HIPAA Breach News

Michigan Medicine Notifies 3,600 Patients of PHI Disclosure Due to Mailing Error

Michigan Medicine is notifying more than 3,600 patients of an impermissible disclosure of a limited amount of their protected health information.

In early September 2018, the Michigan Medicine Development Office launched a fundraising campaign that involved sending letters to a large number of its patients. A third-party vendor was contracted to print the letters for the mailing and while many of the letters were printed correctly, an error was made by the printing company that resulted in an impermissible disclosure of certain patients’ personal information.

According to Michigan Medicine, the error was introduced when the printing company installed new software. As a result of the error, a proportion of the letters contained information that was intended for other Michigan Medicine patients and did not match the name and address on the outside of the envelope.

Since this was a fundraising mailing, the letters did not contain any medical information, Social Security numbers, financial data, or other highly sensitive information. Patients affected by the error has their name, address, and in some cases email address and contact telephone number, disclosed to another Michigan Medicine patient.

The error was detected by Michigan Medicine on September 4, 2018 and prompt action was taken to alert the vendor to the error to prevent any further impermissible disclosures of patient information.

“Patient privacy is extremely important to us, and we take this matter very seriously,” said Jeanne Strickland, Michigan Medicine chief compliance officer. “Michigan Medicine took steps immediately to investigate this matter.”

As an additional measure to prevent similar breaches, Michigan Medicine’s Development Office will be using window envelopes for future mailings, eliminating the need to match envelopes with letters.

The Mailing error was a reportable breach under HIPAA and the Department of Health and Human Services’ Office for Civil Rights (OCR) was notified well inside the 60-day reporting deadline. The breach summary on the OCR website indicates 3,624 patients were affected by the incident.

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California HIV Patient PHI Breach Lawsuit Allowed to Move Forward

A lawsuit filed by Lambda Legal on behalf of a victim of a data breach that saw the highly sensitive protected health information of 93 lower-income HIV positive individuals stolen by unauthorized individuals has survived a motion to dismiss.

The former administrator of the California AIDS Drug Assistance Program (ADAP), A.J. Boggs & Company, submitted a motion to dismiss but it was recently rejected by the Superior Court of California in San Francisco.

In the lawsuit, Lambda Legal alleges A.J. Boggs & Company violated the California AIDS Public Health Records Confidentiality Act, the California Confidentiality of Medical Information Act, and other state medical privacy laws by failing to ensure an online system was secure prior to implementing that system and allowing patients to enter sensitive information.

A.J. Boggs & Company made its new online enrollment system live on July 1, 2016, even though it had previously received several warnings from nonprofits and the LA County Department of Health that the system had not been tested for vulnerabilities.

It was alleged that the failure to ensure its system was secure meant that any information entered in the portal by patients was at risk of exposure and could potentially be obtained by unauthorized individuals. In November 2016, four months after the system went live, A.J. Boggs & Company took the system offline to correct the flaws.

However, in February 2017, the California Department of Health discovered that the flaws in its portal had been exploited and unauthorized individuals had gained access to the system and had downloaded the private and highly sensitive information of 93 patients with HIV or AIDS. Following the discovery, the contract with the firm was cancelled and a new state-run system was adopted.

The ADAP program provides states with federal funding to provide financial assistance to low-income individuals with HIV or AIDS to make HIV medications more affordable, extending access to Medicaid when patients earned too much. Any medical data breach is serious, although the disclosure of an individual’s HIV status is especially so.

“HIV is still a highly stigmatized medical condition,” said Scott Schoettes, HIV Project Director at Lambda Legal. “When members of already vulnerable communities — transgender people, women, people of color, undocumented people, individuals with low incomes — already face challenges in accessing health care, undermining the trust they have in the ADAP is not just a breach of security; it creates a barrier to care.”

Lambda Legal is seeking statutory and compensatory damages for the patient and is seeking class action status to allow the other 92 breach victims to be included in the lawsuit.

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PHI of 37,000 Gold Coast Health Plan Members Potentially Compromised

Camarillo, CA-based Gold Coast Health Plan is informing approximately 37,000 plan members that some of their protected health information has potentially been obtained by hackers who succeeded in compromising the email account of one of its employees.

