Healthcare Data Security

Unpatched Vulnerabilities are the Most Common Attack Vector Exploited by Ransomware Actors

Posted by HIPAA Journal

Ransomware gangs are increasingly targeting unpatched vulnerabilities in software and operating systems to gain access to business networks, and they are weaponizing zero-day vulnerabilities at record speed. Unpatched vulnerabilities are now the primary attack vector in ransomware attacks, according to Ivanti’s Ransomware End of Year Spotlight report.

Ivanti partnered with Certifying Numbering Authority (CNA) Cyber Security Works and the next-gen SOAR and threat intelligence solution provider Cyware for its report, which identified 32 new ransomware variants in 2021 – An increase of 26% from the previous year. There are know 157 known ransomware families that are being used in cyberattacks on businesses.

Ivanti says 65 new vulnerabilities were identified in 2021 that are known to have been exploited by ransomware gangs – an increase of 29% year-over-year – bringing the total number of vulnerabilities tied to ransomware attacks to 288. 37% of the new vulnerabilities were trending on the dark web and have been exploited in multiple attacks, and 56% of the 223 older vulnerabilities continue to be routinely exploited by ransomware gangs.

Ransomware gangs and the initial access brokers they often use are searching for and leveraging zero-day vulnerabilities, oftentimes exploiting them in their attacks before the vulnerabilities have been issued CVE codes and have been added to the National Vulnerability Database (NVD). This was the case with the QNAP (CVE-2021-28799), Sonic Wall (CVE-2021-20016), Kaseya (CVE-2021-30116), and Apache Log4j (CVE-2021-44228) vulnerabilities.

The report highlights the importance of applying patches promptly but also emphasizes the need to prioritize patching to ensure vulnerabilities that have been weaponized are patched first. While it is important to keep track of vulnerabilities as they are added to the NVD, security teams should also sign up to receive threat intelligence feeds and security advisories from security agencies and should be on the lookout for exploitation instances and vulnerability trends.

While ransomware attacks on individual businesses are common, ransomware gangs are looking for major paydays and are increasingly targeting managed service providers and supply chain networks to inflict damage on as many businesses as possible. A supply chain attack or an attack on a managed service provider allows a ransomware gang to conduct ransomware attacks on dozens or even hundreds of victim networks, as was the case with REvil’s ransomware attack on the Kaseya VSA remote management service.

Ransomware gangs are also increasingly collaborating with others, either through ransomware-as-a-service (RaaS), where affiliates are used to conduct large numbers of attacks for a cut of the ransom payments, exploit-as-a-service, where exploits for known vulnerabilities are rented from developers, and dropper-as-a-service operations, where ransomware gangs pay malware operators to drop malicious payloads on infected devices.

“Ransomware groups are becoming more sophisticated, and their attacks more impactful. These threat actors are increasingly leveraging automated tool kits to exploit vulnerabilities and penetrate deeper into compromised networks,” said Srinivas Mukkamala, Senior Vice President of Security Products at Ivanti. “Organizations need to be extra vigilant and patch weaponized vulnerabilities without delays. This requires leveraging a combination of risk-based vulnerability prioritization and automated patch intelligence to identify and prioritize vulnerability weaknesses and then accelerate remediation.”

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Technologies Supporting Telehealth are Placing Healthcare Data at Risk

Posted by HIPAA Journal

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

Massive Increase in the Use of Telehealth

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

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

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

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

Analysis of Telehealth Applications and Related Technology

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

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

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

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

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

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

Cybercriminals Are Looking to Exploit Vulnerabilities to Access Patient Data

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

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

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

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

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Settlement Reached in Excellus Class Action Data Breach Lawsuit

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Excellus Health Plan Inc., its affiliated companies, and the Blue Cross Blue Shield Association (BCBSA) have reached a settlement to resolve a class action lawsuit that was filed in relation to a cyberattack discovered in 2015 involving the personally identifiable information (PII) and protected health information (PHI) of more than 10 million members, subscribers, insureds, patients, and customers.

The cyberattack was detected on August 5, 2015, by a cybersecurity firm that was hired to assess Excellus’s information technology system. The subsequent investigation by Excellus and cybersecurity firm Mandiant determined hackers had first gained access to its systems on or before December 23, 2013. Evidence was found that indicated the hackers were active within its network until Aug. 18, 2014, after which no traces of activity were found; however, malware had been installed which gave the attackers access to its network until May 11, 2015. On that date, something happened that prevented the hackers from accessing its network. It took Excellus 17 months from the initial intrusion to detect the security breach.

