Latest HIPAA News

DOJ Indicts 2 REvil Ransomware Gang Members: State Department Now Offering $10 Million Reward for Information

Posted by HIPAA Journal

The United States Department of Justice (DoJ) has unsealed indictments charging two individuals for their roles in multiple REvil/Sodinokibi ransomware attacks on organizations in the United States.

Ukrainian national, Yaroslav Vasinskyi, 22, has been indicted on multiple charges related to the ransomware attacks, including the supply chain attack that saw Kaseya’s Virtual System/Server Administrator (VSA) platform compromised. That attack involved ransomware being deployed on the systems of around 40 managed service providers and 1,500 downstream businesses.

Russian national, Yevgeniy Igoryevich Polyanin, 28, has been indicted for his role in multiple ransomware attacks, including attacks on government entities in Texas. The DoJ says it seized $6.1 million in ransom payments that were paid to cryptocurrency wallets linked to Polyanin.

The DoJ has indicted several individuals believed to have been involved in cyberattacks in the United States; however, those individuals can only face trial if they are located, arrested, and extradited to the United States. Many ransomware threat actors are believed to reside in Russia, where there is no extradition treaty, so there is little chance of them facing justice unless they leave Russia.

International arrest warrants have been issued for both individuals and Vasinskyi was arrested in October at the Polish border. Poland signed an extradition treaty with the United States in 1996 and the U.S. is currently seeking Vasinskyi’s extradition. Polyanin has yet to be apprehended.

“Ransomware can cripple a business in a matter of minutes. These two defendants deployed some of the internet’s most virulent code, authored by REvil, to hijack victim computers,” said Acting U.S. Attorney Chad E. Meacham for the Northern District of Texas. “In a matter of months, the Justice Department identified the perpetrators, effected an arrest, and seized a significant sum of money. The Department will delve into the darkest corners of the internet and the furthest reaches of the globe to track down cybercriminals.”

State Department Offers $10 Million Reward for Information on Leaders of REvil and DarkSide Ransomware Operations

Individuals with information about Polyanin, other leaders of the REvil and DarkSide ransomware groups, or affiliates who conducted attacks, are being encouraged to come forward. The U.S. State Department has announced a reward of up to $10 million for information about that leads to the identification or location of leaders of the REvil/DarkSide ransomware groups, with up to $5 million paid for information that leads to the arrest and conviction of any individual who conspired to participate or attempted to participate in a REvil/DarkSide ransomware attacks. The size of the rewards being offered for information clearly shows how focused the United States is on bringing ransomware threat actors to justice.

The pressure being put on ransomware gangs appears to be having some effect. Chris Inglis, U.S. National Cyber Director, recently told House lawmakers that there has been a discernable decrease in Russia-based cyberattacks. and the DoJ says it expects there to be several more arrests in relation to the REvil and DarkSide ransomware attacks in the coming weeks.

Global Law Enforcement Effort Results in Multiple Arrests

The United States is not the only country to be laser-focused on bringing ransomware threat actors to justice. An international law enforcement operation dubbed GoldDust involving 17 nations has recently resulted in the arrest of 7 hackers believed to be involved in the REvil and GandCrab ransomware operations. The Europol, Eurojust, and INTERPOL-coordinated operation saw three individuals arrested in South Korea, two in Romania, one in Kuwait, and one in an unnamed European country, with the latest takedown occurring on November 4 in Romania and Kuwait.

The three individuals in South Korea were previously arrested in February, April, and October for their role in the GandCrab ransomware attacks, which is believed to be the predecessor of REvil/Sodinokibi. The GoldDust operation has been active since 2018 and was launched in response to the GandCrab ransomware attacks.

The previous week, Europol announced 12 individuals had been arrested in raids in Ukraine and Switzerland over their suspected involvement in ransomware attacks involving LockerGoga and other ransomware attacks. Those individuals are believed to have had specialist roles in various stages of the attacks, from infiltration to cashing out and laundering millions in ransom payments.

In September, a French National Gendarmerie, Ukrainian National Police, Europol, and INTERPOL operation resulted in the arrest of 2 individuals suspected to be members of two prolific ransomware operations. That operation also saw $375,000 in cash and luxury vehicles seized, and the asset freezing of $1.3 million in cryptocurrency.

