HIPAA Breach News

California Mental Health Services Provider Discovers Unauthorized Email Account Access and File Deletion

The Guidance Center (TGC), a nonprofit provider of mental health care services to disadvantaged children and their families in Long Beach, Compton, San Pedro, and Avalon in California, has discovered a breach of its digital environment.

In a breach notification letter to the California Attorney General, Xavier Becerra, TGC’s counsel explained that unusual activity was detected within TGC’s digital environment in late March 2019. Staff had reported that files and backups appeared to be missing. An internal investigation was launched which concluded the files had been deleted. Further investigation also showed that a TGC computer had been reconfigured to allow it to be remotely accessed.

TGC believes the change to the computer and deletion of files was most likely the work of a former employee. The matter was reported to both the Long Beach Police Department and the FBI, and the individual suspected of the illegal access was sent a cease and desist letter by TGC’s attorney on March 30, 2019. Following that letter, all further unauthorized access stopped.

On April 19, 2019, TGC engaged a difficult forensics company to determine whether any patient information had been accessed without authorization. No evidence of unauthorized PHI access or data exfiltration was discovered; however, certain employee email accounts had been accessed remotely.

According to the substitute breach notification letter on the TGC website, TGC learned on September 19, 2019 that some sensitive information was contained in those email accounts. It took some time to determine which clients had been affected and to find up to date contact information for those individuals. Breach notification letters were sent on October 25, 2019.

In total, the protected health information of 1,235 current and former clients was detailed in the email accounts and could therefore have been accessed, although no evidence of unauthorized PHI access was discovered.

The information in the accounts was limited to names, addresses, dates of birth, health insurance/claims information, medical information and, for a limited number of patients, Social Security numbers.

All individuals whose Social Security number was exposed have been offered 12 months of complimentary credit monitoring services. Additional security controls have now been implemented to prevent any similar incidents from occurring in the future and the deleted files have been restored. No reason was given as to why the email accounts were accessed and files and backups were deleted.

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Utah Valley Eye Center Hacking Incident Leads to Phishing Attack on Patients

Utah Valley Eye Center in Provo, UT is warning patients that some of their personal information may have been accessed by an unauthorized individual following a security breach of its scheduling reminder portal on June 28, 2018.

The hacker obtained the email addresses of 5,764 patients and sent each a phishing email in an attempt to gain access to PayPal credentials. The emails spoofed PayPal and advised the recipients that they had received a payment.

Upon discovery of the security breach, Utah Valley Eye Center contacted all individuals who had been emailed to warn them about the security breach. No evidence has been uncovered to suggest any other information was accessed or misused, although the hacker would have had access to patient names, addresses, phone numbers, and dates of birth. No personal health or financial information is believed to have been accessed.

Only 5,764 phishing emails were sent, but Utah Valley Eye Center could not determine exactly how many patients had been affected by the breach. According to a recent press release, the demographic information of up to 20,000 patients may have been compromised, according to a recent report in the Daily Herald.

The incident has been reported to the Utah Department of Health, the Utah Department of Human Services, and the HHS. Affected individuals have been advised to place a fraud alert on their credit files as a precaution against misuse of their information.

It is currently unclear when the breach was discovered and why it has taken until now for a press release to be issued about the security breach.

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Prisma Health Website Breach Potentially Impacts 22,000 Individuals

Prisma Health Midlands is notifying approximately 19,000 patients and 3,000 employees about a data breach involving the Palmetto Health website.

Prisma Health – formerly Palmetto Health – learned on August 29, 2019 that an unauthorized individual had obtained the login credentials of a Prisma Health employee. Those credentials allowed the attacker to access the Palmetto Health website, which contained volunteer registration information and patient pre-registration forms that had been completed online.

Those forms related to 6 Midlands hospitals and contained information such as names, addresses, dates of birth, limited health information and, for certain individuals, their Social Security number. No medical records or financial information were exposed. Prisma Health was not able to determine for how long the credentials were accessible.