The HHS’ Office for Civil Rights (OCR) launched an investigation into the data breach and uncovered several potential violations of the HIPAA Rules, including security failures and the impermissible disclosure of the PHI of 9.3 individuals. The case was settled in January 2021 and Excellus agreed to pay a financial penalty of $5.1 million to resolve the HIPAA violations and to implement a corrective action plan to address the security failures and the alleged HIPAA non-compliance issues.

The lawsuit was brought against Excellus, Lifetime Healthcare Inc., Lifetime Benefit Solutions Inc., Genesee Region Home Care Association Inc., MedAmerica Inc., Univera Healthcare, and the Blue Cross Blue Shield Association, on behalf of all individuals affected by the data breach. Initially, the lawsuit sought monetary damages and injunctive relief; however, for several legal reasons, the court was unable to certify classes seeking monetary damages, and only certified a class for injunctive relief.

The plaintiffs alleged the defendants had failed to implement appropriate security measures to ensure the confidentiality of PII and PHI, failed to detect the security breach for 17 months, and when the breach was detected, waited too long to notify affected individuals and then failed to provide sufficient information about how victims could protect themselves from harm. The lawsuit required the Excellus defendants and BCBSA to change their information security practices with respect to PII and PHI and to invest in information security. The Excellus defendants and BCBSA denied any wrongdoing and, to date, no court has determined the defendants have done anything wrong.

The Excellus defendants and BCBSA have agreed to cover reasonable attorneys’ fees, costs, and expenses as approved by the courts. The costs include a maximum of $3.3 million to cover attorneys’ fees and the reimbursement of expenses of no more than $1,000,000. Service awards of up to $7,500 will also be provided to class representatives.

Changes will be made to business practices regarding the safeguarding of PII and PHI which will cover the three years from the finalization of the settlement or the two years after each of the changes has been implemented. The information security requirements detailed in the settlement require the Excellus defendants and BCBSA to:

  • Increase and maintain a minimum information security budget
  • Develop a strategy and engage vendors to ensure records containing PII or PHI are disposed of within one year of the original retention period
  • Take steps to improve the security of its network, including the use of tools for detecting suspicious activity, authenticating users, responding to and containing security incidents, and document retention
  • Engage in an extensive data archiving program and provide plaintiffs with documentation confirming the extent, scope, and thoroughness of the archiving project
  • Provide the plaintiffs with copies of documents provided to OCR that demonstrate compliance with the OCR settlement and corrective action plan
  • Make an annual declaration attesting to compliance with each aspect of the items in the settlement, including the extent to which it has not been possible to comply with any of the items

If the settlement is agreed by the court – a hearing has been scheduled for April 13, 2022 – all plaintiffs and class members will be required to release all claims against the Excellus defendants and BCBSA for injunctive and declaratory relief. The settlement will not release any claims against the Excellus defendants and BCBSA for monetary damages.

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New York Fines EyeMed $600,000 for 2.1 Million-Record Data Breach

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The first settlement of 2022 to resolve a healthcare data breach has been announced by New York Attorney General Letitia James. The Ohio-based vision benefits provider EyeMed Vision Care has agreed to pay a financial penalty of $600,000 to resolve a 2020 data breach that saw the personal information of 2.1 million individuals compromised nationwide, including the personal information of 98,632 New York residents.

The data breach occurred on or around June 24, 2020, and saw unauthorized individuals gain access to an EyeMed email account that contained sensitive consumer data provided in connection with vision benefits enrollment and coverage. The attacker had access to the email account for around a week and was able to view emails and attachments spanning a period of 6 years dating back to January 3, 2014. The emails contained a range of sensitive information including names, contact information, dates of birth, account information for health insurance accounts, full or partial Social Security numbers, Medicare/Medicaid numbers, driver’s license numbers, government ID numbers, birth/marriage certificates, diagnoses, and medical treatment information.

Between June 24, 2020, and July 1, 2020, the attackers accessed the account from multiple IP addresses, including some from outside the United States and on July 1, 2020, the account was used to send around 2,000 phishing emails to EyeMed clients. The EyeMed IT department detected the phishing emails and received multiple inquiries from clients querying the legitimacy of the emails. The compromised account was then immediately secured.

The subsequent forensic investigation confirmed the attacker could have exfiltrated data from the email account while access was possible but could not determine if any personal information was stolen. Affected individuals were notified in September 2020 and were offered complimentary credit monitoring, fraud consultation, identity theft restoration services.