In addition, a 30-month operation, dubbed Operation Cyclone, which involved law enforcement agencies in multiple countries resulted in the arrest of 6 individuals believed to be involved in the Clop ransomware operation, with those arrests occurring in June 2021. The operation saw searches conducted at 20 locations and resulted in the seizure of $185,00 in cash and computer equipment suspected of having been used to conduct the attacks. The Clop ransomware gang had conducted many attacks in the United States, including those on the University of Colorado, Stanford Medicine, University of California, and the University of Maryland Baltimore.

While these arrests will cause some disruption to the activities of ransomware gangs, they represent just a fraction of the individuals involved in ransomware attacks, many of whom can be easily replaced. The core members of the ransomware operations are believed to reside in Russia where they remain untouchable.

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HS3: Cobalt Strike Penetration Testing Framework Increasingly Used in Cyberattacks on Healthcare Organizations

Posted by HIPAA Journal

The HHS’ Health Sector Cybersecurity Coordination Center (HC3) has issued a threat brief for the healthcare industry warning about the use of the Cobalt Strike penetration testing tool by cyber threat actors.

Cobalt Strike is a powerful red team tool used by penetration testers when conducting risk and vulnerability assessments, but it can also be abused and is increasingly being used by cyber threat actors in attacks on the healthcare and public health sector.

Cobalt Strike can be used for reconnaissance to gain valuable information about the target infrastructure to allow threat actors to determine the best use of their time when attacking healthcare networks. The system profiler function can be used to discover client-side applications used by a target and provides version information. The system profiler starts a local web server, fingerprints visitors, identifies internal IP addresses behind a proxy, and obtains reconnaissance data from the weblog, applications, and provides information on targets.

Cobalt Strike includes a spear phish tool that can be used to create and send fake emails using arbitrary message templates. If a message is imported, Cobalt Strike will replace links/text and create and send convincing phishing emails and track users that click.

The Beacon tool is used to discover client-side applications and versions and allows the loading of malleable command and control profiles, uses HTTP/HTTPS/DNS to egress a network, and named pipes to control Beacons, peer-to-peer, over SMB for covert communications. Beacon can also be used for post-exploitation and can execute PowerShell scripts, log keystrokes, take screenshots, download files, and spawn other malicious payloads. Cobalt Strike also uses attack packages to allow attacks to progress through their many stages and has the capability to transform innocent files into a Trojan horse.

Cobalt Strike uses browser pivoting, which can be used to bypass 2-factor authentication and access sites as the target. Cookies, authenticated HTTP sessions, and client SSL certifications can be leveraged to hijack a compromised user’s authenticated web sessions. Using the Cobalt Strike team server, attackers can share data, communicate in real-time, and take full control of compromised systems.

Cobalt Strike is a powerful penetration testing tool and since it is an entire framework, it has many more capabilities than most malware variants, which makes it a valuable tool for black hat hackers, and many nation-state hacking groups and cybercriminal organizations have been using Cobalt Strike in attacks on the healthcare sector in the United States.

Given the extent to which the framework is used in cyberattacks, healthcare organizations should work on the assumption that Cobalt Strike will be used in an attack and should therefore focus on prevention and detection strategies and follow the MITRE D3FEND framework.

Cobalt Strike is delivered by many different infection vectors, so defending against attacks can be difficult. There is also no single containment technique that is effective against the framework as a whole.

Cobalt Strike is often delivered via malware downloaders such as BazarLoader, which are often delivered using phishing emails containing malicious Office files. It is therefore important to implement advanced email security defenses that can block phishing threats and provide ongoing security awareness training to the workforce to teach employees to identify malicious messages containing malware downloaders such as BazarLoader.

Threat actors often exploit known vulnerabilities in software and operating systems to gain access to healthcare networks. It is therefore important to ensure a full inventory of devices and software is maintained, and patches or other mitigating measures are implemented to address vulnerabilities promptly. Healthcare organizations should also improve their defenses against attacks abusing their remote access capabilities.

Detecting Cobalt Strike once installed can be a challenge. HC3 recommends using signatures for intrusion detection and endpoint security systems and Yara Rules. Further information can be found in the HC3 Cobalt Strike White Paper.