The employee was fooled by a phishing email and responded disclosing login credentials to the email account. The attackers gained access to the email account on June 18, 2018 and access remained possible until August 1, 2018. Gold Coast Health Plan discovered the security breach on August 8 and took steps to secure the account and prevent any further remote access.

A leading third-party cybersecurity firm was engaged to conduct an investigation into the breach and assess the scope of the incident and determine whether any patients’ health information was accessed. It was not possible to rule out PHI access and data theft with 100% certainty, although no reports have been received to date that suggest any PHI in the account has been misused.

Gold Coast Health Plan believes the attack was financially motivated and the purpose of the attackers was to gain access to banking information in order to make fraudulent transfers from Gold Coast Health Plan accounts rather than to steal plan members’ data.

The investigation confirmed that the compromised account contained claims data, health plan ID numbers, and the dates medical services had been received by plan members. Some individuals also had their name, birthdate, and/or medical procedure codes exposed. The types of information exposed varied for each patient with many patients only having one or two of the above data elements exposed.

Even though Social Security numbers and financial information was not exposed, Gold Coast Health Plan is offering breach victims a MyIDCare subscription and identity theft protection services through ID Experts without charge.

The breach has prompted Gold Coast Health Plan to implement further security controls to prevent similar breaches from occurring in the future. Those measures include enhanced end user training on security with a specific focus on phishing, increased monitoring of email accounts, and enhancements to email security controls.

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Summary of Recent Healthcare Data Breaches

A round up of healthcare data breaches recently announced by healthcare providers and business associates of HIPAA covered entities.

Tillamook Chiropractic Clinic Discovers 26-Month Malware Infection

The medical records of 4,058 patients of the Tillamook Chiropractic Clinic in Tillamook, OR have been stolen as a result of a malware infection.

On August 3, 2018, the clinic conducted an internal security audit which showed that malware had been installed on its network, even though a firewall was in place, antivirus and antimalware software were installed and up to date, and its software was fully patched. An investigation into the security breach revealed the malware had been installed on May 24, 2016 and had remained undetected for 26 months. The malware had been installed on the primary insurance billing system, which the clinic reports was used as a staging area by the attackers to collect patient records before exfiltrating the data.

The information believed to have been stolen includes full names, home addresses, work addresses, dates of birth, phone numbers, diagnoses, lab test results, medications, driver’s license numbers, insurance billing information, bank routing numbers, bank account numbers, employee payroll data, and for Medicare patients, Social Security numbers.

Tillamook Chiropractic Clinic removed the malware on August 3, 2018 and has now modernized and upgraded its computer security systems and policies.

Gwinnett Medical Center Investigating Possible Hack

A possible data breach has occurred at Lawrenceville, GA-based Gwinnett Medical Center. The PHI of approximately 40 patients has been accessed by an unauthorized individual according to Gwinnett Medical Center spokeswoman Beth Hardy. Names, genders, and dates of birth were exposed on Twitter and notification letters are being sent to those 40 individuals to alert them to the breach.

However, the breach could be far larger. Steve Ragan at Salted Hash reported that a source at the medical center said threats had been received from the attackers and that the breach potentially impacts hundreds of patients. The attackers allegedly posted data on Twitter as they claimed the medical center was attempting to cover up the breach.

Gwinnett Medical Center has informed the FBI about the security breach and is still conducting investigations into the cyberattack.

Hardy said, “GMC takes cyber security very seriously and we are committed to maintaining the integrity, availability and confidentiality of our systems and data.”

Toyota Industries North America Breach Impacts 19,000 Individuals

Columbus, IN-based Toyota Industries North America (TINA) has announced that approximately 19,000 current and former employees and health plan participants of the TINA family of companies have been informed that some of their PHI has been exposed. An unauthorized individual succeeded in gaining access to a small number of company email accounts and potentially viewed/copied PHI.

The breach was discovered on August 30 and information security experts were called in to help secure its system and investigate the breach. A wide range of PII and PHI were present in the compromised email accounts including first and last names, home addresses, dates of birth, phone numbers, financial account information, social security numbers, photographs of social security cards, driver’s license numbers, photographs of driver’s licenses, email addresses, photographs of birth certificates, photographs of passports, treatment information, prescription information, diagnoses, health plan beneficiary numbers and portal usernames, passwords and security questions.