The Office of the New York Attorney General investigated the security incident and data breach and determined that, at the time of the attack, EyeMed had failed to implement appropriate security measures to prevent unauthorized individuals from accessing the personal information of New York residents.

The email account was accessible via a web browser and contained large quantities of consumers’ sensitive information spanning several years, yet EyeMed had failed to implement multifactor authentication on the account. EyeMed also failed to implement adequate password management requirements for the email account. The password requirements for the account were not sufficiently complex, only requiring a password of 8 characters, when it was aware of the importance of password complexity as the password requirements for admin-level accounts required passwords of at least 12 characters. EyeMed also allowed 6 failed password attempts before locking out the user ID. EyeMed had also failed to maintain adequate logging of email accounts and was not monitoring email accounts, which made it difficult to identify and investigate security incidents. It was also unreasonable to retain consumer data in the email account for such a long period of time. Older emails should have been transferred to more secure systems and be deleted from the email account.

State attorneys general have the authority to impose financial penalties for HIPAA violations and it would have been possible to cite violations of HIPAA; however, New York only cited violations of New York General Business Law.

Under the terms of the settlement, EyeMed is required to pay a financial penalty of $600,000 and must implement several measures to improve security and prevent further data breaches. Those measures include:

  • Maintaining a comprehensive information security program that is regularly updated to keep pace with changes in technology and security threats
  • Maintaining reasonable account management and authentication, including the use of multi-factor authentication for all administrative or remote access accounts
  • Encrypting sensitive consumer information
  • Conducting a reasonable penetration testing program to identify, assess, and remediate security vulnerabilities
  • Implementing and maintaining appropriate logging and monitoring of network activity
  • Permanently deleting consumers’ personal information when there is no reasonable business or legal purpose to retain it.

“New Yorkers should have every assurance that their personal health information will remain private and protected. EyeMed betrayed that trust by failing to keep an eye on its own security system, which in turn compromised the personal information of millions of individuals,” said Attorney General James. “Let this agreement signal our continued commitment to holding companies accountable and ensuring that they are looking out for New Yorkers’ best interest. My office continues to actively monitor the state for any potential violations, and we will continue to do everything in our power to protect New Yorkers and their personal information.”

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More Than Half of All Healthcare IoT Devices Have a Known, Unpatched Critical Vulnerability

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A recent study by the healthcare IoT security platform provider Cynerio has revealed 53% of connected medical devices and other healthcare IoT devices have at least one unaddressed critical vulnerability that could potentially be exploited to gain access to networks and sensitive data or affect the availability of the devices. The researchers also found a third of bedside healthcare IoT devices have at least one unpatched critical vulnerability that could affect service availability, data confidentiality, or place patient safety in jeopardy.

The researchers analyzed the connected device footprints at more than 300 hospitals to identify risks and vulnerabilities in their Internet of Medical Things (IoMT) and IoT devices. IV pumps are the most commonly used healthcare IoT device, making up around 38% of a hospital’s IoT footprint. It is these devices that were found to be the most vulnerable to attack, with 73% having a vulnerability that could threaten patient safety, service availability, or result in data theft. 50% of VOIP systems contained vulnerabilities, with ultrasound devices, patient monitors, and medicine dispensers the next most vulnerable device categories.

The recently announced Urgent11 and Ripple20 IoT vulnerabilities are naturally a cause for concern; however, there are much more common and easily exploitable vulnerabilities in IoT and IoMT devices. The Urgent11 and Ripple20 vulnerabilities affect around 10% of healthcare IoT and IoMT devices, but the most common risk was weak credentials. Default passwords can easily be found in online device manuals and weak passwords are vulnerable to brute force attacks. One-fifth (21%) of IoT and IoMT devices were found to have default or weak credentials.

The majority of pharmacology, oncology, and laboratory devices and large numbers of the devices used in radiology, neurology, and surgery departments were running outdated Windows versions (older than Windows 10) which are potentially vulnerable.

Unaddressed software and firmware vulnerabilities are common in bedside devices, with the most common being improper input validation, improper authentication, and the continued use of devices for which a device recall notice has been issued. Without visibility into the devices connected to the network and a comprehensive inventory of all IoT and IoMT devices, identifying and addressing vulnerabilities before they are exploited by hackers will be a major challenge and it will be inevitable that some devices will remain vulnerable.

Many medical devices are used in critical care settings, where there is very little downtime. More than 80% of healthcare IoT devices are used monthly or more frequently, which gives security teams a small window for identifying and addressing vulnerabilities and segmenting the network. Having an IT solution in place that can provide visibility into connected medical devices and provide key data on the security of those devices will help security teams identify vulnerable devices and plan for updates.

