HIPAA Breach News

Phishing Attacks Reported by Choice Cancer Care Treatment Center and CAH Holdings

Choice Cancer Care Treatment Center (CCCT), a network of cancer care centers in Texas, has discovered the protected health information of some of its patients has potentially been accessed by unauthorized individuals as a result of a phishing attack in May 2019.

Suspicious activity in the email account of an employee was detected on May 21, 2019. The subsequent investigation confirmed that the account had been accessed by an unauthorized individual between May 1st and May 21st, 2019. The email account was immediately secured, and a third-party digital forensic firm was engaged to conduct a thorough investigation.

An analysis of CCCT systems confirmed that the breach was confined to the email system and only one email account had been subjected to unauthorized access. A programmatic and manual review of all emails and email attachments in the account revealed the protected health information of certain patients had been exposed. The review was completed on September 18, 2019. CCCT then reviewed all affected records and confirmed the contact information for all individuals affected. Breach notifications were sent to affected individuals in November. Individuals affected by the breach have been offered complimentary credit monitoring and identity theft protection services.

The breach was mostly limited to names, medical information and health insurance information. A very small number of patients also had their Social Security number, driver’s license number, passport number, and/or credit card number exposed.

It was not possible to determine whether the attacker viewed or acquired any patient health information. No reports have been received to suggest there has been any actual or attempted misuse of patient information.

CCCT has reviewed its data security policies and procedures and further training has been provided to employees on data privacy and security.

CAH Holdings Reports Phishing Attack Impacting Several Employee Email Accounts

CAH Holdings Inc., an independent insurance agency that provides regional insurance and risk management services, has discovered the email accounts of several employees have been accessed by unauthorized individuals.

CAH Holdings has not publicly disclosed when the breach occurred nor when it was detected, only stating that a review of the affected employee email accounts was completed on September 16, 2019. That review confirmed that billing related information had potentially been compromised, including names and Social Security numbers and some or all of the following data elements: Date of birth, address, health insurance number, driver’s license number, diagnosis, and treatment plan. That information had been provided to CAH holdings by insurance companies and employers.

A third-party computer forensics firm assisted with the review of the compromised accounts, but it was not possible to determine whether any emails or email attachments had been opened or copied by the attackers.

The breach has prompted CAH Holdings to implement multi-factor authentication on its Office 365 email accounts, and anti-spam controls have also been augmented. CAH Holdings has also hired a Chief Information Security Officer (CISO) who will be performing a thorough review of its security protocols. Additional security measures will be implemented, as appropriate, based on the findings of that review.

No evidence of misuse of sensitive information has been uncovered but, as a precaution, all affected individuals have been offered complimentary credit monitoring and identity theft protection services. Affected individuals are also covered by a $1 million insurance reimbursement policy.

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Former Aegis Medical Group Employee Potentially Accessed 9,800 Records Without Authorization

The Florida physician network, Aegis Medical Group, has started notifying 9,800 patients that their protected health information may have been accessed by a former employee. That individual is understood to have attempted to sell patient records to third parties suspected of being involved in identity theft and fraud.

Aegis Medical Group was informed by law enforcement on September 11, 2019 about the employee. The law enforcement investigation determined that the employee attempted to sell the data of just two patients. Working with law enforcement, the physician network determined that the records of up to 9,800 patients were potentially accessed by the employee between July 24, 2019 and September 9, 2019.

The information contained in the records was limited to first and last names, dates of birth, account numbers, postal addresses, diagnosis information, and Social Security numbers. Approximately 75% of the records that may have been accessed were physical records rather than electronic copies.

Following notification by law enforcement, Aegis Medical Group immediately terminated the employee. It is unclear at this point in time whether the former employee has been charged.

Due to the nature of data exposed, all affected patients have been advised to monitor their accounts, explanation of benefits statements, and credit card statements for signs of misuse of their information and have been told about other steps they can take to prevent identity theft and fraud. Complimentary credit monitoring and identity theft protection services are also being provided.

