Latest HIPAA News

New Jersey Infertility Clinic Settles Data Breach Investigation with State and Pays $495,000 Penalty

A New Jersey infertility clinic accused of violating HIPAA and New Jersey laws by failing to implement appropriate cybersecurity measures has settled the investigation with the state and will pay a $495,000 penalty.

Millburn, NJ-based Diamond Institute for Infertility and Menopause, LLC (Diamond) operates two healthcare facilities in New Jersey, one in New York, and provides consultancy services in Bermuda. Providing those services involves the collection, storage, and use of personal and protected health information (PHI).

Between August 2016 and January 2017, at least one unauthorized individual accessed Diamond’s network which contained the PHI of 14,663 patients, 11,071 of which were New Jersey residents.

As a HIPAA covered entity, Diamond is required to implement technical, physical, and administrative safeguards to ensure the confidentiality, integrity, and availability of PHI. Diamond is also subject to New Jersey laws and is similarly required to implement reasonable and adequate safeguards to protect medical data from unauthorized access.

Diamond Investigated for Compliance with Federal and State Laws

The State of New Jersey Department of Law and Public Safety Division of Consumer Affairs investigated Diamond over the data breach to determine compliance with federal and state laws. The investigation revealed Diamond had entered into a support contract with the managed service provider (MSP) Infoaxis Technologies in 2007, which including security and information technology services including maintaining its third-party server and workstations. The service agreement included third-party software for the management and reporting of audit logs intended to interpret triggers for event alerts.

Around March 2014, Diamond downgraded its support package with the MSP, resulting in a reduction in the services provided, although Diamond maintains there was no reduction in services between the two support agreements other than the amount of time included for on-site support services.

Prior to the breach occurring, Diamond’s HIPAA Privacy and Security Officer used a Remote Desktop Protocol (RDP) service with a VPN to access the Diamond network, but because the VPN was blocked from the Bermuda office, the MSP provided a different method of access that involved opening a port in the firewall to allow RDP access, instead of using the VPN for authentication.

Between August 28, 2016 and January 14, 2017, a workstation in the Millburn office was accessed by an unauthorized individual on several occasions from a foreign IP address. The unauthorized access was detected and blocked on January 14, 2017. During the time the workstation was accessible, data on the device was not encrypted. The intruder therefore potentially accessed patient data including names, dates of birth, Social Security numbers, and medical record numbers.

An investigation into the breach also revealed an intruder accessed Diamond’s third-party server which housed its electronic medical records within a password-protected SQL server using two compromised Diamond user accounts that had weak passwords. The investigation revealed weak security settings were in place for failed login attempts and password expiration.

While the EMR data was not compromised, the intruder was able to access PHI such as test results, ultrasound images, and clinical and post-operative notes. Diamond’s investigation was unable to confirm how access to the network was gained.

Multiple HIPAA Violations Uncovered

The state investigation into the data breach revealed business associate agreements were not in place prior to sharing ePHI with three business associates: Infoaxis, BMedTech, and Igenomix, in violation of the HIPAA Rules. Diamond was also alleged to have violated the CFA, HIPAA Security Rule, and HIPAA Privacy Rule by removing administrative and technological safeguards protecting PHI and ePHI, which allowed unauthorized individuals to gain access to its systems and ePHI for around five and a half months.

The CFA violations included misrepresentation of HIPAA practices in its privacy and security policy, a failure to secure its network leading to a data breach, and unconscionable commercial practices.

The settlement agreement lists failures to comply with twenty-nine provisions of the HIPAA Privacy and Security Rules. Alleged violations include the failure to conduct a comprehensive risk assessment, failure to encrypt ePHI, failure to modify security measures to ensure reasonable protections for ePHI were maintained, failure to implement procedures for creating, changing, and modifying passwords, and a failure to verify the identify of individuals seeking access to ePHI.

Diamond disputes many of the claims made by the state but agreed to settle the case and pay a $495,000 financial penalty, which consists of $412,300 in civil penalties and $82,700 in investigation fees.

“Patients seeking fertility treatment rightly expect their healthcare providers to protect their privacy,” said Acting Attorney General Bruck. “Major cybersecurity lapses like the ones leading up to this data breach are unacceptable. Today’s settlement sends the message that such privacy lapses come with significant consequences.”