Oftentimes it is not possible for patches to be applied. Oftentimes healthcare IoT devices are in constant use and they are frequently used past the end-of-support date. In such cases, the best security alternative is virtual patching, where steps are taken to prevent the vulnerabilities from being exploited such as quarantining devices and segmenting the network.

Segmenting the network is one of the most important steps to take to improve healthcare IoT and IoMT security. When segmentation is performed that takes medical workflows and patient care contexts into account, Cybnerio says 92% of critical risks in IoT and IoMT devices can be effectively mitigated.

Most healthcare IoT and IoMT cybersecurity efforts are focused on creating a comprehensive inventory of all IoT and IoMT devices and gathering data about those devices to identify potential risks. “Visibility and risk identification are no longer enough. Hospitals and health systems don’t need more data – they need advanced solutions that mitigate risks and empower them to fight back against cyberattacks, and as medical device security providers, it’s time for all of us to step up,” said Daniel Brodie, CTO and co-founder, Cynerio.

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HHS Releases Final Trusted Exchange Framework and Common Agreement

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The Department of Health and Human Services’ Office of the National Coordinator for Health IT has released the final version of its Trusted Exchange Framework and the Common Agreement (TEFCA) – a governance framework for nationwide health information exchange. Two previous versions of TEFCA have been released, the first in 2018 and the second in 2019, with the final version taking into consideration feedback provided by healthcare industry stakeholders. TEFCA was a requirement of the 21st Century Cures Act and has been 5 years in the making. The announcement this week sees the HHS finally move into the implementation phase of TEFCA.

The Trusted Exchange Framework is a set of non-binding foundational principles for health information exchange and outlines propositions for standardization, cooperation, privacy, security, access, equity, openness and transparency, and public health. The second component is the common agreement, which is a legal contract that a Qualified Health Information Network (QHIN) enters into with the ONC’s Recognized Coordinating Entity (RCE). The RCE, the Sequoia Project, is a body charged with developing, updating, and maintaining the Common Agreement and overseeing QHINs.

The framework promotes secure health information exchange across the United States and is intended to improve the interoperability of health information technology, including the electronic health record systems used by hospitals, health centers, and ambulatory practices, and health information exchange with federal government agencies, health information networks, public health agencies, and payers.

“The Common Agreement establishes the technical infrastructure model and governing approach for different health information networks and their users to securely share clinical information with each other – all under commonly agreed-to rules-of-the-road,” explained ONC in a press release. The Common Agreement supports multiple exchange purposes that are required to improve healthcare and should benefit a wide variety of healthcare entities. The Common Agreement operationalizes electronic health information exchange and provides easier ways for individuals and organizations to securely connect. TEFCA will also provide benefits to patients, such as allowing them to obtain access to their healthcare data through third parties that offer individual access services.

ONC’s RCE will sign a legal contract with each QHIN and entities will be able to apply to be designated as QHINs shortly. When designated as a QHIN they will be able to connect with each other and their participants will be able to participate in health information exchange across the country. ONC has released a QHIN Technical Framework which details the functional and technical requirements that QHINs will need to bring the new connectivity online. The HHS has also announced that the TEFCA Health Level Seven (HL7) Fast Healthcare Interoperability Resource (FHIR) Roadmap (TEFCA FHIR Roadmap) is now available, which explains how TEFCA will accelerate the adoption of FHIR-based exchange across the industry.

“Operationalizing TEFCA within the Biden Administration’s first year was a top priority for ONC and is critical to realizing the 21st Century Cures Act’s goal of a secure, nationwide health information exchange infrastructure,” said Micky Tripathi, Ph.D., national coordinator for health information technology. “Simplified nationwide connectivity for providers, health plans, individuals, and public health is finally within reach. We are excited to help the industry reap the benefits of TEFCA as soon as they are able.”

ONC said its RCE will be hosting a series of public engagement webinars to provide further information on the Trusted Exchange Framework and the Common Agreement, which will explain how they work to help prospective QHINs determine whether to sign the Common Agreement

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December 2021 Healthcare Data Breach Report

Posted by HIPAA Journal

56 data breaches of 500 or more healthcare records were reported to the HHS’ Office for Civil Rights (OCR) in December 2021, which is a 17.64% decrease from the previous month. In 2021, an average of 59 data breaches were reported each month and 712 healthcare data breaches were reported between January 1 and December 31, 2021. That sets a new record for healthcare data breaches, exceeding last year’s total by 70 – An 10.9% increase from 2020.