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Ransomware Roundup: 5 Healthcare Organizations Fall Victim to Ransomware Attacks

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Ransomware attacks have recently been reported by Surecare Specialty Pharmacy, Victory Health Partners, Strategic Benefits Advisors, Blue Shield of California, and Blue Cross of California.

PHI of 8,412 Patients Potentially Compromised in Surecare Specialty Pharmacy Ransomware Attack

El Paso, TX-based Surecare Specialty Pharmacy has recently announced it was the victim of a sophisticated ransomware attack on August 16, 2021. Surecare’s IT service provider took immediate action when the attack was detected, and a third-party forensics firm was engaged to investigate the attack.

The investigation confirmed on August 31, 2021, that files containing a limited amount of patients’ protected health information may have been accessed and/or exfiltrated prior to the deployment of ransomware, although no evidence was found to indicate that was the case nor have any reports been received that suggest any misuse of patient data.

A review of the encrypted files confirmed they contained patient names, addresses, dates of birth, health insurance information, and prescription information. The Social Security numbers of a very small subset of individuals were also included in the compromised files.

Surecare says additional security measures have now been implemented to prevent further cyberattacks and policies and procedures are being reviewed and will be updated as necessary to improve data security.

Ransomware Attack on Vendor Affects Blue Shield of California and Blue Cross of California Members

A ransomware attack on the Santa Ana, CA-based health insurance broker, Team Alvarez Insurance Services, has resulted in the exposure of the protected health information of 2,841 Blue Shield of California and 672 Blue Cross of California members.

On August 27, 2021, Team Alvarez notified the health plans about a cyberattack that occurred on August 25. Team Alvarez immediately secured its network to prevent further unauthorized access and conducted a comprehensive investigation to determine the nature and scope of the attack.

On October 13, 2021, the health plans learned the attacker accessed parts of the Team Alvarez network where members’ enrollment forms were saved. It was not possible to determine if those forms were viewed or downloaded. The forms contained the following data elements: name, address, phone number, email address, date of birth, gender, subscriber ID number, policy effective date, emergency contact information, authorized representative/power of attorney information, and broker information.

Team Alvarez said that in addition to performing a reset of all passwords, firewall configurations have been reviewed, a system-wide security scan has been conducted, and its infrastructure and servers are being rebuilt in a clean environment on new servers.

Affected Individuals have been offered complimentary access to the Experian IdentityWorksSM identity theft protection service for 12 months.

Victory Health Partners Notifies Patients About September 2021 Ransomware Attack

Mobile, AL-based Victory Health Partners has notified patients about a ransomware attack it discovered on September 23, 2021. Prior to the encryption of files, the attackers exfiltrated sensitive data which has potentially been released.

When the attack was detected, systems were shut down to contain the incident and prevent further unauthorized access. A forensic investigation was launched to determine the extent and nature of the attack which confirmed that the following types of patient information may have been obtained by the attackers: name, address, Social Security number, date of birth, and other protected health information. Health information such as diagnoses, health conditions, and other health data was not involved as Victory Health Partners still uses paper charts.

Victory Health Partners has conducted a thorough review of existing operating and IT systems and steps will be taken to improve the confidentiality and security of its records. Further, an external computer consultant has been engaged to advise the clinic on new systems and equipment to protect against future cyberattacks.

PHI Potentially Compromised in Ransomware Attack on Strategic Benefits Advisors

The Georgia-based benefits consulting firm, Strategic Benefits Advisors, has announced it suffered a ransomware attack in which protected health information may have been accessed and/or acquired.

The attack was detected on September 19, 2021, and steps were immediately taken to prevent further unauthorized IT system access. An investigation was conducted into the attack and while that investigation is ongoing, it was determined on October 7, 2021, that certain files within its environment had been accessed and/or exfiltrated by the attackers.

It has yet to be determined exactly how many individuals have been affected, and which types of protected health information were compromised for each individual, but the types of information on the compromised systems included names, addresses, and Social Security numbers. Strategic Benefits Advisors says it is unaware of any actual or attempted misuse of personal information.

Notifications are being sent to affected individuals and steps have been taken to improve the security of its systems to prevent further cyberattacks.

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OCR: Ensure Legacy Systems and Devices are Secured for HIPAA Compliance

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The Department of Health and Human Services’ Office for Civil Rights has advised HIPAA-covered entities to assess the protections that they have implemented to secure their legacy IT systems and devices.

