect and prevent email spoofing and abuse of their domains; however, relatively few healthcare organizations are using DMARC, according to a recent study conducted by the email authentication vendor Valimail.

DMARC is an open standard that ensures a domain can only be used by authorized senders. If DMARC is not implemented, it is easy for a hacker to send an email that contains a company’s domain in the From field of the email.

Security awareness programs train employees never to click on hyperlinks or open attachments contained in emails from unknown senders. However, when the email appears to have been sent from a contact or known individual, the messages are often opened, links are clicked, and attachments are opened.

Research conducted by Cofense suggests more than 91% of all cyberattacks start with a phishing email, and the majority of successful phishing attacks use email impersonation techniques. If controls are not implemented to block email impersonation, companies will be vulnerable to phishing attacks.

DMARC is one of the most effective anti-phishing controls. When a DMARC record is created for a domain, the receiving server checks to determine whether the sender of the message is authorized to use the domain. If the message is authenticated, it will be delivered. If the authentication fails, the receiving server will take the action detailed in the DMARC record. If permissive controls are set, the message will still be delivered although policies can be set to direct the message to the quarantine (spam) folder or at the most aggressive level, the message will be rejected.

For the study, Valimail assessed the domains of 928 healthcare companies around the world with annual revenues in excess of $300 million, including hospitals, medical equipment suppliers, pharmacies, physicians and health practitioners. Just 121 of those companies (13%) have adopted DMARC to secure their domains and prevent email spoofing.

Even when DMARC is implemented, most healthcare companies set permissive monitor-only policies. While those organizations will be alerted to email impersonation attacks, the messages will not be blocked. Few healthcare organizations have implemented DMARC at the enforcement level, which is necessary to protect against email impersonation attacks. Overall, only 1.7% of healthcare organizations have set policies that reject emails sent by unauthorized senders.

While few healthcare companies have adopted DMARC, the study showed a majority – 60% – have adopted the Sender Policy Framework (SPF) standard. While SPF is an effective control, it only validates the return-path field. It does not prevent hackers from conducting email impersonation attacks and using an organization’s domain in the from field.

DMARC adoption is increasing, although implementation is clearly a challenge for many healthcare organizations. Valimail notes in its report that it is typically only the largest healthcare organizations that successfully implement DMARC, suggesting DMARC implementation is a resource issue for smaller companies.

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HITRUST Now Offers NIST Cybersecurity Framework Certification

Posted by HIPAA Journal

The security and privacy standards development and accreditation organization HITRUST has started offering certification for the National Institute of Standards and Technology’s (NIST) Framework for Improving Critical Infrastructure Cybersecurity (Cybersecurity Framework). The certification program makes it easier for healthcare organizations to report progress to management, business partners, and regulators and verify they have met NIST cybersecurity framework controls.

The NIST Cybersecurity Framework is a set of standards and best practices that help organizations improve security, manage cybersecurity risk, and protect critical infrastructure. Many healthcare organizations have adopted the NIST cybersecurity framework but are unsure how they are doing in the cybersecurity categories.

Through the HITRUST CSF Assurance Program, healthcare organizations can assess whether they have met the requirements in each of the NIST categories.

The HITRUST CSF now includes a scorecard that allows organizations to check how their security program maps to the core subcategories of the NIST Cybersecurity Framework and provides compliance ratings for each core subcategory. HITRUST also provides certification to confirm that organizations are meeting all requirements of the NIST Cybersecurity Framework. If an organization achieves a certain score, certification will be issued against the NIST Cybersecurity Framework.

The Government Accountability Office (GAO) has confirmed that the HITRUST CSF aligns with the NIST Cybersecurity Framework and allows organizations to demonstrate compliance.

NIST has also developed guidance for healthcare organizations to help them implement the various controls detailed in the NIST Framework. The implementation guidance can be used even if organizations choose not to go through the assessment process.

“The HITRUST CSF’s integration and harmonization of multiple industry-relevant statutory, regulatory and best practice requirements into a single, prescriptive, yet highly tailorable framework makes it extremely easy for organizations to determine an appropriate Target Profile and subsequently implement and report their progress towards a cybersecurity program that fulfills the goals and objectives of the NIST Framework”

HITRUST CSF Assurance Program has been adopted by approximately 80% of hospitals and insurance companies. Through a single assessment, healthcare organizations can assess compliance with the HIPAA Security and Privacy Rules, the NIST Cybersecurity Framework, GDPR, ISO 27001, PCI and other leading standards and frameworks.