2021 healthcare data breaches

Across December’s 56 data breaches, 2,951,901 records were exposed or impermissibly disclosed – a 24.52% increase from the previous month. At the time of posting, the OCR breach portal shows 45,706,882 healthcare records were breached in 2021 – The second-highest total since OCR started publishing summaries of healthcare data breaches in 2009.

2021 healthcare data breaches - records breached

Largest Healthcare Data Breaches in December 2021

Name of Covered Entity State Covered Entity Type Individuals Affected Breach Cause
Oregon Anesthesiology Group, P.C. OR Healthcare Provider 750,500 Ransomware
Texas ENT Specialists TX Healthcare Provider 535,489 Ransomware
Monongalia Health System, Inc. WV Healthcare Provider 398,164 Business Email Compromise/Phishing
BioPlus Specialty Pharmacy Services, LLC FL Healthcare Provider 350,000 Hacked network server
Florida Digestive Health Specialists, LLP FL Healthcare Provider 212,509 Business Email Compromise/Phishing
Daniel J. Edelman Holdings, Inc. IL Health Plan 184,500 Business associate hacking/IT incident
Southern Orthopaedic Associates d/b/a Orthopaedic Institute of Western Kentucky KY Healthcare Provider 106,910 Compromised email account
Fertility Centers of Illinois, PLLC IL Healthcare Provider 79,943 Hacked network server
Bansley and Kiener, LLP IL Business Associate 50,119 Ransomware
Oregon Eye Specialists OR Healthcare Provider 42,612 Compromised email accounts
MedQuest Pharmacy, Inc. UT Healthcare Provider 39,447 Hacked network server
Welfare, Pension and Annuity Funds of Local No. ONE, I.A.T.S.E. NY Health Plan 20,579 Phishing
Loyola University Medical Center IL Healthcare Provider 16,934 Compromised email account
Bansley and Kiener, LLP IL Business Associate 15,814 Ransomware
HOYA Optical Labs of America, Inc. TX Business Associate 14,099 Hacked network server
Wind River Family and Community Health Care WY Healthcare Provider 12,938 Compromised email account
Ciox Health GA Business Associate 12,493 Compromised email account
A New Leaf, Inc. AZ Healthcare Provider 10,438 Ransomware

Causes of December 2021 Healthcare Data Breaches

18 data breaches of 10,000 or more records were reported in December, with the largest two breaches – two ransomware attacks – resulting in the exposure and potential theft of a total of 1,285,989 records. Ransomware continues to pose a major threat to healthcare organizations. There have been several successful law enforcement takedowns of ransomware gangs in recent months, the most recent of which saw authorities in Russia arrest 14 members of the notorious REvil ransomware operation, but there are still several ransomware gangs targeting the healthcare sector including Mespinoza, which the HHS’ Health Sector Cybersecurity Coordination Center (HC3) issued a warning about this month due to the high risk of attacks.

Phishing attacks continue to result in the exposure of large amounts of healthcare data. In December, email accounts were breached that contained the ePHI of 807,984 individuals. The phishing attack on Monongalia Health System gave unauthorized individuals access to email accounts containing 398,164 records.

8 of the largest breaches of the month involved compromised email accounts, two of which were business email compromise attacks where accounts were accessed through a phishing campaign and then used to send requests for changes to bank account information for upcoming payments.

Causes of December 2021 healthcare data breaches

Throughout 2021, hacking and other IT incidents have dominated the breach reports and December was no different. 82.14% of the breaches reported in December were hacking/IT incidents, and those breaches accounted for 91.84% of the records breached in December – 2,711,080 records. The average breach size was 58,937 records and the median breach size was 4,563 records. The largest hacking incident resulted in the exposure of the protected health information of 750,050 individuals.

The number of unauthorized access and disclosure incidents has been much lower in 2021 than in previous years. In December there were only 5 reported unauthorized access/disclosure incidents involving 234,476 records. The average breach size was 46,895 records and the median breach size was 4,109 records.

There were two reported cases of the loss of paper/films containing the PHI of 3,081 individuals and two cases of theft of paper/films containing the PHI of 2,129 individuals. There was also one breach involving the improper disposal of a portable electronic device containing the ePHI of 934 patients.

As the chart below shows, the most common location of breached PHI was network servers, followed by email accounts.