A legacy system is any system that has one or more components that have been supplanted by newer technology and reached end-of-life. When software and devices reach end-of-life, support comes to an end, and patches are no longer issued to correct known vulnerabilities. That makes legacy systems and devices vulnerable to cyberattacks.

Healthcare organizations should be aware of the date when support will no longer be provided, and a plan should be developed to replace outdated software and devices; however, there are often valid reasons for continuing to use outdated systems and devices.

Legacy systems may work well and be well-tailored to an organization’s business model, so there may be a reluctance to upgrade to new systems that are supported. Upgrading to a newer system may require time, funds, and human resources that are not available, or it may not be possible to replace a legacy system without disrupting critical services, compromising data integrity, or preventing ePHI from being available.

HIPAA-covered entities should ensure that all software, systems, and devices are kept fully patched and up to date, but in healthcare, there are often competing priorities and obligations. If the decision is made to continue using legacy systems and devices, it is essential for security to be considered and for safeguards to be implemented to ensure those systems and devices cannot be hacked. That is especially important if legacy systems and devices can be used to access, store, create, maintain, receive, or transmit electronic protected health information (ePHI).

It is not a violation of the HIPAA Rules to continue using software and devices that have reached the end of life, provided compensating controls are implemented to ensure ePHI is protected. “Despite their common use, the unique security considerations applicable to legacy systems in an organization’s IT environment are often overlooked,” said OCR in its cybersecurity newsletter, which would violate the HIPAA Rules.

In healthcare, there may be many legacy systems and devices in use that need to be protected. Healthcare organizations need to have full visibility into the legacy systems that reside in their organization, as if the IT department is unaware that legacy systems are in use, compensating controls will not be implemented to ensure they are appropriately protected.

It is vital for a comprehensive inventory to be created that includes all legacy systems and devices and for a security risk assessment to be performed on each system and device. “The HIPAA Security Rule requires covered entities and their business associates to conduct an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of ePHI throughout their environment, including ePHI used by legacy systems,” explained OCR in its recent cybersecurity newsletter.

Risks must be identified, prioritized, and mitigated to reduce them to a low and acceptable level. Mitigations include upgrading to a supported version or system, contracting with a vendor to provide extended support, migrating the system to a supported cloud-based solution, or segregating the system from the network.

If HIPAA-covered entities choose to continue maintaining a legacy system existing security controls should be strengthened or compensating controls should be implemented. OCR says consideration should be given to the burdens of maintenance, as they may outweigh the benefits of continuing to use the legacy system and plans should be made for the eventual removal and replacement of the legacy system.

In the meantime, OCR suggests the following controls for improving security:

  • Enhance system activity reviews and audit logging to detect unauthorized activity, with special attention paid to security configurations, authentication events, and access to ePHI.
  • Restrict access to the legacy system to a reduced number of users.
  • Strengthen authentication requirements and access controls.
  • Restrict the legacy system from performing functions or operations that are not strictly necessary
  • Ensure backups of the legacy system are performed, especially if strengthened or compensating controls impact prior backup solutions.
  • Develop contingency plans that contemplate a higher likelihood of failure.
  • Implement aggressive firewall rules.
  • Implement supported anti-malware solutions.

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Microsoft Warns of Ongoing Attacks by SolarWinds Hackers on Service Providers and Downstream Businesses

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The advanced persistent threat (APT) actor Nobelium (aka APT29; Cozy Bear) that was behind the 2020 SolarWinds supply chain attack is targeting cloud service providers (CSPs), managed service providers (MSPs), and other IT service providers, according to a recent alert from Microsoft.

Rather than conducting attacks on many companies and organizations, Nobelium is favoring a compromise-one-to-compromise-many approach. This is possible because service providers are often given administrative access to customers’ networks to allow them to provide IT services. Nobelium is attempting to leverage that privileged access to conduct attacks on downstream businesses and has been conducting attacks since at least May 2021.

Nobelium uses several techniques to compromise the networks of service providers, including phishing and spear phishing attacks, token theft, malware, supply chain attacks, API abuse, and password spraying attacks on accounts using commonly used passwords and passwords that have previously been stolen in data breaches.