All affected individuals have been notified by mail and have been offered a year of free credit monitoring and identity theft protection services. TINA has taken several steps following the breach to improve security, including implementing multi-factor authentication, making real-time security monitoring enhancements, and revising its password protection and password resetting policies. TINA is also currently reviewing and updating user training and technology and security practices to reduce the risk of further email breaches.

722 Patients Affected by Kansas City Business Associate Mis-mailing Incident

The Kansas City, MO-based revenue cycle management company, Pulse Systems, has announced that the PHI of 722 patients of Lincoln Pulmonary and Critical Care in Nebraska has been impermissibly disclosed. An error was made sending statements on July 27 that resulted in individuals receiving statements intended for other patients. The statements included only included names and procedure information. Steps have now been taken to prevent similar errors from being made in the future and all affected individuals have been notified about the privacy breach.

Oklahoma Department of Human Services Mis-mailing Incident Affects 813 Individuals

More than 800 parents and guardians who were involved in a developmental disabilities services program run by the Oklahoma Department of Human Services (ODHS) have been notified that some of their PHI has been impermissibly disclosed as a result of a computer software error. The error resulted in envelopes being mis-addressed in Plan of Care change notice mailings sent between May 17 and July 25.

The mailings contained names, addresses, DHS case numbers, Medicaid client ID numbers, plan of care numbers, providers’ names, services authorized and beginning and end dates, and an explanation that the person is authorized to receive Medicaid Home and Community-Based Waiver Services. No Social Security numbers were disclosed.

ODHS believes 813 individuals have received mailings containing someone else’s information, although it is not possible to tell if any other individuals have been affected.

Email Account Breaches Result in Exposure of 16,000 Individuals’ PHI

Ransom Memorial Hospital in Ottawa, KS, has discovered an unauthorized individual has gained access to an as of yet undisclosed number of email accounts which have been determined to contain the PHI of 14,239 individuals. A further email account breach was detected by Lakewood, CO-based Personal Assistance Services of Colorado, which has resulted in the exposure of 1,839 individuals’ PHI.

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PHI of 1,800 Patients Found Abandoned in Houston Street

Paperwork containing the protected health information of approximately 1,800 patients has been discovered abandoned in a Midtown, Houston street by an employee of the CBS-affiliated television station KBOU 11.

The paperwork contained information such as patients’ names, birth dates, diagnoses, treatment information, medications, vital signs, and admission dates. KBOU launched an investigation into the breach and determined the paperwork related to patients from five Houston hospitals – MD Anderson Cancer Center, LBJ Hospital, Children’s Memorial Hermann, Memorial Hermann Hospital, and TIRR Memorial Hermann. The investigation led to UT Health.

According to the report, the records were stolen from the locked trunk of a vehicle belonging of a medical resident who, while studying at UTHealth’s McGovern Medical School, had worked at the above hospitals. The records were stolen from his vehicle in July.

Officials at UT Health confirmed to KBOU that they are aware of the breach. Reporters spoke to the medical graduate and confirmed that the incident had not been reported to the police until after he had been contacted by KBOU reporters.

A spokesperson for UTHealth issued a statement saying, “We promptly took steps to investigate the circumstances of the disclosure, which revealed that the stolen documents had been discarded on a city street and found a day later by an employee of KHOU-TV Channel 11.” The records were collected by that employee and were returned to UTHealth and have now been secured. UTHealth found no evidence to suggest that any information in the documents was viewed by unauthorized individuals.

It is unclear why the records were removed from the hospitals in the first place, why the theft was not reported to law enforcement immediately, and why the hospitals concerned had not been informed about the breach until after the records were discovered by KBOU. According to UTHealth, the affected hospitals will be issuing notifications to all affected patients in due course.

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Study Reveals 70% Increase in Healthcare Data Breaches Between 2010 and 2017

There has been a 70% increase in healthcare data breaches between 2010 and 2017, according to a study conducted by two physicians at the Massachusetts General Hospital Center for Quantitative Health.

The study, published in the Journal of the American Medical Association on September 25, involved a review of 2,149 healthcare data breaches reported to the Department of Health and Human Services’ Office for Civil Rights between 2010 and 2017.

“While we conduct scientific programs designed to recognize the enormous research potential of large, centralized electronic health record databases, we designed this study to better understand the potential downsides for our patients – in this case the risk of data disclosure,” said Dr. Thomas McCoy Jr, director of research at Massachusetts General Hospital’s Center for Quantitative Health in Boston and lead author of the study.