Aegis Medical Group has confirmed that all physical records were stored properly although, to improve security, physical records are now being converted to digital formats as digital records are easier to secure and monitor for unauthorized access. Employees have been notified about the incident, told about the consequences of improper PHI access, and the importance of maintaining the confidentiality and security of patient records.

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Solara Medical Supplies and Select Health Network Report Phishing Attacks

Solara Medical Supplies, LLC, a Chula Vista, CA-based provider of medical devices and disposable medical products, has announced that the protected health information of many of its customers has potentially been compromised as a result of a phishing attack.

On June 28, 2019, Solara Medical identified suspicious activity in the email account of an employee and an investigation was launched to determine the nature and scope of the breach.  Assisted by third party computer forensics experts, Solara Medical learned that the breach was far more extensive, and several Office 365 email accounts had been compromised between April 2, 2019 and June 20, 2019.

A programmatic and manual review of all compromised accounts was conducted to determine which patients’ protected health information had potentially been accessed. The information in the email accounts varied from patient to patient and included patients’ first and last names in combination with one or more of the following data elements: Address, birth date, employee ID number, Social Security number, health insurance information, financial information, credit card/debit card number, passport details, state ID number, driver’s license number, password/PIN or account login information, claims data, billing information, and Medicare/Medicaid ID.

Upon discovery of the breach, Solara Medical immediately secured the compromised accounts and has since implemented additional security measures to improve email security. Individuals affected by the breach have been notified and offered complimentary credit monitoring and identity theft protection services for 12 months out of an abundance of caution.

The breach has been reported to the Department of Health and Human Services’ Office for Civil Rights, but it has yet to be displayed on the OCR breach portal, so it is currently unknown how many individuals have been affected.

Select Health Network Phishing Attack Reported

The Mishawaka, IN-based physician hospital organization, Select Health Network, has also announced that the protected health information of certain individuals has potentially been compromised as a result of a phishing attack.

Suspicious activity was detected in the email accounts of certain employees and a team of computer forensics experts was engaged to investigate a potential breach. The investigation revealed several email accounts were compromised between May 22, 2019 and June 13, 2019.

The results of an audit of the compromised email accounts was provided to Select Health Network on October 1, 2019, which confirmed that a wide range of protected health information was contained in the compromised accounts.

The types of information exposed varied from individual to individual and may have included first and last names in addition to one or more of the following data elements: Address, date of birth, member id number, health insurance information, medical history, treating/referring physician’s name, treatment information, treatment cost, health insurance policy number, and medical record number. A limited number of individuals also had their Social Security number exposed.

Select Health Network is unaware of any misuse of patient information as a result of the breach. Individuals whose Social Security numbers have been exposed have been offered complimentary credit monitoring and identity theft protection services for 12 months.

Select Health Network has conducted a review of its policies and procedures and additional safeguards are being implemented to improve email security and prevent further attacks of this nature.

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Update Issued on Unsecured PACS as Exposed Medical Image Total Rises to 1.19 Billion

It has been 60 days since Greenbone Networks uncovered the extent to which medical images in Picture Archiving and Communication Systems (PACS) servers are being exposed online. In an updated report, the German vulnerability analysis and management platform provider has revealed the problem is getting worse, not better.

Picture Archiving and Communication Systems (PACS) servers are extensively used by healthcare providers for archiving medical images and sharing those images with physicians for review, yet many healthcare providers are not ensuring their PACS servers have appropriate security. Consequently, medical images (X-Ray, MRI, CT Scans), along with personally identifiable patient information, is being exposed over the Internet. Anyone who knows where to look and how to search for the files can find them, view them and, in many cases, download the images without any authentication required. The images are not accessible due to software vulnerabilities. Data access is possible because of the misconfiguration of infrastructure and PACS servers.

Between July and September 2019, Greenbone Networks conducted an analysis to identify unsecured PACS servers around the globe. The study shed light on the scale of the problem. In the United States, 13.7 million data sets were found on unsecured PACS servers, which included 303.1 million medical images of which 45.8 million were accessible. The discovery was widely reported in the media at the time, and now further information on the scale of the problem has been released.