Once access to service providers’ networks has been gained, Nobelium moves laterally in cloud environments then leverages the trusted access to conduct attacks on downstream businesses using trusted channels such as externally facing VPNs or the unique software solutions used by service providers to access customers’ networks.

Some of the attacks conducted by Nobelium have been highly sophisticated and involved chaining together artifacts and access from multiple service providers in order to reach their end target, as indicated in the diagram below.

Example of a Nobelium attack leveraging multiple service providers. Source: Microsoft Threat Intelligence Center

Microsoft Threat Intelligence Center (MSTIC) has made several recommendations for service providers and downstream businesses to help with mitigation and remediation.

CPSs and MSPs that rely on elevated privileges to provide services to their customers have been advised to verify and monitor compliance with Microsoft Partner Center security requirements, which include enabling multifactor authentication and enforcing conditional access policies, adopting the Secure Application Model Framework, checking activity logs and monitoring user activities, and removing delegated administrative privileges that are no longer in use.

All downstream businesses that rely on service providers that have administrative access have been advised to review, audit, and minimize access privileges and delegated permissions, including hardening and monitoring all tenant administrator accounts and reviewing service provider permissions access from B2B and local accounts. They should also verify MFA is enabled and conditional access policies are being enforced and regularly review audit logs and configurations.

Microsoft has published detailed information on the tactics, techniques, and procedures (TTP) of Nobelium in its alerts to help IT security teams to block, detect, investigate, and mitigate attacks.

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Study Reveals Healthcare Employees Have Unnecessary Access to Huge Amounts of PHI

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A new study has revealed widespread security failures at healthcare organizations, including poor access controls, few restrictions on access to protected health information (PHI), and poor password practices, all of which are putting sensitive data at risk.

The study, conducted by the data security and insider threat detection platform provider Varonis, involved an analysis of around 3 billion files at 58 healthcare organizations, including healthcare providers, pharmaceutical companies, and biotechnology firms. The aim of the study was to determine whether security controls had been implemented to secure sensitive data and to help organizations better understand their cybersecurity vulnerabilities in the face of increasing threats.

The Health Insurance Portability and Accountability Act (HIPAA) requires access to PHI to be limited to employees who need to view PHI for work purposes. When access is granted, the HIPAA minimum necessary standard applies, and only the minimum amount of PHI should be accessible. Each user must be provided with a unique username that allows access to PHI to be tracked. Passwords are required to authenticate users, with the HIPAA Security Rule requiring HIPAA-regulated entities to implement, “procedures for creating, changing, and safeguarding passwords.”

The Varonis study, the results of which were published in its 2021 Data Risk Report: Healthcare, Pharmaceutical, & Biotech, revealed an average healthcare worker has access to 31,000 sensitive files containing PHI, financial, and proprietary data on their first day of work. Those files were stored on parts of the network that can be accessed by all employees.

On average, 20% of each organization’s files are open to every employee, even though in many cases access was not required to complete work duties. 50% of organizations investigated had more than 1,000 sensitive files open to all employees, and one in four files at small healthcare organizations could be accessed by every employee. There were no restrictions on access to 1 in 10 files that contained PHI or intellectual property.

“We discovered that smaller organizations have a shocking amount of exposed data, including sensitive files, intellectual property, and patient records. On their first day, new employees at small companies have instant access to over 11,000 exposed files, and nearly half of them contain sensitive data,” explained Varonis in the report. “This creates a massive attack surface and increases the risk of noncompliance in the event of a data breach.”

To reduce risk, it is vital to operate under the principle of least privilege. If employees are given broad access to sensitive information, not only does that increase the opportunity for insider data theft, if their credentials are compromised in a phishing attack, external threat actors will have easy access to huge volumes of data.

The problem is made worse by poor password practices. 77% of companies studied for the report had 501 or more accounts with passwords set to never expire, and 79% of organizations had more than 1,000 ghost accounts. Ghost accounts are inactive accounts that have not been disabled. These accounts give hackers an easy way to access sensitive data and traverse networks and file structures undetected.

According to the Verizon Data Breach Investigations Report, data breaches increased by 58% in 2020 with cyber threat actors actively targeting the healthcare, pharma, and biotech industries to steal sensitive data, intellectual property, and vaccine research data. The healthcare industry has the highest data breach costs which, according to the IBM Security Cost of a Data Breach Report, are $7.13 million per breach. Organizations that fail to restrict access to protected healthcare information can also face heavy financial penalties, which under HIPAA/HITECH are up to $1.5 million per year, per violation category.