Location of breached PHUI in December 2021 healthcare data breaches

HIPAA Regulated Entities Reporting Data Breaches in December 2021

Healthcare providers suffered the most data breaches in December, with 36 breaches reported. There were 11 breaches reported by health plans, and 9 breaches reported by business associates. Six breaches were reported by healthcare providers (3) and health plans (3) that occurred at business associates. The adjusted figures are shown in the pie chart below.

December 2021 healthcare data breaches by HIPAA-regulated entity type

December 2021 Healthcare Data Breaches by U.S. State

Illinois was the worst affected state with 11 data breaches, four of which were reported by the accountancy firm Bansley and Kiener and related to the same incident – A ransomware attack that occurred in December 2020. the firm is now facing a lawsuit over the incident and the late notification to affected individuals – 12 months after the attack was discovered.

State Number of Breaches
Illinois 11
Indiana 5
Florida, Oklahoma, and Texas 4
Arizona 3
California, Georgia, Kansas, Michigan, New York, Oregon, Utah, and Virginia 2
Alabama, Colorado, Kentucky, Maryland, North Carolina, Rhode Island, Wisconsin, West Virginia, and Wyoming 1

HIPAA Enforcement Activity in December 2021

There were no further HIPAA penalties imposed by the HHS’ Office for Civil Rights in December. The year closed with a total of 14 financial penalties paid to OCR to resolve violations of the HIPAA Rules. 13 of the cases were settled with OCR, and one civil monetary penalty was imposed. 12 of the OCR enforcement actions were for violations of the HIPAA Right of Access.

The New Jersey Attorney General imposed a $425,000 financial penalty on Regional Cancer Care Associates, which covered three separate Hackensack healthcare providers – Regional Cancer Care Associates LLC, RCCA MSO LLC, and RCCA MD LLC – that operate healthcare facilities in 30 locations in Connecticut, New Jersey, and Maryland.

The New Jersey Attorney General and the New Jersey Division of Consumer Affairs investigated a breach of the email accounts of several employees between April and June 2019 involving the protected health information of 105,000 individuals and a subsequent breach when the breach notification letters were sent to affected individuals’ next of kin in error.

The companies were alleged to have violated HIPAA and the Consumer Fraud Act by failing to ensure the confidentiality, integrity, and availability of patient data, failing to protect against reasonably anticipated threats to the security/integrity of patient data, a failure to implement security measures to reduce risks and vulnerabilities to an acceptable level, the failure to conduct an accurate and comprehensive risk assessment, and the lack of a security awareness and training program for all members of its workforce. The case was settled with no admission of liability. There were 4 HIPAA enforcement actions by state attorneys general in 2021. New Jersey was involved in 3 of those enforcement actions.

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Healthcare Supply Chain Association Issues Guidance on Medical Device and Service Cybersecurity

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The Healthcare Supply Chain Association (HSCA) has issued guidance for healthcare delivery organizations, medical device manufacturers, and service suppliers on securing medical devices to make them more resilient to cyberattacks.

The use of medical devices in healthcare has grown at an incredible rate and they are now relied upon to provide vital clinical functions that cannot be compromised without diminishing patient care. Medical devices are, however, often vulnerable to cyber threats and could be attacked to cause harm to patients, be taken out of service to pressure healthcare providers into meeting attackers’ extortion demands, or could be accessed remotely to obtain sensitive patient data. Medical devices are often connected to the Internet and can easily be attacked, so it is essential for proactive steps to be taken to improve security.

The HSCA represents healthcare group purchasing organizations (GPOs) and advocates for fair procurement practices and education to improve the efficiency of purchases of healthcare goods and services and, as such, has a unique line of sight over the entire healthcare supply chain. The HSCA guidance is for the entire supply chain and explains some of the key considerations for medical device manufacturers, HDOs, and service providers to improve cybersecurity and address weaknesses before they are exploited by threat actors.

Two of the most important steps to take are to participate in at least one Information Sharing and Analysis Organization (ISAO), such as the Health Information Sharing and Analysis Center (H-ISAC), and to adopt an IT security risk assessment methodology, such as the NIST Cybersecurity Framework (CSF).

An ISAO is a community that actively collaborates to identify and disseminate actionable threat intelligence about the latest cybersecurity threats that allows members to take proactive steps to reduce risk. The NIST CSF and other cybersecurity frameworks help organizations establish and improve their cybersecurity program, prioritize activities, understand their current security status, and identify security gaps that need to be addressed.

HCSA also recommends appointing an information technology and/or network security officer who has overall responsibility for the security of the organization who can communicate risks to decision makers and oversee the security efforts of the organization.