On Monday, November 18, Greenbone Networks issued an updated report that shows globally, 1.19 billion medical images have now been identified, increasing the previous total of 737 million by 60%. The results of 35 million medical examinations are online, up from 24 million.

In the United States, the researchers found 21.8 million medical examinations and 786 million medical images. 114.5 of those images were accessible and there are 15 systems that allow unprotected Web/FTP access and directory listing. In one PACS alone, the researchers found 1.2 million examinations and 61 million medical images. The researchers had full access to the data, which included the images and associated personally identifiable information. Greenbone Networks has confirmed that in the 24 hours prior to publication of its latest report, data access was still possible. “For most of the systems we scrutinized, we had – and still have – continued access to the personal health information,” explained Greenbone Networks CMS, Dirk Schrader.

Exposed Medical Images on PACS Servers. Source: Greenbone Networks

Earlier in November, Sen. Mark. R. Warner wrote to HHS’ Office for Civil Rights Director, Roger Severino, expressing concern over the apparent lack of action from OCR over the exposed files. Far from the situation improving following the announcement about the exposed data, it appears that very little is being done to secure the PACS servers and stop further data exposure.

The types of information in the images, which is classed as Protected Health Information (PHI) under HIPAA, includes names, dates of birth, examination dates, scope of the investigations, imaging procedures performed, attending physicians’ names, location of scan, number of images and, for 75% of the images, Social Security numbers.

The exposure of this data places patients at risk of identity theft and fraud, although there are other risks. Previously, security researchers have shown that flaws in the DICOM image format allows the insertion of malicious code. Images could therefore be downloaded, have malicious code inserted, and be uploaded back to the PACS. This could all be down without the knowledge of the data owner. For the purpose of the study, Greenbone Networks only investigated reading access, not image manipulation and upload.

Images were accessed and viewed using the RadiAnt DICOM Viewer. Instructions on configuration to view images using the RadiAnt DICOM Viewer are freely available online, as is the viewer and the list of IPs where the images are stored.

Greenbone Networks estimates that the exposed medical images and PHI has a value in excess of $1 billion dollars. The data could be used for a variety of nefarious purposes including identity theft, social engineering and phishing, and blackmail.

The exposure of the data is in violation of the Health Insurance Portability and Accountability Act (HIPAA), the EU’ s General Data Protection Regulation (GDPR), and many other data privacy and security laws. The data relates to more individuals in more than 52 countries.

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93,000 Files Belonging to California Addiction Treatment Center Exposed Online

An AWS S3 storage bucket belonging to Sunshine Behavioral Health, LLC, a San Juan Capistrano, CA-based network of drug and alcohol addiction rehabilitation centers, has been misconfigured, resulting in the exposure of sensitive patient information.

The misconfigured AWS S3 bucket was initially reported to databreaches.net in August 2019. Sunshine Behavioral Health was contacted and the bucket was secured; however, the data exposure does not appear to have been reported to the HHS’ Office for Civil Rights, there is no breach report on the California Attorney General’s website, and no mention of the breach on the Sunshine Behavioral Health website, even though it has been more than 60 days since Sunshine Behavioral Health was made aware of the breach.

Dissent of databreaches.net followed up on the breach in November and discovered that files were still exposed. The URLs of the PDF files in the bucket were still accessible and could be viewed without the need for a password. If the URLs had been obtained while the bucket was exposed, the PDF files could have been accessed and downloaded. In total, 93,000 patient files were stored in the S3 bucket.

According to Dissent, the files did not correspond to 93,000 patients. Some patients had multiple files and some of the files appeared to contain test data or were templates. Further contact was made with Sunshine Behavioral Health, but no reply was received, although the email was read as the URLs are no longer accessible.

It is unclear how many patients have been affected, how long the files were exposed online, and whether they were accessed by unauthorized individuals during that time. The files were mostly billing records, some of which contained full names, birth dates, email addresses, postal addresses, telephone numbers, full credit card numbers, partial expiry dates, full CVV codes, and health insurance information.