“To get in front of increasingly malicious and sophisticated cyberattacks, hospitals, pharmaceutical companies, and biotech’s need to double down on maturing incident response procedures and mitigation efforts,” said Varonis. “Enforcing least privilege, locking down sensitive data, and restricting lateral movement in their environments are the absolute bare minimum precautionary measures that healthcare organizations need to take.”

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UPMC Hacker Who Stole PII of 65,000 Employees Gets Maximum 7-Year Sentence

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The hacker who gained access to the databases of University of Pittsburgh Medical Center (UPMC) and stole the personally identifiable information (PII) and W-2 information of approximately 65,000 UPMC employees has been handed the maximum sentence for the offenses and will serve 7 years in jail.

Sean Johnson, of Detroit, Michigan – aka TheDearthStar and Dearthy Star – hacked into the databases of UPMC in 2013 and 2014 and stole highly sensitive information which was then sold on dark web hacking forums and was used by identity thieves to file fraudulent tax returns in the names of UPMC employees. The Department of Justice (DOJ) also alleged Johnson conducted further cyberattacks between 2014 and 2017 and stole the PII of an additional 90,000 individuals. Those sets of data were also sold to identity thieves on dark web forums.

In total, fraudulent tax returns totaling $2.2 million were filed and around $1.7 million was dispersed by the IRS. The funds received were converted to Amazon gift cards, which were used to purchase high-value goods that were shipped to Venezuela.

Three of Johnson’s co-conspirators were arrested and charged for their roles in the UPMC cyberattack. In August 2016, Cuban national Yolandy Perex Llanes was extradited to the United States and pleaded guilty in April 2017 to money laundering and aggravated identity theft. He was sentenced in 2017 to 6 months of time served.

In April 2017, Justin A. Tollefson of Spanaway, Washington, a staff sergeant at Joint Base Lewis-McChord in Tacoma, Washington, pleaded guilty to four counts of using the stolen identities of UPMC employees to file fraudulent tax returns. He had purchased the PII on a dark web forum and used the data to file fraudulent tax returns in the names of four UPMC employees. $56,333 was paid by the IRS in income tax refunds, but Tollefson was arrested before he received any funds. The judge was lenient as Tollefson had not profited from the fraud and sentenced him in 2017 to 3 years of probation.

Maritza Maxima Soler Nodarse, a Venezuelan national, pleaded guilty to conspiracy to defraud the United States in July 2017 for her role in the identity theft and tax fraud crimes. She received a 16-month time-served sentence and was deported to Venezuela.

Johnson received the maximum sentence despite pleading guilty to the hacking charges due to the severity of the offenses and the impact they had on the lives of his victims. Chief United States District Judge Mark R, Hornak said Johnson’s behavior was like a “bulldozer” through people’s lives and his indiscriminate hacking activities showed no regard for his victims. “The actions of criminals like Justin Johnson can have long-lasting and devastating effects on the lives of innocent people,” said Yury Kruty, Acting Special Agent in Charge of IRS-Criminal Investigation.

Johnson was sentenced to serve 60 months in jail for the conspiracy to defraud the United States charge and a mandatory 24-month sentence for aggravated identity theft, with the sentences to run consecutively.

“Justin Johnson stole the names, Social Security numbers, addresses, and salary information of tens of thousands of UPMC employees, then sold that personal information on the dark web so that other criminals could further exploit his victims,” said Acting U.S. Attorney Kaufman. “Today’s sentence sends a deterrent message that hacking has serious consequences.”

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September 2021 Healthcare Data Breach Report

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There was a 23.7% month-over-month increase in reported healthcare data breaches in September, which saw 47 data breaches of 500 or more records reported to the Department of Health and Human Services’ Office for Civil Rights. While that is more than 1.5 breaches a day, it is under the average of 55.5 breaches per month over the past 12 months.

Healthcare data breaches August 2020 to September 2021

While data breaches increased, there was a major decrease in the number of breached healthcare records, dropping 75.5% from August to 1,253,258 records across the 47 reported data breaches, which is the third-lowest total over the past 12 months.