Every year, with the exception of 2015, the number of healthcare data breaches has increased, rising from 199 breaches in 2010 to 344 breaches in 2017. Those breaches have resulted in the loss, theft, exposure, or impermissible disclosure of 176.4 million healthcare records. 75% of those records were exposed or stolen as a result of hacking or IT incidents.

While the number of hacking and IT incidents continues to increase each year, the number of theft incidents has declined by two thirds since 2010 when it was the leading cause of healthcare data breaches. This is due to healthcare organizations transitioning to electronic health records and encrypting health data stored on portable electronic devices.

In 2010, the most common location of breached health data was laptop computers followed by paper records and films. In 2017, the most common locations of breached health data were network servers and email, both of which are targeted by hackers.

The study covered healthcare providers, health plans and business associates of HIPAA covered entities. Healthcare providers experienced the most breaches (70%) over the period of study, which stands to reason given that there are many more healthcare providers than health plans in the United States. However, while there were fewer health plan data breaches – 13% of the total – they resulted in the exposure of more records – 63% of all breached records between 2010 and 2017.

“More breaches happen—for the sake of argument—in doctor’s offices, quote-on-quote ‘healthcare providers,’ but more records get lost by big insurance companies,” said McCoy.

The high number of records exposed by health plan data breaches is largely due to three health plan data breaches which resulted in the theft of 99.8 million records: The 78.8 million record breach at Anthem Inc., the 11 million record breach at Premera Blue Cross, and the 10 million record breach at Excellus Blue Cross Blue Shield. Those three breaches accounted for more than half of all exposed health records between 2010 and 2017.

The most serious healthcare data breaches involve records stored on network servers. There were 410 data breaches involving network servers over the period of study and they impacted almost 140 million patients, compared to 510 breaches involving paper/films which impacted 3.4 million patients.

“For me, the message is that working with big data carries big responsibility. This is an area where health plans, health systems, clinicians and patients need to work together. We hear a lot about the huge opportunity to improve how we care for patients – but there is also risk, which we need to manage responsibly,” said Roy Perlis, MD, MSc, director of the Center for Quantitative Health, and co-author of the study.

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Claxton-Hepburn Medical Center Fires Several Employees for Inappropriate PHI Access

Claxton-Hepburn Medical Center, a not-for-profit 115-bed community hospital in Ogdensburg, NY, has fired several employees for accessing patient health records without authorization.

The PHI breaches were discovered during an internal investigation. It is unclear whether that investigation was launched following a complaint that had been received or if the patient privacy violations were uncovered during a routine audit of PHI access logs – A requirement of HIPAA.

Claxton-Hepburn Medical Center has not publicly disclosed how many employees were terminated over the violations, only reporting that all employees who purposely committed the acts were terminated. It is also currently unclear exactly how many patients’ PHI was breached.

Claxton-Hepburn Medical Center has confirmed that training is given to all employees on the first day of employment detailing the requirements of HIPAA and the importance of protecting the privacy of patients. All employees are made aware that accessing patient health information is only permitted when PHI needs to be viewed to complete work duties or when patient records need to be updated, as per the requirements of the HIPAA Privacy Rule. Employees are also made aware that any unauthorized accessing of PHI will result in disciplinary action. It would have been clear to the employees concerned that their actions were in violation of HIPAA Rules.

The discovery of the privacy breaches has prompted the hospital to implement further safeguards to reduce the likelihood of future HIPAA violations of this nature occurring. Claxton-Hepburn Medical Center has also notified all patients by mail whose records were inappropriately accessed.

While it is possible for criminal charges to be filed against healthcare employees for HIPAA Privacy Rule violations, in this instance Claxton-Hepburn Medical Center has not involved the police.

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Protected Health Information Stolen in Aspire Health Phishing Attack

Aspire Health, a Nashville, TN-based provider of in-home services for patients diagnosed with serious illnesses, has experienced a phishing attack that resulted in the email account of an employee being accessed by an unauthorized individual.

Once access to the email account was gained, the attacker forwarded 124 emails to an external email account. Several of the forwarded email messages contained the protected health information of patients and “confidential and proprietary information and files”.