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Phishing Attacks Reported by UNC Chapel Hill School of Medicine and Starling Physicians

University of North Carolina Chapel Hill School of Medicine has experienced a phishing attack in which the protected health information of 3,716 patients has potentially been accessed by unauthorized individuals.

An investigation by third-party forensics experts confirmed that several employee email accounts were compromised between May 17, 2018 and June 18, 2018. It is unclear when the security breach was first detected.

The types of information in emails and email attachments in the compromised accounts varied from patient to patient and may have included names, birth dates, demographic information, Social Security numbers, health insurance details, financial account information, and credit card numbers.

Affected individuals were notified about the breach on November 12, 2019. Patients whose Social Security numbers were potentially compromised have been offered complimentary credit monitoring and identity theft protection services.

Multi-factor authentication has now been implemented and employees have been provided with further cybersecurity and phishing awareness training.

Three Email Accounts Compromised in Phishing Attack on Starling Physicians

The Connecticut physician group, Starling Physicians P.C. has announced that the personal and health information of certain patients has potentially been compromised in a phishing attack.

The attack occurred on February 8, 2019 and a third-party forensics firm was engaged to conduct an investigation into the breach and assess the nature on scope of the attack. Three employee email accounts were discovered to have been compromised.

Starling Physicians learned on September 12 that the compromised email accounts contained names, addresses, dates of birth, Social Security numbers, passport numbers, health insurance information, billing information, and medical information of certain patients. It is unclear when the phishing attack was discovered.

Notification letters were sent to affected patients on November 12, 2019. Patients whose Social Security number was potentially compromised have been offered complimentary credit monitoring and identity theft protection services.

It is currently unclear exactly how many patients have been affected. A spokesperson for the group said the incident impacted fewer than 0.01 percent of active patients.

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PHI Theft Incidents Reported by Loyola Medicine and Main Street Clinical Associates

Main Street Clinical Associates, PA., in Durham, NC has informed certain patients that some of their protected health information was stored on devices that were stolen from its offices.

The theft occurred when the Main Street offices had been evacuated due to a severe gas explosion. Staff at the office were ordered to evacuate the building on April 10, 2019 following an explosion in an adjacent building. Files and equipment were left on desks due to the urgent evacuation, and the room containing patient records was left unlocked. The damage to the building was extensive. Staff were not permitted to re-enter the building until September 9, 2019. When the staff returned, it was discovered the offices had been looted and equipment had been stolen. Two laptop computers had been taken, along with the cell phone of a clinician, and a printer containing some patient information.

Main Street explained in a recent press release that the laptop computers and cell phone were password-protected, as were files that contained patient information. Since they devices were not encrypted, it is possible that patient information could have been accessed. The devices contained information such as names, driver’s license numbers, Social Security numbers, health insurance information, and diagnosis and treatment information.

Main Street has changed passwords to prevent patient information from being accessed and is monitoring for any attempted misuse of the devices. Patients known to have had their information exposed, for whom up to date contact information is held, are being notified by mail. Since it was not possible to determine exactly which patients have been affected, several media outlets have also been notified about the breach.

Loyola Medicine Notifies Patients of Theft of Autopsy Photos

Loyola Medicine in Maywood, IL has announced a camera containing autopsy photographs has been stolen from Loyola University Medical Center. The camera contained images of 18 deceased patients. Photographs of nine of those individuals had not been uploaded to the patients’ medical record files and have been permanently lost.

According to a CBS 2 report, the photographs had not been uploaded to the hospital system as a new camera had been purchased and it was not supplied with a cable to allow the photographs to be uploaded, so they remained on the memory card.

According to a spokesperson for Loyola Medicine, steps have been taken to prevent further breaches of this nature from occurring, including providing further training for staff and improving physical security.

The families of the deceased patients have now been notified of the loss of photographs and the privacy breach has been reported to the Department of Health and Human Services’ Office for Civil Rights.

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Tens of Thousands of TennCare and Florida Blue Members Impacted by Phishing Attack on Business Associate

Further healthcare organizations have confirmed they have been affected by a data breach at Magellan Health National Imaging Associates, a business associate of several HIPAA-covered entities that provides managed pharmacy and radiology benefits services.