Healthcare records breached over the past 12 months

Largest Healthcare Data Breaches Reported in September 2021

16 healthcare data breaches were reported in September 2021 that involved the exposure, theft, or impermissible disclosure of more than 10,000 healthcare records.

The largest breach of the month was reported by the State of Alaska Department of Health & Social Services. The breach was initially thought to have resulted in the theft of the personal and protected health information (PHI) of all state residents, although the breach was reported to the HHS as affecting 500,000 individuals. The cyberattack is believed to have been conducted by a nation-state hacking group.

Two major data breaches were reported by eye care providers: A hacking incident at U.S. Vision Optical resulted in the exposure of the PHI of 180,000 individuals, and a phishing incident at Simon Eye Management gave the attackers access to email accounts containing the PHI of 144,373 individuals. The breaches are not believed to be related, but they are two of a handful of recent incidents affecting eye care providers.

Ransomware continues to be extensively used in attacks on the healthcare industry. 6 of the top 16 attacks in September involved ransomware and potentially saw PHI stolen. Several ransomware gangs have targeted the healthcare sector, with the FIN12 group one of the most active. A recent analysis of FIN12 attacks by Mandiant revealed 20% of the gang’s attacks have been on the healthcare industry, with the attacks accounting for around 20% of all incidents Mandiant responds to.

Hackers have been targeting the healthcare industry, but data breaches can also be caused by insiders with privileged access to PHI. One notable ‘insider’ breach was reported by Premier Management Company and involved data being accessed by a former employee after termination. The incident highlights the importance of ensuring access to PHI (and IT systems) is blocked immediately when an employee is terminated, leaves the company, or when job functions change that no longer require an employee to have access to PHI.

Name of Covered Entity State Covered Entity Type Individuals Affected Cause of Breach
State of Alaska Department of Health & Social Services AK Health Plan 500,000 Nation-state hacking Incident
U.S. Vision Optical NJ Healthcare Provider 180,000 Unspecified hacking incident
Simon Eye Management DE Healthcare Provider 144,373 Email account breach (phishing)
Navistar, Inc. Health Plan and the Navistar, Inc. Retiree Health Benefit and Life Insurance Plan IL Health Plan 49,000 Ransomware attack
Talbert House OH Healthcare Provider 45,000 Unspecified hacking incident (data exfiltration)
Premier Management Company TX Healthcare Provider 37,636 PHI accessed by an employee after termination
Central Texas Medical Specialists, PLLC dba Austin Cancer Centers TX Healthcare Provider 36,503 Malware
Orlick & Kasper, M.D.’s, P.A. FL Healthcare Provider 30,000 Theft of electronic devices containing PHI
McAllen Surgical Specialty Center, Ltd. TX Healthcare Provider 29,227 Ransomware attack
Asarco Health, Dental, Vision, Flexible Spending, Non-Union Employee Benefits, and Retiree Medical Plans AZ Health Plan 28,000 Ransomware attack
Horizon House, Inc. PA Healthcare Provider 27,823 Ransomware attack
Rehabilitation Support Services, Inc. NY Healthcare Provider 23,907 Unspecified hacking incident (data exfiltration)
Samaritan Center of Puget Sound WA Healthcare Provider 20,866 Theft of electronic devices containing PHI
Directions for Living FL Healthcare Provider 19,494 Ransomware attack
Buddhist Tzu Chi Medical Foundation CA Healthcare Provider 18,968 Ransomware attack
Eastern Los Angeles Regional Center CA Business Associate 12,921 Email account breach (phishing)

Causes of September 2021 Healthcare Data Breaches

Hacking and other IT incidents continue to dominate the breach reports, accounting for 53.2% of all breaches reported in the month and 91.6% of all breached records. 1,147,383 healthcare records were exposed or stolen in those incidents, with an average breach size of 33,747 records and a median breach size of 2,453 records.

The number of incidents involving the theft of physical records or electronic equipment containing PHI increased month-over-month. September saw 6 theft incidents reported and 60,236 records compromised. The mean breach size was 10,039 records and the median breach size was 3,918 records. 4 of those breaches involved electronic equipment and could have been prevented had encryption been used.

There were 7 data breaches reported that involved unauthorized access or disclosures of data by insiders. 45,639 records were breached across those incidents, 37,636 of which were obtained in a single incident. The average breach size was 6,520 records and the median breach size was 1,738 records.