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Healthcare Data Breach Report: April 2018

Posted by HIPAA Journal

April was a particularly bad month for healthcare data breaches with both the number of breaches and the number of individuals impacted by breaches both substantially higher than in March.

There were 41 healthcare data breaches reported to the Department of Health and Human Services’ Office for Civil Rights in April. Those breaches resulted in the theft/exposure of 894,874 healthcare records.

Healthcare Data Breach Trends

For the past four months, the number of healthcare data breaches reported to OCR has increased month over month.

Healthcare data breaches by month

For the third consecutive month, the number of records exposed in healthcare data breaches has increased.

HEalthcare records exposed by month

Causes of Healthcare Data Breaches in April 2018

The healthcare industry may be a big target for hackers, but the biggest cause of healthcare data breaches in April was unauthorized access/disclosure incidents. While cybersecurity defences have been improved to make it harder for hackers to gain access to healthcare data, there is still a major problem preventing accidental data breaches by insiders and malicious acts by healthcare employees.

Causes of Healthcare Data Breaches in April 2018

Records exposed by breach type (April 2018)

Largest Healthcare Data Breaches in April 2018

More than half of the healthcare records exposed in April were the result of a single security incident at the California Department of Developmental Services. Thieves broke into California Department of Developmental Services offices, stole electronic equipment, and started a fire. Digital copies of PHI on the stolen equipment were encrypted and were therefore not exposed. Most of the PHI was in physical form and it does not appear any paperwork was taken by the burglars.

While hacking usually results in the highest number of exposed/stolen records, in April the most serious breaches in terms of the number of individuals affected, were unauthorised access/disclosure incidents. In April there were 11 major breaches involving the theft/exposure of more than 10,000 records.

Covered Entity Entity Type Records Exposed Breach Type
CA Department of Developmental Services Health Plan 582,174 Unauthorized Access/Disclosure
Center for Orthopaedic Specialists – Providence Medical Institute (PMI) Healthcare Provider 81,550 Hacking/IT Incident
MedWatch LLC Business Associate 40,621 Unauthorized Access/Disclosure
Inogen, Inc. Healthcare Provider 29,528 Hacking/IT Incident
Capital Digestive Care, Inc. Healthcare Provider 17,639 Unauthorized Access/Disclosure
Iowa Health System d/b/a UnityPoint Health Business Associate 16,429 Hacking/IT Incident
Knoxville Heart Group, Inc. Healthcare Provider 15,995 Hacking/IT Incident
Athens Heart Center, P.C. Healthcare Provider 12,158 Hacking/IT Incident
Fondren Orthopedic Group L.L.P. Healthcare Provider 11,552 Unauthorized Access/Disclosure
Kansas Department for Aging and Disability Services Healthcare Provider 11,000 Unauthorized Access/Disclosure
Carolina Digestive Health Associates, PA Healthcare Provider 10,988 Unauthorized Access/Disclosure

Location of Breached PHI

One of the main causes of healthcare breaches in April was phishing attacks. There were nine data breaches involving the hacking of email accounts in April. The high number of phishing attacks highlights the need for healthcare organizations to invest in technology to prevent malicious emails from being delivered to employees’ inboxes and to improve security awareness of the workforce.

Location of Breached PHI (April 2018)

Data Breaches by Covered Entity

The majority of breaches in April were reported by healthcare providers, followed by health plans and business associates. While five breaches were reported by business associates, there was business associate involvement in at least 11 incidents in April.

Data Breaches by Covered Entity (April 2018)

Healthcare Data Breaches by State

California is the most populated state and often tops the list for healthcare data breaches, although in April Illinois was the worst affected state with 6 reported breaches. California was second worst with 5 breaches, followed by Texas with 3 breaches.

Florida, Iowa, Kansas, Louisiana, Maryland, Minnesota, North Carolina, New Jersey, Virginia, and Wisconsin each has two breaches reported, while Georgia, Kentucky, Montana, Nebraska, New York, Pennsylvania, and Tennessee each had one reported breach in April.

Financial Penalties for HIPAA Covered Entities

The HHS’ Office for Civil Rights has only issued two financial penalties for HIPAA violations so far in 2018, with no cases resolved since February.