In addition to the financial penalty, Diamond is required to implement additional measures to improve data security, including the use of encryption to prevent unauthorized access to ePHI, implementing a comprehensive information security program, appointing a new HIPAA officer, providing additional training to staff on security policies, developing a written incident response plan, and improving logging, monitoring, access controls, password management, and implementing a risk assessment program.

“Inadequate data systems and protocols are every hacker’s dream,” said Division of Consumer Affairs Acting Director Sean P. Neafsey. “Companies that fail to comply with basic security requirements are an easy target, and we will not stand by as they violate our laws and expose clients’ sensitive information and make them vulnerable to identity theft.”

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Ransom Disclosure Act Requires Disclosure of Payments to Ransomware Gangs Within 48 Hours

A new bill has been introduced that requires victims of ransomware attacks to disclose any payments made to the attackers to the Department of Homeland Security (DHS) within 48 hours of the ransom being paid.

The Ransom Disclosure Act was introduced by Sen. Elizabeth Warren (D-Mass.) and Rep. Deborah Ross (D-N.C.) and aims to provide the DHS with the data it needs to investigate ransomware attacks and improve understanding of how cybercriminal enterprises operate, thus allowing the DHS to gain a much better picture of the ransomware threat facing the United States.

Between 2019 and 2020 ransomware attacks increased by 62% worldwide, and by 158% in the United States. The Federal Bureau of Investigation (FBI) received 2,500 complaints about ransomware attacks in 2020, up 20% from the previous year and there were more than $29 million in reported losses to ransomware attacks in 2020. Not all ransomware attacks are reported. Many victims choose to quietly pay the attackers for the keys to decrypt their data and prevent the public disclosure of any data stolen in the attack.

Chainalysis believes almost $350 million in cryptocurrency was paid to ransomware gangs globally in 2020, which is a year-over-year increase of 311%. Attacks have continued to increase in 2021. According to Check Point’s mid-year security report, in the first half of 2021, there were 93% more ransomware attacks than the corresponding period last year.

As the ransomware attack on Colonial Pipeline demonstrated, the gangs behind these attacks pose a significant national security threat. That attack resulted in the closure of a major fuel pipeline for around a week. The attack on JPS Foods threatened food production, and the huge number of attacks on the healthcare industry has affected the ability of healthcare providers to provide care to patients. This year, CISA said ransomware attacks delay care and affect patient outcomes, and there has already been a death in the United States which is alleged to have been due to a ransomware attack.

Ransomware attacks are continuing to increase because they are profitable and give ransomware gangs and their affiliates a good return on investment. There is also little risk of being caught and brought to justice. Unfortunately, investigations of ransomware gangs can be hampered by a lack of data, hence the introduction of the Ransom Disclosure Act.

“Ransomware attacks are skyrocketing, yet we lack critical data to go after cybercriminals,” said Senator Warren. “My bill with Congresswoman Ross would set disclosure requirements when ransoms are paid and allow us to learn how much money cybercriminals are siphoning from American entities to finance criminal enterprises – and help us go after them.”

While the FBI encourages the reporting of ransomware attacks to assist with its investigations, reporting attacks is not mandatory. “Unfortunately, because victims are not required to report attacks or payments to federal authorities, we lack the critical data necessary to understand these cybercriminal enterprises and counter these intrusions,” sad Congresswoman Ross. “I’m proud to introduce this legislation with Senator Warren which will implement important reporting requirements, including the amount of ransom demanded and paid, and the type of currency used. The U.S. cannot continue to fight ransomware attacks with one hand tied behind our back.”

The Ransom Disclosure Act will require:

  • Ransomware victims (except individuals) to disclose any ransom payments within 48 hours of the date of payment, including the amount, currency used, and any information that has been gathered on the entity demanding the ransom.
  • The DHS will be required to publish information disclosed during the previous year about the ransoms paid, excluding identifying information about the entities who paid.
  • The DHS will be required to set up a website for individuals to voluntarily report ransom payments.
  • The Secretary of Homeland Security will be required to conduct a study on commonalities among ransomware attacks and the extent to which cryptocurrency facilitated the attacks, and make recommendations for protecting information systems and strengthening cybersecurity.