Cybersecurity training for the workforce is vital. All employees must be made aware of the threats they are likely to encounter and should be taught best practices to follow to reduce risk. Training should be provided annually, and phishing simulations conducted regularly to reinforce training. Any employee who fails a simulation should be provided with further training.

Good patch management practices are essential for addressing known vulnerabilities before they can be exploited, anti-virus software should be deployed on all endpoints and be kept up to date, firewalls should be implemented at the network perimeter and internally, least-privilege access should be applied to system resources, and networks should be segmented to prevent lateral movement in the event of a breach. Password policies should also be implemented that are consistent with the latest NIST guidance.

To prevent the interception of sensitive data, all data in transit should be encrypted, backup and data restoration procedures should be implemented and regularly tested to ensure recovery is possible in the event of a cyberattack, and the life expectancy of all devices and software solutions should be specified in all purchase agreements, including all supporting components. Plans should then be made to upgrade equipment and software prior to reaching end-of-life.

In addition to these standard cybersecurity best practices, HCSA has provided specific considerations for HDOs, device manufacturers, and service providers in the guidance – Medical Device and Service Cybersecurity: Key Considerations for Manufacturers & Healthcare Delivery Organizations – which is available for download from the HCSA website.

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November 2021 Healthcare Data Breach Report

Posted by HIPAA Journal

The number of reported healthcare data breaches has increased for the third successive month, with November seeing 68 data breaches of 500 or more records reported to the HHS’ Office for Civil Rights – a 15.25% increase from October and well above the 12-month average of 56 data breaches a month. From January 1 to November 30, 614 data breaches were reported to the Office for Civil Rights. It is looking increasingly likely that this year will be the worst ever year for healthcare data breaches.

The number of data breaches increased, but there was a sizable reduction in the number of breached records. Across the 68 reported breaches, 2,370,600 healthcare records were exposed, stolen, or impermissibly disclosed – a 33.95% decrease from the previous month and well below the 12-month average of 3,430,822 breached records per month.

Largest Healthcare Data Breaches Reported in November 2021

In November, 30 data breaches of 10,000 or more records were reported to the HHS’ Office for Civil Rights, and 4 of those breaches resulted in the exposure/theft of more than 100,000 records. The average breach size in November was 34,862 records and the median breach size was 5,403 records.

The worst breach of the month saw the protected health information of 582,170 individuals exposed when hackers gained access to the network of Utah Imaging Associates. Planned Parenthood also suffered a major data breach, with hackers gaining access to its network and exfiltrating data before using ransomware to encrypt files.

Sound Generations, a non-profit that helps older adults and adults with disabilities obtain low-cost healthcare services, notified patients about two ransomware attacks that had occurred in 2021, which together resulted in the exposure and potential theft of the PHI of 103,576 individuals.

Name of Covered Entity Covered Entity Type Individuals Affected Type of Breach Location of Breached PHI Cause of Breach
Utah Imaging Associates, Inc. Healthcare Provider 582,170 Hacking/IT Incident Network Server Unspecified hacking incident
Planned Parenthood Los Angeles Healthcare Provider 409,759 Hacking/IT Incident Network Server Ransomware attack
The Urology Center of Colorado Healthcare Provider 137,820 Hacking/IT Incident Network Server Unspecified hacking incident
Sound Generations Business Associate 103,576 Hacking/IT Incident Network Server Two ransomware attacks
Mowery Clinic LLC Healthcare Provider 96,000 Hacking/IT Incident Network Server Malware infection
Howard University College of Dentistry Healthcare Provider 80,915 Hacking/IT Incident Electronic Medical Record, Network Server Ransomware attack
Sentara Healthcare Healthcare Provider 72,121 Hacking/IT Incident Network Server Unspecified hacking incident at a business associate
Ophthalmology Associates Healthcare Provider 67,000 Hacking/IT Incident Electronic Medical Record, Network Server Unspecified hacking incident
Maxim Healthcare Group Healthcare Provider 65,267 Hacking/IT Incident Email Phishing attack
True Health New Mexico Health Plan 62,983 Hacking/IT Incident Network Server Unspecified hacking incident
TriValley Primary Care Healthcare Provider 57,468 Hacking/IT Incident Network Server Ransomware attack
Broward County Public Schools Health Plan 48,684 Hacking/IT Incident Network Server Ransomware attack
Consociate, Inc. Business Associate 48,583 Hacking/IT Incident Network Server  
Doctors Health Group, Inc. Healthcare Provider 47,660 Hacking/IT Incident Network Server Patient portal breach at business associate (QRS Healthcare Solutions)
Baywood Medical Associates, PLC dba Desert Pain Institute Healthcare Provider 45,262 Hacking/IT Incident Network Server Unspecified hacking incident
Medsurant Holdings, LLC Healthcare Provider 45,000 Hacking/IT Incident Network Server Ransomware attack
One Community Health Healthcare Provider 39,865 Hacking/IT Incident Network Server Unspecified hacking incident
Educators Mutual Insurance Association Business Associate 39,317 Hacking/IT Incident Network Server Malware infection
Victory Health Partners Healthcare Provider 30,000 Hacking/IT Incident Network Server Ransomware attack
Commission on Economic Opportunity Business Associate 29,454 Hacking/IT Incident Network Server Hacked public claimant portal