There was one HIPAA violation case resolved by a state attorney general in April. Virtua Medical Group agreed to resolve violations of state and HIPAA laws with the New Jersey attorney general’s office for $417,816.

The breach that triggered the investigation exposed the names, diagnoses, and prescription information of 1,654 New Jersey residents. The information was accessible over the Internet as a result of a misconfigured server.

A Division of Consumer Affairs investigation alleged Virtua Medical Group had failed to conduct a thorough risk analysis and did not implement appropriate security measures to reduce risk to a reasonable and acceptable level.

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Healthcare IT Security Budgets Frozen Despite Increase in Cyberattacks

Posted by HIPAA Journal

A recent report from Black Book Research has revealed more than 90% of healthcare organizations have experienced a data breach since Q3 2016, yet IT security spending at 88% of hospitals remains at 2016 levels.

The data comes from a survey of more than 2,400 security professionals from 680 provider organizations. The aim of the study was to identify the reasons why the healthcare industry is particularly vulnerable to cyberattacks.

Black Book Research explains in the report that since 2015 there have been more than 180 million healthcare records stolen, with approximately one in 12 healthcare consumers affected by a data breach at a provider organization. Nine out of ten healthcare providers have experienced a breach, but almost 50% of providers have experienced more than 5 data breaches since Q3, 2016.

There has been a marked increase in healthcare data breaches over the past three years, with cybercriminals and nation state-backed hackers increasingly targeting the healthcare industry. Even though cyberattacks are on the rise, healthcare IT security budgets are not increasing. It is proving difficult to find the necessary money to make significant improvements to cybersecurity defenses since cybersecurity does not generate revenue. Part of the problem is a lack of funds to replace vulnerable legacy systems and devices. There simply isn’t the money available to commit to such an undertaking.

96% of IT professionals believe that threat actors now have the upper hand and medical enterprises are not identifying and addressing vulnerabilities quickly enough. Each year security posture should improve as cybersecurity programs mature, but that does not appear to be the case in healthcare. Only 12% of respondents believe their security posture will improve in 2019, and 23% of provider organizations believe their security posture will be worse next year.

Money is being spent on cybersecurity solutions, although all too often solutions are purchased blindly, with IT departments lacking vision or discernment. The study revealed 92% of data security product and service decisions have been made at the C-suite level, with department managers having no input into purchasing decisions.

89% of surveyed CIOs said they purchased cybersecurity solutions to meet compliance requirements rather than to reduce risk. When cybersecurity solutions are purchased, it is rare for the effectiveness of those solutions to be evaluated. Only 4% of organizations surveyed had a steering committee that evaluated the impact of investments in cybersecurity.

Healthcare providers appear to have realized the benefits of appointing a chief information security officer (CISO) yet recruiting a suitably qualified person to fill the position is proving difficult. As a result of the inability to recruit staff, 21% of healthcare providers have turned to MSPs to provide security-as-a-service or have outsourced security to partners and consultants.

Engaging the services of a cybersecurity vendor prior to an attack allows hospitals to negotiate the best deal; however, many hospitals have been placed at a severe disadvantage by seeking help from third parties following a cybersecurity incident. 58% of hospitals only chose to outsource security following a cybersecurity breach.

While scanning for vulnerabilities allows healthcare organizations to identify and address weaknesses to prevent data breaches, 32% of healthcare organizations did not perform a scan prior to suffering a cyberattack.

A fast response to a cyberattack can greatly limit the harm caused, although detecting cyberattacks and data breaches remains a major challenge. 29% of healthcare organizations lack a security solution that allows them to instantly detect and respond to a cyberattack.

While most hospitals have developed an incident response plan, 83% of surveyed healthcare organizations have not performed a cybersecurity incident drill to test the effectiveness of their incident response plan. Without testing, it is not possible to tell how effective the plan will be.

A lack of security objectives in strategic and tactical plans, insufficient funding, poorly chosen cybersecurity solutions, and a reactive rather than proactive cybersecurity strategy makes the healthcare industry particularly prone to attack. Until changes are made to address all of those areas, the healthcare industry will remain particularly vulnerable to attack and cyberattacks are likely to continue to increase.