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Insider Threat Self-Assessment Tool Released by CISA

Public and private sector organizations have a new tool to help them assess their level of vulnerability to insider threats. The new Insider Threat Risk Mitigation Self-Assessment Tool has been created by the Cybersecurity and Infrastructure Security Agency (CISA) to help users further their understanding of insider threats and develop prevention and mitigation programs.

In healthcare, security efforts often focus on the network perimeter and implementing measures to block external threats, but insider threats can be just as damaging, if not more so. Insiders can steal sensitive information for financial gain, can take information to provide to their next employer, or can abuse their privileged access to cause significant harm.

Insider breaches can have major consequences for businesses, with may include reputation damage, loss of revenue, theft of intellectual property, reduced market share, and even physical harm. CISA says insider threats can include current and former employers, contractors, or other individuals with inside knowledge about a business. The threat posed by insiders can be considerable due to the knowledge those individuals have about a business and the fact they are trusted and have privileged access to systems and sensitive data.

Large organizations are likely to have conducted risk assessments and put measures in place to mitigate insider threats. Small- and medium-sized businesses tend to have limited resources and may not have assessed their risk level and are most likely to benefit from using the new tool.

The tool consists of a series of questions that will establish the level of vulnerability to insider threats and will provide feedback to users to help them develop appropriate mitigations to guard against insider threats and reduce risk to a low and acceptable level.

“CISA urges all our partners, especially small and medium businesses who may have limited resources, to use this new tool to develop a plan to guard against insider threats.  Taking some small steps today can make a big difference in preventing or mitigating the consequences of an insider threat in the future,” said CISA Executive Assistant Director for Infrastructure Security David Mussington.

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Lawsuit Alleges Ransomware Attack Resulted in Hospital Baby Death

A medical malpractice lawsuit has been filed against an Alabama Hospital alleging vital information that could have prevented the death of a baby was not available due to a ransomware attack.

Springhill Medical Center in Mobile, AL suffered a ransomware attack in 2019 which caused widespread encryption of files and a major IT system outage. Computer systems were taken offline for 8 days, during which time care continued to be provided to patients with staff operating under the hospital’s emergency protocol during the downtime. With no access to computer systems patient information was recorded on paper charts.

Following the attack, Springhill Medical Center issued a statement about the incident and said it had no impact on patient care, “We’d like to assure our patients and the community that patient safety is always our top priority and we would never allow our staff to operate in an unsafe environment.”

During the system downtime, Teiranni Kidd arrived at the hospital to have her baby delivered. Her baby was born on July 17, 2019 but tragically the umbilical cord had become wrapped around the baby’s neck resulting in severe brain damage. Following the birth, Kidd’s daughter Nicko was transferred to a neonatal intensive care unit. Due to the brain damage, Nicko required frequent oxygen supplementation, had to be fed through a gastrointestinal tube, and needed around the clock medical care. Nicko died 9 months later on April 16, 2020.

In January 2020, a lawsuit was filed in the Circuit Court of Mobile County, AL on behalf of Teiranni Kidd, as mother and next friend of Nicko Silar. The lawsuit alleges the hospital failed to inform the plaintiff about the cyberattack and outage, and had the hospital done so, she would have chosen a different hospital for labor and delivery.

The lawsuit alleges physicians and nurses at Springhill Medical Center failed to conduct multiple tests prior to the birth which would have revealed the umbilical cord had wrapped around the baby’s neck and that those tests were not conducted due to the distraction caused by the ransomware attack.

The lawsuit alleges a wireless tracker used to locate medical staff was out of order, patient health records were inaccessible, and electronic systems that provided fatal tracing information were also not working. The lawsuit alleges patient information was not available at the nurses’ station and the only fetal monitoring information was a paper record at the patient’s bedside in the labor and delivery room.

“As a result, the number of healthcare providers who would normally monitor [the plaintiff’s] labor and delivery were substantially reduced and important safety-critical layers of redundancy were eliminated,” according to the lawsuit, which claims medical malpractice and wrongful death.

“Defendant Springhill Memorial Hospital planned, orchestrated, and implemented a scheme by hospital management and ownership in which they conspiratorially hid, suppressed, and failed to disclose critical patient safety-related information, and further created a false, misleading, and deceptive narrative concerning the July 2019 cyberattack by deliberately failing to disclose critical factual information,” according to the lawsuit.