Causes of November 20021 Healthcare Data Breaches

Hacking/IT incidents dominated the breach reports in November, accounting for 50 of the reported breaches. Ransomware continues to be extensively used in attacks on healthcare providers and their business associates, with the attacks often seeing sensitive patient data stolen and posted on data leak sites. The theft of patient data in these attacks also makes lawsuits more likely. Planned Parenthood, for example, was hit with a class action lawsuit a few days after mailing notification letters to affected patients.

2,327,353 healthcare records were exposed or stolen across those hacking incidents, which is 98.18% of all records breached in November. The average breach size for those incidents was 42,316 records and the median breach size was 11,603 records.

There were 11 unauthorized access/disclosure breaches in November – half the number of unauthorized access/disclosure breaches reported in October. Across those breaches, 37,646 records were impermissibly accessed or disclosed. The average breach size was 3,422 records and the median breach size was 1,553 records. There were also two reported cases of theft of portable electronic devices containing the electronic protected health information of 5,601 individuals.

November Healthcare Data Breaches by Covered Entity Type

Healthcare providers were the worst affected covered entity type with 50 reported breaches, with four of those breaches occurring at business associates but were reported by the healthcare provider. 8 data breaches were reported by health plans, 3 of which occurred at business associates, and business associates self-reported 10 data breaches. The pie chart below shows the breakdown of breaches based on where the breach occurred.

Geographic Distribution of November Healthcare Data Breaches

Healthcare data breaches of 500 or more records were reported by HIPAA-regulated entities in 32 states and the District of Columbia.

State Number of Reported Data Breaches
California & New York 7
Maryland & Pennsylvania 4
Colorado, Kentucky, Ohio, & Utah 3
Illinois, Indiana, Michigan, Minnesota, New Mexico, Tennessee, Texas, Virginia, and the District of Columbia 2
Alabama, Arizona, Arkansas, Florida, Georgia, Idaho, Kansas, Massachusetts, Missouri, Nebraska, New Hampshire, New Jersey, North Carolina, Oregon, South Carolina, and Washington 1

HIPAA Enforcement Activity in November 2021

There was a flurry of HIPAA enforcement activity in November with financial penalties imposed by federal and state regulators. The HHS’ Office for Civil Rights announced a further 5 financial penalties to resolve alleged violations of the HIPAA Right of Access. In all cases, the healthcare providers had failed to provide patients with a copy of their requested PHI within a reasonable period of time after a request was received.

Covered Entity Penalty Penalty Type Alleged Violation
Rainrock Treatment Center LLC (dba Monte Nido Rainrock)

 

 $160,000

 

 Settlement HIPAA Right of Access
Advanced Spine & Pain Management $32,150

 

 Settlement HIPAA Right of Access
Denver Retina Center $30,000

 

 Settlement HIPAA Right of Access
Wake Health Medical Group

 

 $10,000

 

 Settlement HIPAA Right of Access
Dr. Robert Glaser

 

 $100,000 Civil Monetary Penalty HIPAA Right of Access

The New Jersey Attorney General and the Division of Consumer Affairs announced in November that a settlement had been reached with two New jersey printing firms – Command Marketing Innovations, LLC and Strategic Content Imaging LLC – to resolve violations of HIPAA and the New Jersey Consumer Fraud Act. The violations were uncovered during an investigation into a data breach involving the PHI of 55,715 New Jersey residents.

The breach was due to a printing error that saw the last page of one individual’s benefit statement being attached to the benefit statement of another individual.  The Division of Consumer Affairs determined the companies failed to ensure confidentiality of PHI, did not implement sufficient PHI safeguards and failed to review security measures following changes to procedures. A financial penalty of $130,000 was imposed on the two firms, and $65,000 was suspended and will not be payable provided the companies address all the security failures identified during the investigation.

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