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Warnings Issued Over Vulnerable Medical Devices

Posted by HIPAA Journal

Warnings have been issued by the Department of Homeland Security’s (DHS) Industrial Control Systems Cyber Emergency Response Team (ICS-CERT) about vulnerabilities in several medical devices manufactured by Silex Technology, GE Healthcare, and Phillips. If the vulnerabilities were to be exploited, an unauthorized individual could potentially take control of the devices.

Phillips Brilliance CT Scanners

In early May, Phillips alerted the National Cybersecurity and Communications Integration Center (NCCIC) about security vulnerabilities affecting its Brilliance CT scanners. Phillips has been working to remediate the vulnerabilities and has been working with DHS to alert users of its devices to help them reduce risk. There have been no reports received to suggest any of the vulnerabilities have been exploited in the wild.

Three vulnerabilities have been discovered to affect the following scanners:

  • Brilliance 64 version 2.6.2 and below
  • Brilliance iCT versions 4.1.6 and below
  • Brillance iCT SP versions 3.2.4 and below
  • Brilliance CT Big Bore 2.3.5 and below

See ICS-CERT advisory (ICSMA-18-123-01)

The Brilliance CT scanners operate user functions within a contained kiosk environment in the Windows OS. The vulnerability – CVE-2018-8853 – could be exploited to allow an unauthorized individual or kiosk application user to gain unauthorized elevated privileges and access to unauthorized resources from the underlying Windows OS.

CVE-2018-8861 is a vulnerability in the Brilliance CT kiosk environment which could be exploited to allow an unauthorized attacker or limited access kiosk user to break out of the containment of the kiosk environment, gain elevated privileges from the underlying Windows OS, and access resources from the operating system.

CVE-2018-8857 is a vulnerability associated with hard-coded credentials used for inbound authentication and outbound communication. Those credentials could be compromised, allowing access to the system to be gained.

CVE-2018-8853 and CVE-2018-8861 both have a CVSS v3 base score of 6.1, while CVE-2018-8857 has a CVSS v3 base score of 8.4.

The vulnerabilities cannot be exploited remotely and require user interaction. According to a statement issued by Phillips, “An attacker would need local access to the kiosk environment of the medical device to be able to implement the exploit.” If exploited, the attacker could execute commands with elevated privileges and gain access to “restricted system resources and information.” The vulnerability would require a low level of skill to exploit.

The vulnerabilities are considered low-risk, but under the company’s responsible disclosure policy, an advisory was issued to alert users to the risk and provide information to reduce risk to a minimal level.

Phillips recommends only using Brilliance CT products within the specifications authorized by Phillips, such as only using Phillips-approved software, system services, and security configurations. Physical controls should also be implemented to limit access to the devices.

Phillips has taken action by remediating hard-coded credentials for its Brilliance iCT 4.x system and later versions and will continue to assess further options for remediating the vulnerabilities.

Silex SX-500, SD-320AN Wireless and GE Healthcare MobileLink

Two vulnerabilities have been discovered to affect certain Silex Technology products and GE Healthcare MobileLink technology. The vulnerabilities, tracked as CVE-2018-6020 and CVE-2018-6021, have been assigned a CVSS v3 rating of 6.5 and 7.4 respectively. See ICS-CERT advisory (ICSMA-18-128-01)

The following products are susceptible to one or both of the vulnerabilities:

GEH-500 (V 1.54 and earlier), SX-500 (all versions), GEH-SD-320AN (V GEH-1.1 and earlier), and SD-320AN (V 2.01 and earlier). The following GE MAC Resting ECG analysis systems may use vulnerable MobileLink Technology: MAC 3500, MAC 5000 (E.O.L 2012), MAC 5500 and MAC 5500 HD.

The vulnerabilities would require a low level of skill to exploit and could allow an unauthorized individual to modify system settings and remotely execute code. ICS-CERT notes that public exploits for the vulnerabilities are available.

CVE-2018-6020 concerns a lack of verification of authentication when making certain POST requests, which could allow the modification of system settings. CVE-2018-6021 concerns an improperly sanitized system call parameter, which could allow remote code execution.

The following recommendations have been made by Silex/GE Healthcare:

To mitigate CVE-2018-6020 on GE MobileLink/SX-500, users should enable ‘update’ account within the web interface, as this is not enabled by default.  To prevent changes to device configuration, users should set a secondary password for the ‘update’ account.