The lawsuit alleges that as a proximate consequence of the non-disclosure of the attack and outage, the baby suffered “personal injuries and general damages, including permanent injury from which she died.” The hospital has denied any wrongdoing.

Following a ransomware attack, hospitals continue to provide medical services to patients in their care and follow their emergency protocols and switch to recording patient information on paper charts and conducting normally automated processes manually. It is common for emergency patients to be redirected to alternative facilities as a precaution while systems are restored and access to medical records is regained.

This is the first case where a ransomware attack is alleged to have resulted in a patient death, although it is not the only attack where patient safety has been put at risk. Last week, the U.S. Cybersecurity and Infrastructure Security Agency (CISA) published a report on healthcare ransomware attacks during the pandemic and confirmed the impact they have had on patient care and outcomes. “Although there are no deaths directly attributed to hospital cyberattacks, statistical analysis of an affected hospital’s relative performance indicates reduced capacity and worsened health outcomes, which can be measured in the time of the COVID-19 pandemic in excess deaths,” explained CISA in the report.

Also, a recent survey on IT and IT security professionals at healthcare delivery organizations in the United States conducted by the Ponemon Institute on behalf of cybersecurity risk management firm Censinet revealed respondents believed ransomware attacks resulted in an increase in the length of patient stays in hospital, delays in testing, and an increase in medical complications. 22% of respondents believed there was an increase in patient mortality after a ransomware attack.

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Cybersecurity Awareness Month: Do Your Part, #BeCyberSmart

October is Cybersecurity Awareness Month; a full month where the importance of cybersecurity is highlighted, and resources are made available to help organizations improve their security posture through the adoption of cybersecurity best practices and improving security awareness of the workforce.

Cybersecurity Awareness Month was launched by the National Cyber Security Alliance and the United States Department of Homeland Security in 2004 to raise awareness of the importance of cybersecurity. Each year has a different theme, although the overall aim is the same – To empower individuals and the organizations they work for to improve cybersecurity and make it harder for hackers and scammers to succeed.

The month is focused on improving education about cybersecurity best practices, raising awareness of the digital threats to privacy, encouraging organizations and individuals to put stronger safeguards in place to protect sensitive data, and highlighting the importance of security awareness training.

This year has the overall theme – “Do Your Part, #BeCyberSmart” – and is focused on communicating the importance of everyone playing a role in cybersecurity and protecting systems and sensitive data from hackers and scammers. Throughout the month, the National Cyber Security Alliance and its partners will be running programs to raise awareness of specific aspects of cybersecurity, with each week of the month having a different theme.

  • Week of October 4 (Week 1): Be Cyber Smart.
  • Week of October 11 (Week 2): Phight the Phish!
  • Week of October 18 (Week 3): Explore. Experience. Share.
  • Week of October 25 (Week 4): Cybersecurity First

Cybersecurity Awareness month kicks off with the theme of “Be Cyber Smart” in week 1, where cybersecurity best practices are highlighted to protect the vast amounts of personal and business data that are stored on Internet-connected platforms.

“This evergreen theme encourages individuals and organizations to own their role in protecting their part of cyberspace, stressing personal accountability and the importance of taking proactive steps to enhance cybersecurity,” said the U.S. Cybersecurity and Infrastructure Security Agency (CISA).

Best practices being highlighted in week 1 are those that businesses and individuals should be implementing. They include always creating strong passwords, implementing multi-factor authentication on accounts, keeping software updated and patching promptly, and creating backups to ensure data can be recovered in the event of a ransomware attack or other destructive cyberattack.

“Since its inception, Cybersecurity Awareness Month has elevated the central role that cybersecurity plays in our national security and economy.  This Cybersecurity Awareness Month, we recommit to doing our part to secure and protect our internet-connected devices, technology, and networks from cyber threats at work, home, school, and anywhere else we connect online,” said, President Biden in a White House statement announcing the start of Cybersecurity Awareness Month. “I encourage all Americans to responsibly protect their sensitive data and improve their cybersecurity awareness by embracing this year’s theme: “Do Your Part.  Be Cyber Smart.”