Upon discovery of the incident, the employee’s password was changed to prevent any further unauthorized access and policies and procedures are being updated to prevent similar breaches in the future. Affected individuals have been notified by mail and individuals whose Social Security number was exposed have been offered complimentary credit monitoring and identity theft protection services for 12 months.

Prisma Health has suffered multiple privacy breaches this year. In April, Prisma Health announced it had been the victim of a phishing attack that saw the email accounts of several employees accessed by an unauthorized individual. The PHI of 23,811 individuals was exposed as a result of the attack. A further privacy breach was announced in July when a notebook containing the PHI of OB/GYN patients from its Richland Campus in Columbia was discovered to have been stolen from a physician’s car. Information on up to 2,770 individuals was recorded in the notebook.

Seattle Cancer Care Alliance Email Error Exposed Patients’ Email Addresses

944 patients of Seattle Cancer Care Alliance (SCCA) have had their email addresses exposed to other patients as a result of an error by a member of staff when sending an August 27, 2019 email invitation.

Rather than adding email addresses to the blind carbon copy (BCC) field, thus shielding the recipients’ email addresses from each other, the email addresses were added to visible fields and could be seen by all individuals who received the email invitation. No other information was disclosed.

SCCA is now evaluating its systems, policies and procedures and safeguards will be implemented to prevent similar breaches in the future. Notification letters were sent to affected patients on October 16, 2019.

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Quest Diagnostics $195,000 Class Action Settlement Approved by Federal Judge

Following a November 2016 cyberattack at Quest Diagnostics that resulted in an unauthorized individual accessing and stealing the personal information and medical test results of 34,000 individuals, a class action lawsuit was filed by the breach victims. Quest Diagnostics proposed a $195,000 settlement to resolve the case. The settlement has recently been approved by a U.S district court judge in New Jersey.

The types of information obtained by the hacker included names, phone numbers, dates of birth, and the results of medical tests, including HIV test results.

The lawsuit alleged Quest Diagnostics had violated New Jersey laws and had been negligent for failing to safeguard the sensitive health information of its clients, Quest Diagnostics had breached its contract with clients, and that the company failed to provide timely notifications to patients informing them about the hacking incident and theft of their data.

Quest Diagnostics maintains the claims are meritless, but the decision was taken to settle the lawsuit to avoid ongoing litigation and further legal costs. Under the terms of the settlement, all individuals who can demonstrate they have suffered monetary losses as a direct result of the breach will be entitled to claim $250. The payment is intended to compensate individuals for having to take action to secure their accounts and pay for credit monitoring and identity theft protection services.

Any individual whose HIV test results were included in the stolen data will be entitled to claim $75, in addition in the $250 if they have also suffered monetary losses.

Quest Diagnostics has also been named as a co-defendant in several lawsuits filed by victims of the data breach at American Medical Collection Agency (AMCA) earlier this year. The hacking of the AMCA payment portal enabled the attacker to steal the protected health information of more than 26 million individuals, 11,500,000 of whom had received medical tests at Quest Diagnostics and their PHI had been passed to AMCA for collection.

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Improper Disposal Incident at Smith’s Food & Drug Affects Almost 58,000 Patients

Salt Lake City, OH-based Smith’s Food & Drug has announced that the pharmacy records of around 58,000 patients have been disposed of in an improper manner.

The improper disposal incident was discovered by the grocery and drug store chain on August 29, 2019 and affected customers of its store at 4600 East Sunset Road in Henderson, NV.

12 boxes of files containing physical pharmacy records, including prescriptions, were disposed of by a former associate in an improper manner. The records were not shredded, pulped, burned, or pulverized to render them unreadable, indecipherable, and ensure they could not otherwise be reconstructed, as is required by HIPAA. The boxes of files were put in the store’s trash compactor along with regular trash.

Since the records are no longer accessible, it was not possible to determine which patients were impacted and the exact types of information that had been exposed. Smith’s Food & Drug has estimated the sensitive information of approximately 57,600 patients was likely contained in the pharmacy records. The types of HIPAA-covered information in the records likely included the full names of patients, along with an address, phone number, date of birth, gender, prescription number, drug name, and third-party payor information. According to a statement issued by Smith’s Food & Drug, the records were 11 or more years old.