Silex Technology and GE Healthcare have produced updated firmware to resolve the CVE-2018-6021 vulnerability for GE MobileLink/GEH-SD-320AN, which will be available for download from May 31, 2018 once testing has been completed.

NCCIS suggests users should minimize network exposure for control system devices and/or systems to ensure they cannot be accessed over the Internet. All controls systems and remote devices should be located behind firewalls and isolated from business networks. If remote access is required, a VPN should be used.

NCCIC has advised users to conduct an impact analysis and risk assessment prior to any attempt to mitigate the vulnerabilities.

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Spate of Phishing Attacks on Healthcare Organizations Sees 90,000 Records Exposed

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The past few weeks have seen a significant rise in successful phishing attacks on healthcare organizations. In a little over four weeks there have been 10 major email hacking incidents reported to the Department of Health and Human Services’ Office for Civil Rights, each of which has resulted in the exposure and potential theft of more than 500 healthcare records. Those ten incidents alone have seen almost 90,000 healthcare records compromised.

Recent Email Hacking and Phishing Attacks on Healthcare Organizations

HIPAA-Covered Entity Records Exposed
Inogen Inc. 29,529
Knoxville Heart Group 15,995
USACS Management Group Ltd 15,552
UnityPoint Health 16,429
Texas Health Physicians Group 3,808
Scenic Bluffs Health Center 2,889
ATI Holdings LLC 1,776
Worldwide Insurance Services 1,692
Billings Clinic 949
Diagnostic Radiology & Imaging, LLC 800
The Oregon Clinic Undisclosed

 

So far this year there have been three data breaches involving the hacking of email accounts that have exposed more than 30,000 records. Agency for Health Care Administration suffered a 30,000-record breach in January, ATI Holdings, LLC experienced a breach in March that resulted in the exposure of 35,136 records, and the largest email hacking incident of the year affected Onco360/CareMed Specialty Pharmacy and impacted 53,173 patients.

Wombat Security’s 2018 State of the Phish Report revealed three quarters of organizations experienced phishing attacks in 2017 and 53% experienced a targeted attack. The Verizon 2017 Data Breach Investigations Report, released in May, revealed 43% of data breaches involved phishing, and a 2017 survey conducted by HIMSS Analytics on behalf of Mimecast revealed 78% of U.S healthcare providers have experienced a successful email-related cyberattack.

How Healthcare Organizations Can Improve Phishing Defenses

Phishing targets the weakest link in an organization: Employees. It therefore stands to reason that one of the best defenses against phishing is improving security awareness of employees and training the workforce how to recognize phishing attempts.

Security awareness training is a requirement under HIPAA (45 C.F.R. § 164.308(a)(5)(i)). All members of the workforce, including management, must be trained on security threats and the risk they pose to the organization.

“An organization’s training program should be an ongoing, evolving process and flexible enough to educate workforce members on new cybersecurity threats and how to respond to them,” suggested OCR in its July 2017 cybersecurity newsletter.

HIPAA does not specify how frequently security awareness training should be provided, although ongoing programs including a range of training methods should be considered. OCR indicates many healthcare organizations have opted for bi-annual training accompanied by monthly security updates and newsletters, although more frequent training sessions may be appropriate depending on the level of risk faced by an organization.

A combination of classroom-based sessions, CBT training, newsletters, email alerts, posters, team discussions, quizzes, and other training techniques can help an organization develop a security culture and greatly reduce susceptibility to phishing attacks.

The threat landscape is constantly changing. To keep abreast of new threats and scams, healthcare organizations should consider signing up with threat intelligence services. Alerts about new techniques that are being used to distribute malicious software and the latest social engineering ploys and phishing scams can be communicated to employees to raise awareness of new threats.

In addition to training, technological safeguards should be implemented to reduce risk. Advance antivirus solutions and anti-malware defences should be deployed to detect the installation of malicious software, while intrusion detection systems can be used to rapidly identify suspicious network activity.

Email security solutions such as spam filters should be used to limit the number of potentially malicious emails that are delivered to end users’ inboxes. Solutions should analyze inbound email attachments using multiple AV engines, and be configured to quarantine emails containing potentially harmful file types.

Embedded URLs should be checked at the point when a user clicks. Attempts to access known malicious websites should be blocked and an analysis of unknown URLs should be performed before access to a webpage is permitted.