Each week this month, HIPAA Journal will share information and resources based on the theme of the week that can be used to raise awareness of cybersecurity in your organization and improve your resilience to cyberattacks and privacy threats.

Be Cyber Smart – Your Role in Cybersecurity

Cybersecurity Basics – How to Secure Your Online Life

CISA – Cybersecurity Awareness Tip Sheets

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NSA/CISA Issue Guidance on Selecting Secure VPN Solutions and Hardening Security

The National Security Agency (NSA) and the Cybersecurity and Infrastructure Security Agency (CISA) have issued new guidance on selecting and improving the security of Virtual Private Networks (VPN) solutions.

VPN solutions allow remote workers to securely connect to business networks. Data traffic is routed through an encrypted virtual tunnel to prevent the interception of sensitive data and to block external attacks. VPNs are an attractive targeted for hackers, and vulnerabilities in VPN solutions have been targeted by several Advanced Persistent Threat (APT) groups. APT actors have been observed exploiting vulnerabilities in VPN solutions to remotely gain access to business networks, harvest credentials, remotely execute code on the VPN devices, hijack encrypted traffic sessions, and obtain sensitive data from the devices.

Several common vulnerabilities and exposures (CVEs) have been weaponized to gain access to the vulnerable devices, including Pulse Connect Secure SSL VPN (CVE-2019-11510), Fortinet FortiOS SSL VPN (CVE-2018-13379), and Palo Alto Networks PAN-OS (CVE_2020-2050). In some cases, threat actors have been observed exploiting vulnerabilities in VPN solutions within 24 hours of patches being made available.

Earlier this year, the NSA and CISA issued a warning that APT groups linked to the Russian Foreign Intelligence Service (SVR) had successfully exploited vulnerabilities in Fortinet and Pulse Secure VPN solutions to gain a foothold in the networks of U.S. companies and government agencies. Chinese nation state threat actors are believed to have exploited a Pulse Connect Secure vulnerability to gain access to the networks of the U.S. Defense Industrial Base Sector. Ransomware gangs have similarly been targeting vulnerabilities in VPNs to gain an initial foothold in networks to conduct double-extortion ransomware attacks.

The guidance document is intended to help organizations select secure VPN solutions from reputable vendors that comply with industry security standards who have a proven track record of remediating known vulnerabilities quickly. The guidance recommends only using VPN products that have been tested, validated and included in the National Information Assurance Partnership (NIAP) Product Compliant List. The guidance recommends against using Secure Sockets Layer/Transport Layer Security (SSL/TLS) VPNs, which use non-standard features to tunnel traffic via TLS as this creates additional risk exposure.

The guidance document also details best practices for hardening security and reducing the attack surface, such as configuring strong cryptography and authentication, only activating features that are strictly necessary, protecting and monitoring access to and from the VPN, implementing multi-factor authentication, and ensuring patches and updates are implemented promptly.

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Lisa J. Pino Named New Director of HHS’ Office for Civil Rights

OCR Director, Lisa J. Pino

Lisa J. Pino has been named Director of the Department of Health and Human Services’ Office for Civil Rights (OCR) and replaces Robinsue Frohboese, who has served as acting OCR Director since President Trump-appointed Roger Severino resigned from the post in mid-January.

OCR is the main enforcer of compliance with the Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security, and Breach Notification Rules, the Patient Safety and Quality Improvement Act, and Patient Safety Rule, as well as as well as enforcing federal civil rights, conscience and religious freedom laws.

Pino is from New York City, a fluent Spanish speaker, and the first-generation daughter of immigrant parents. She completed a B.A., M.A., and J.D. at Arizona State University with honors, and Harvard Kennedy School leadership program as a National Hispana Leadership Institute Fellow.

Pino has served as legal aid attorney in the Southwest, fighting to protect the rights of migrant farm workers. Her civil rights activities carried on while working for the United States Department of Agriculture (USDA) where she served as USDA Deputy Administrator of the Supplemental Nutrition Assistance Program (SNAP) and USDA Deputy Assistant Secretary for Civil Rights.