Danville, PA-based Geisinger Health Plan announced last month that 5,848 of its members had been affected by the breach. In the past few days, health insurance company Florida Blue and the Tennessee state Medicaid program, TennCare, have made similar announcements.

Albuquerque, NM-based Presbyterian Health Plan also confirmed that it had been affected and 56,226 of its members had been affected. Further information can be found on this link.

The phishing attack occurred on May 28, 2019. Magellan Health NIA learned of the breach on July 5, 2019 and took action to secure the affected email account. The breach was detected when the compromised account was used to send out large quantities of spam email.

The internal investigation confirmed that the mailbox had been accessed on several occasions by an individual based outside the United States. The purpose of the attack appears to have been solely to use the email account to send out spam. No evidence was found to indicate protected health information had been accessed or stolen, but the possibility could not be discounted.

TennCare was advised it had been affected on September 11, a day after Magellan Health discovered it had been impacted. Magellan Health NIA notified Geisinger Health Plan about the breach on September 24, and Florida Blue was alerted on September 25.

Florida Blue has not yet disclosed exactly how many of its members have been affected, only stating that fewer than 1% of its 5 million members had their protected health information exposed. The information compromised in the attack was limited to name, date of birth, member ID number, health plan name, provider name, drug name, name of imaging procedures performed, benefit authorization outcome, and authorization number. Florida Blue is providing complimentary credit monitoring services to affected members.

TennCare has confirmed that 43,847 individuals were impacted by the breach. the following information as potentially compromised: Names, member ID numbers, health plan information, provider names, names of prescribed medications, and Social Security numbers. TennCare has confirmed that members affected by the breach are being offered credit monitoring services as a precaution against misuse of their information.

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Salem Health Hospitals & Clinics and Delta Dental of Arizona Notify Patients About Phishing Attacks

Salem Health Hospitals & Clinics in Oregon experienced a phishing attack on July 31, 2019 that resulted in an unauthorized individual gaining access to the email accounts of several employees. The breach was detected within a day of the accounts being accessed and the compromised accounts were secured.

Patients were notified about the breach on September 27 and were told that a review of the affected accounts was underway. The compromised email accounts were expected to contain a limited amount of patient information such as names, dates of birth, and information related to the medical services patients had received. At the time of issuing the notice, the investigation into the breach was ongoing.

On Thursday, November 7, 2019, Salem Health spokesperson, Elijah Penner, said “The incident was reviewed thoroughly, and Salem Health has no indication that any patient information has been misused.” No evidence was uncovered to suggest patient information in emails and email attachments was accessed.

Salem Health has advised affected patients to exercise caution and monitor their accounts and explanation of benefits statements for signs of fraudulent activity. Email security is being enhanced and Salem Health will be reinforcing education of employees to help them identify and avoid malicious emails in the future.

The breach has not yet appeared on the HHS’ Office for Civil Rights breach portal so it is currently unclear how many patients have been impacted by the security breach.

Delta Dental of Arizona Notifies Members About July Phishing Attack

The Glendale, AZ-based detail insurance company, Delta Dental of Arizona, has announced it has experienced an email security breach in which the information of plan members has been exposed. The security breach came to light on July 8, 2019 following the detection of suspicious activity in an employee’s email account.

The attacker used the employee’s credentials to access the email account on July 8. According to the substitute breach notice on the Delta Dental website, determining which members had information exposed was “a lengthy and labor-intensive process.”

Delta Dental of Arizona issued a statement on November 8, 2019 confirming the investigation found no evidence of unauthorized data access, although it was not possible to rule out unauthorized data access. Consequently, affected members have been notified as a precaution.

The types of information in the email account included names, addresses, dates of birth, member ID numbers, Social Security numbers, driver’s license numbers, passport numbers, financial account information, credit/debit card numbers, dental insurance information, usernames/passwords, and digital signatures.

The incident has yet to be listed on the HHS’ Office for Civil Rights breach portal so it is unclear how many members have been affected.

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