Phishing is highly profitable, attacks are often successful, and it remains one of the easiest ways to gain a foothold in a network and gain access to PHI. As such, phishing will remain one of the biggest threats to the confidentiality, integrity, and availability of PHI. It is up to healthcare organizations to make it as difficult as possible for the attacks to succeed.

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DoD IG Discovers Serious Flaws in Navy and Air Force EHR and Security Systems and Potential HIPAA Violations

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A Department of Defense Inspector General (DoDIG) audit of the electronic health record (EHR) and security systems at the Defense Health Agency (DHA), Navy, and Air Force has uncovered serious security vulnerabilities that could potentially be exploited to gain access to systems and protected health information (PHI).

This is the second DoDIG report from recent audits of military training facilities (MTFs). The first report revealed the DHA and Army had failed to consistently implement security protocols to safeguard EHRs and systems that stored, processed, or transmitted PHI. The latest report, which covers the DHA, Navy, and Air Force, has revealed serious vulnerabilities in 11 different areas.

Inconsistency of implementing security protocols to protect EHRs and PHI, and the ineffective administrative, technical, and physical safeguards deployed constitute violations of Health Insurance Portability and Accountability Act (HIPAA) Rules. Those violations could attract financial penalties of up to $1.5 million per violation category.

The DoDIG visited three Navy and two Air Force facilities and assessed 17 information systems across the five locations.

  • Naval Hospital Camp Pendleton, Camp Pendleton, CA
  • San Diego Naval Medical Center, San Diego, CA
  • S. Naval Ship Mercy, San Diego, CA
  • 436th Medical Group, Dover, DW
  • Wright-Patterson Medical Center, Dayton, OH

3 DoD EHR systems, 3 modified DoD EHR systems, 9 service-specific systems, and 2 DHA-owned systems were assessed.

There were instances where vulnerabilities had gone undetected and many cases of detected vulnerabilities failing to be addressed in a reasonable time frame. In its report, DoDIG said the audit at the 436th Medical Group revealed 342 of the 1,430 vulnerabilities identified in May had not been addressed and appeared in the vulnerability scan conducted in June.

The reason for the failure to consistently implement security protocols and address vulnerabilities differed at each audited site, but were largely due to a lack of resources, a lack of guidance, system incompatibility, and vendor limitations.

Security issues were identified in the following areas:

  • Failure to consistently implement multi-factor authentication
  • Failure to configure passwords to meet DoD length/complexity requirements
  • Failure to address known network vulnerabilities
  • Failures to set privileges based on users’ assigned duties
  • Failure to configure controls to lock EHRs after 15 minutes of inactivity
  • Failure to review system activity reports to identify suspicious activities and access attempts
  • Failure to develop standard operating procedures and manage system access
  • Failure to implement appropriate and adequate security protocols to protect ePHI and PHI from unauthorized access
  • Failure to maintain an inventory of all service-specific systems that stored, processed, or transmitted PHI
  • Failure to develop and maintain privacy impact assessments

“Without well-defined, effectively implemented system security protocols, the DHA, Navy, and Air Force compromised the integrity, confidentiality, and availability of PHI”, wrote DoDIG in its report. “Security protocols, when not applied or ineffective, increase the risk of successful cyberattacks; system and data breaches; data loss and manipulation; and unauthorized disclosures of PHI.”

DoDIG made several recommendations to improve security which included configuring systems used to store, process, or transmit ePHI to lock automatically after 15 minutes of inactivity; the development of an oversight plan to ensure recommendations are applied across all locations; actions to be taken to address vulnerabilities in a timely manner; implement procedures to only grant access to systems used to store, process, and transmit Phi based on users’ responsibilities.

DoDIG also recommended the Surgeons General for the Departments of the Navy and Air Force coordinate with the Navy Bureau of Medicine and Surgery and the Air Force Medical Service to assess whether the issues discovered exist at other service-specific military training facilities.

On the whole, the recommendations were accepted, although at certain locations some recommendations remain unresolved and require additional comments.

The DHA Director agreed that the DHA could potentially configure systems to lock after 15 minutes of inactivity, but did not provide assurances that its systems would be changed to incorporate that control.

The Executive Director for the Naval Medical Center, San Diego disagreed with one recommendation. The Military Sealift Command Chief of Staff partly agreed with two recommendations and disagreed with one, but suggested additional controls and alternate actions that could be taken to address all recommendations for the USNS Mercy.

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