While at the USDA, Pino drafted and championed USDA’s first gender identity anti-discrimination program regulation along with its first USDA limited English proficiency guidance. Pino played a key role in ensuring minority farmers had access to benefits awarded through class action settlements through her direction of USDA’s outreach and engagement activities.

Pino is a former senior executive service who was also appointed by President Barack Obama and served at the U.S. Department of Homeland Security (DHS) as Senior Counselor. There she played a key role in the mitigation of the largest federal data breach in history, the 2015 hacking of the data of 4 million federal personnel and 22 million surrogate profiles, by renegotiating 700 vendor procurements and establishing new cybersecurity regulatory protections.

Most recently, Pino served as Executive Deputy Commissioner of the New York State Department of Health, the agency’s second-highest executive position. During her time in the role, Pino spearheaded the state’s operational response to the COVID-19 pandemic and programming for Medicaid, Medicare, Nutrition Program for Women, Infants, and Children (WIC), Hospital and Alternative Care Facility, Wadsworth Laboratories, Center for Environmental Health, Center for Community Health, and AIDS Institute.

“Lisa is an exceptional public servant, and I am delighted to welcome her to the role of the Director of the Office for Civil Rights at HHS,” said HHS Secretary Xavier Becerra. “Her breadth of experience and management expertise, particularly her hand in advancing civil rights regulations and policy at the U.S. Department of Agriculture (USDA) during the Obama-Biden Administration, will help ensure that we protect the rights of every person across the country as we work to build a healthier America.”

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Fifth of Healthcare Providers Report Increase in Patient Mortality After a Ransomware Attack

While there have been no reported cases of American patients dying as a direct result of a ransomware attack, a new study suggests patient mortality does increase following a ransomware attack on a healthcare provider. According to a recent survey conducted by the Ponemon Institute, more than one fifth (22%) of healthcare organizations said patient mortality increased after a ransomware attack.

Ransomware attacks on healthcare providers often result in IT systems being taken offline, phone and voicemail systems can be disrupted, emergency patients are often redirected to other facilities, and routine appointments are commonly postponed. The recovery process can take several weeks, during which time services continue to be disrupted.

While some ransomware gangs have a policy of not attacking healthcare organizations, many ransomware operations target healthcare. For instance, the Vice Society ransomware operation has conducted around 20% of its attacks on the healthcare sector and attacks on healthcare organizations have been increasing. During the past 2 years, 43% of respondents said their organization had suffered a ransomware attack, and out of those, 67% said they had one while 33% said they had more than one.

The study, which was sponsored by Censinet, involved a survey of 597 healthcare organizations including integrated delivery networks, community hospitals, and regional health systems. The cost of ransomware attacks on the healthcare industry had been determined in a previous Ponemon Institute survey, with the data presented in the IBM Security Cost of a Data Breach Report. In 2021, costs had risen to an average of $9.23 million per incident. The Censinet study sought to determine whether these attacks had a negative impact on patient safety while also seeking to understand how COVID-19 has impacted the ability of healthcare organizations to protect patient care and patient information from ransomware attacks.

COVID-19 introduced many new risk factors, such as an increase in remote working and new IT systems to support those workers. Patient care requirements increased, and COVID-19 caused staff shortages. The survey confirmed that COVID-19 has affected the ability of healthcare organizations to defend against ransomware attacks and other increasingly virulent cyberattacks. Prior to COVID-19, 55% of healthcare organizations said they were not confident they would be able to mitigate the risks of ransomware, whereas now, 61% of healthcare organizations said they are not confident or have no confidence in their ability to mitigate the risks of ransomware.

These attacks were found to be negatively affecting patient safety. 71% of respondents said ransomware attacks resulted in an increased length of stay in hospitals and 70% said delays in testing and medical procedures due to ransomware attacks resulted in poor patient outcomes. Following an attack, 65% of respondents said there was an increase in the number of patients being redirected to alternative facilities, 36% said they had increases in complications from medical procedures, and 22% said they had an increase in mortality rate after an attack.

One of the factors that has contributed to a higher risk of a ransomware attack occurring is the increased reliance on business associates for digitizing and distributing healthcare information and providing medical devices. On average, respondents said they work with 1,950 third parties and that number is expected to increase over the next 12 months by around 30% to an average of 2,541.