According to a statement issued by a spokesperson for Aspire Health, breach notification letters have already been sent to a “small handful” of its patients, although the exact number affected by the breach has not been disclosed. The data breach has yet to appear on the Department of Health and Human Services’ Office for Civil Rights’ breach portal.

As is the case with many phishing scams, an email was sent to the employee which contained a hyperlink to a website which requested login credentials. The website, created on August 28, 2018, is hosted in the Russian Federation and was accessed by the employee on or around September 3, 2018. The employee’s email account was breached on September 3. The website has since been marked as potentially malicious by Google.

Aspire Health has launched an internal investigation into the breach, is attempting to determine whether any of the forwarded PHI has been accessed and is trying to identify the individual responsible for the attack. Part of that process has involved filing a federal court motion to get Google to reveal more information about the hacker.

The email account to which the messages were forwarded is a Gmail account and Aspire Health believes that Google could provide vital information that could allow the hacker to be identified and also help to determine whether any of the forwarded messages have been opened. According to The Tennessean, Aspire Health made informal attempts to get Google to release information about the owner of the website and the subscriber to the email account but was advised that a subpoena would be required.

Should Aspire Health’s efforts prove successful, the attacker could be identified; however, bringing that individual to justice for the attack is likely to be a much more difficult task.

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UMass Memorial Health Care Pays $230,000 to Resolve Alleged HIPAA Violations

Mass Memorial Health Care has been fined $230,000 by the Massachusetts attorney general for HIPAA failures related to two data breaches that exposed the protected health information (PHI) of more than 15,000 state residents.

A lawsuit was filed against UMass Memorial Health Care in which attorney general Maura Healey claimed UMass Memorial Medical Group Inc., and UMass Memorial Medical Center Inc., failed to implement sufficient measures to protect patients’ sensitive health information.

In two separate incidents, employees accessed and copied patient health information without authorization and used that information to open cell phone and credit card accounts in the victims’ names.

It was also alleged that UMass Memorial Medical Group Inc., and UMass Memorial Medical Center Inc., were both aware of employee misconduct, yet failed to properly investigate complaints related to data breaches and discipline the employees concerned in a timely manner. Both entities also failed to ensure that patients’ PHI was properly safeguarded. These failures violated Massachusetts data security laws, the Consumer Protection Act, and the Health Insurance Portability and Accountability Act.

UMass Memorial Health Care cooperated fully with the state attorney general’s investigation into the data breaches and agreed to settle the resulting lawsuit. In addition to paying the $230,000 fine, UMass Memorial Health Care will ensure that employee background checks are conducted prior to hiring new staff, all employees will receive further training on the correct handling of PHI, employee access to patient health information will be limited, risk analyses will be conducted to identify potential security issues, and any issues that are found will be subjected to a HIPAA-compliant risk management process. UMass Memorial Health Care will also ensure proper employee discipline and any suspected cases of improper accessing of ePHI will be investigated promptly.

Both UMass Memorial Medical Group Inc., and UMass Memorial Medical Center Inc., are also required to hire an independent firm to conduct a thorough review of data security policies and procedures and must report back to the Mass attorney general’s office on the findings of those reviews.

“Massachusetts residents rely on their health care providers to keep private health information safe and secure,” said Maura Healey. “This resolution ensures UMass Memorial implements important measures to prevent this type of breach from happening again.”

“In the four years since [these breaches] took place we have taken steps aimed at further strengthening our privacy and information security program,” said a UMass Memorial Health Care spokesperson in a written statement. “This includes the implementation of additional technical tools that safeguard patient information, and enhancement of our existing privacy and information security procedures.”

State Attorneys General Pick Up the Slack in HIPAA Enforcement

After two years of increased enforcement of HIPAA Rules the HHS’ Office for Civil Rights has eased up on settlements and civil monetary penalties to resolve HIPAA violations, with only five settlements reached in 2018 and one civil monetary penalty issued. While OCR has eased up on financial penalties for HIPAA violations, state attorneys general fines are on track to make 2018 a record year for HIPAA enforcement.

UMass Memorial Health Care is the fifth healthcare organization to settle a HIPAA violation case with a state attorney general in 2018, joining The Arc of Erie County ($200,000), EmblemHealth ($575,000), and Aetna ($1,150,000) which have all been fined by the New York AG this year, and Virtua Medical Group which settled HIPAA violations with the New Jersey AG for $417,816 in April.

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