While it is unlikely that the records were viewed or obtained by unauthorized individuals, since the records were not disposed of in a secure manner, unauthorized access cannot be ruled out. Smith’s Food & Drug has not received any reports to suggest any patient information has been misused but has advised customers to review their explanation of benefits statements from their health plans and to report any medical services listed that have not been received.

Smith’s Food & Drug is re-educating select associates on company policies and HIPAA Rules concerning the disposal of sensitive information and additional safeguards are being implemented to prevent similar incidents in the future.  Smith’s Food & Drug has confirmed that the associate responsible has been terminated.

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

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

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

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

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

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

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

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

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

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

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

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Betty Jean Kerr People’s Health Centers Ransomware Attack Impacts 152,000 Patients

St Louis, MO-based Betty Jean Kerr People’s Health Centers experienced a ransomware attack on September 2, 2019 that prevented staff at its health centers from accessing certain types of patient, provider, and employee information.

The security incident was detected on September 3 and law enforcement was notified. A ransom demand was received, but the decision was taken not to pay. A third-party IT firm was engaged to assist with recovery, but it has not been possible to recover the encrypted data. The encrypted data is considered to have been permanently lost, unless a decryptor is developed by security researchers that allows files to be recovered. No mention has been made about the type of ransomware used in the attack and if backup files were also encrypted in the attack.

The investigation revealed the following types of information had been encrypted in the attack: Patient names, addresses, dates of birth, Social Security numbers, pharmacy data, health insurance information, dental x-rays, and a limited amount of clinical data. Affected patients had received medical services at Betty Jean Kerr People’s Health Centers between 2011 and September 2, 2019. The attack did not affect its electronic medical record system.

Healthcare providers affected by the breach had sought to be credentialed by People’s Health Centers between 2010 and September 2019. Names, addresses, and Social Security numbers provided by those healthcare organizations were also encrypted, as were the names, addresses, and Social Security numbers of individuals employed by People’s Health Centers between 2012 and September 2, 2019.

People’s Health Centers has confirmed that patient data, provider data, and employee information was encrypted, but it was not possible to determine whether the attackers accessed or copied any data during the attack. The individual(s) responsible for the attack is believed to be based outside the United States.

In total, up to 152,000 individuals have had their sensitive data exposed. People’s Health Centers is offering 12 months of free credit monitoring services to individuals affected by the breach.

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Geisinger Health Plan Notifies Members About Business Associate Phishing Attack

Danville, PA-based Geisinger Health Plan has discovered the protected health information (PHI) of some of its members has been exposed as a result of a suspected phishing attack on one of its business associates, Magellan NIA.

Magellan NIA provides radiology benefits management services to the health plan, which requires access to plan members’ PHI.

Magellan NIA discovered the breach on July 5, 2019 when suspicious activity was detected in the email account of one of its employees. The account was immediately secured to prevent further unauthorized access and misuse and an investigation was launched to determine the extent of the breach. The investigation revealed the account was breached on May 28, and there had been several connections to the account between up until July 5. Those connections were made from a location outside the United States.

Geisinger Health Plan believes the sole purpose of the attack was to gain access to email accounts for the purpose of spamming, rather than to steal sensitive plan member data. However, it was not possible to rule out unauthorized data access and theft of plan member data, so the incident is being classed as a data breach. Affected members have been offered complimentary credit monitoring and identity theft protection services as a precautionary measure.

Magellan NIA has since implemented additional security measures to protect against further phishing attacks, including disabling certain email protocols, implementing Microsoft Password Hash Sync, and establishing geofencing.

Geisinger Health Plan says it was informed about the breach on September 24 and was sent a list of affected members on October 3. The business associate has notified affected members directly. Geisinger Health Plan ensured that the notification process was completed correctly and has now terminated its business relationship with the company.

At this stage, no information is available on the number of plan members that have been affected.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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