Business associates of healthcare organizations are being targeted by ransomware gangs and other cybercriminal organizations. Cybersecurity at business associates is often weaker than their healthcare clients, and one attack on a business associate could provide access to the networks of multiple healthcare clients.

Even though working with third parties increases risk, 40% of respondents said they do not always complete a risk assessment of third parties prior to entering into a contract. Even when risk assessments are conducted, 38% of respondents said those risk assessments were often ignored by leaders. Once contracts have been signed, over half (53%) of respondents said they had no regular schedule of conducting further risk assessments or that they were only conducted on demand.

Censinet recommends creating an inventory of all vendors and protected health information. It is only possible to ensure systems and data are secured if accurate inventories are maintained. Workflow automation tools are useful for establishing a digital inventory of all third parties and PHI records. These tools should also be used for creating an inventory of medical devices. Medical devices can provide an easy entry point into healthcare networks, so it is essential that these devices are secured. Only 36% of respondents said their organization knew where all medical devices were located, and only 35% said they were aware when those devices would reach end-of-life and would no longer be supported.

The report recommends conducting a thorough risk assessment of a vendor prior to entering into a contract, and then conducting periodic risk assessments thereafter and ensuring action is taken to address any issues identified. Further investment in cybersecurity is required specifically to cover re-assessments of high-risk third parties, as currently, only 32% of critical and high-risk third parties are assessed annually, and just 27% are reassessed annually.

The report also strongly recommends assigning risk accountability and ownership to one role, which will help to ensure an effective enterprise-risk management strategy can be adopted and maintained.

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CISA and FBI Warn About Escalating Conti Ransomware Attacks

The Cybersecurity and Infrastructure Security Agency (CISA) and the Federal Bureau of Investigation (FBI) have issued a warning about escalating Conti ransomware attacks. CISA and the FBI have observed Conti ransomware being used in more than 400 cyberattacks in the United States and globally.

Like many ransomware gangs, prior to deploying Conti ransomware the gang exfiltrates data from victims’ networks. A ransom demand is issued along with a threat to publish the stolen data if the ransom is not paid. The developers of Conti ransomware run a ransomware-as-a-service operation, where affiliates are recruited to conduct attacks. Under this model, affiliates usually receive a percentage of any ransoms they generate. Conti appears to operate slightly differently, where affiliates are paid a wage to conduct attacks.

A variety of methods are used to gain access to victims’ networks. Spear phishing emails are common, where malicious attachments such as Word documents with embedded scripts are used as malware droppers. Typically, a malware variant such as TrickBot or IcedID is downloaded which gives the attackers access to victims’ networks. The attackers then move laterally within the compromised network, identify data of interest, then exfiltrate the data before deploying the Conti ransomware payload.

Brute force attacks are often conducted to guess weak Remote Desktop Protocol (RDP) credentials, vulnerabilities in unpatched systems are exploited, and search engine poisoning has been used to get malicious sites appearing in the search engine listings offering fake software. Malware distribution networks such as Zloader have been used, and attacks have been conducted where credentials have been obtained through telephone calls (vishing).

CISA and the FBI have observed legitimate penetration testing tools being used to identify routers, cameras, and network-attached storage devices with web interfaces that can be brute forced and legitimate remote monitoring and management software and remote desktop software have been used as backdoors to maintain persistence on victim networks. The attackers use tools such as Windows Sysinternals and Mimikatz to escalate privileges and for lateral movement.

Vulnerabilities known to be exploited include ZeroLogon (CVE-2020-1472), PrintNightmare (CVE-2021-34527), and the vulnerabilities in Microsoft Windows Server Message Block that were exploited in the WannaCry ransomware attacks in 2017.

Because a variety of tactics, techniques, and procedures are used to gain access to victim networks, there is no single mitigation that can be implemented to prevent attacks. CISA and the FBI recommend the following mitigations to improve defenses against Conti ransomware attacks:

  • Use multi-factor authentication
  • Implement network segmentation and filter traffic
  • Scan for vulnerabilities and keep software updated
  • Remove unnecessary applications and apply controls
  • Implement endpoint and detection response tools
  • Limit access to resources over the network, especially by restricting RDP
  • Secure user accounts
  • Ensure critical data are backed up, with backups stored offline and tested to ensure file recovery is possible

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