Causes of September 2021 healthcare data breaches

Given the high number of hacking and ransomware incidents reported, it is no surprise that the most common location of breached PHI is network servers. Email accounts continue to be targeted in phishing attacks, with 13 incidents in September involving PHI stored in email accounts. The number of devices containing PHI that were stolen highlights the importance of using encryption to protect stored data.

Location of PHI in September 2021 healthcare data breaches

September 2021 Data Breaches by HIPAA-Regulated Entity

Healthcare providers were the worst affected covered entity with 30 reported breaches. 10 breaches were reported by health plans, 6 breaches were reported by business associates, and one breach was reported by a healthcare clearinghouse.

5 breaches of those breaches were reported by a HIPAA-covered entity but occurred at a business associate. The adjusted figures are shown in the pie chart below.

September 2021 healthcare data breaches by HIPAA-regulated entity type

September 2021 Healthcare Data Breaches by State

Data breaches were reported by HIPAA-regulated entities based in 25 states. Texas was the worst affected state with 6 reported breaches of 500 or more records, followed by California with 5 breaches and Connecticut with 4.

State Breaches
Texas 6
California 5
Connecticut 4
Florida & Washington 3
Arizona, Georgia, Illinois, New York, Ohio, & Pennsylvania 2
Alaska, Delaware, Indiana, Kentucky, Maryland, Minnesota, Missouri, New Jersey, New Mexico, Oregon, Rhode Island, Tennessee, Virginia, & Wisconsin 1

HIPAA Enforcement Activity in September 2021

The Department of Health and Human Services’ Office for Civil Rights now has a new director, and it is currently unclear what direction she will take in the department’s HIPAA enforcement actions.

Since the fall of 2019 OCR has been targeting HIPAA-regulated entities that fail to comply with the HIPAA Right of Access and September saw the 20th financial penalty imposed under this initiative for the failure to provide individuals with access to their healthcare records.

Children’s Hospital & Medical Center in Omaha, NE, settled its HIPAA Right of Access case with OCR and paid an $80,000 financial penalty. This was the ninth OCR case this year to have resulted in a financial penalty for non-compliance with the HIPAA Rules.

There were no reported enforcement activities by state attorneys general in September.

The post September 2021 Healthcare Data Breach Report appeared first on HIPAA Journal.

Alert Issued About Ongoing BlackMatter Ransomware Attacks

Posted by HIPAA Journal

A joint alert has been issued by the Federal Bureau of Investigation (FBI), National Security Agency (NSA), and the Cybersecurity and Infrastructure Security Agency (CISA) about ongoing BlackMatter ransomware attacks.

The group has been conducting attacks in the United States since July 2021, which have included attacks on critical infrastructure entities and two organizations in the U.S. Food and Agriculture Sector. Evidence has been obtained that links the gang to the DarkSide ransomware gang that conducted attacks between September 2020 and May 2021, including the attack on Colonial Pipeline, with BlackMatter ransomware potentially a rebrand of the DarkSide operation.

Investigations into the attacks have allowed the agencies to obtain important information about the tactics, techniques, and procedures (TTPs) of the group, and an analysis has been performed on a sample of the ransomware in a sandbox environment.

The group is known to use previously compromised credentials to gain access to victims’ networks, then leverages the Lightweight Directory Access Protocol (LDAP) and Server Message Block (SMB) protocol to access the Active Directory (AD) and discover all hosts on the network. The BlackMatter gang deploys ransomware and remotely encrypts the hosts and shared drives as they are identified. The gang is known to exfiltrate data and typically demands ransom payments of between $80,000 and $15 million in Bitcoin or Monero.

In the joint alert, the NSA, FBI, and CISA shared TTPs, provide Snort signatures that can be used for detecting the network activity associated with BlackMatter ransomware attacks, and several mitigations to reduce the risk of a compromise by the gang.

Mitigations include:

  • Implementing detection signatures to identify and block attacks in progress
  • Using strong passwords resistant to brute force attacks
  • Implementing multi-factor authentication to block the use of stolen credentials
  • Patching and updating systems promptly
  • Limiting access to resources over networks
  • Implementing network segmentation and traversal monitoring
  • Using admin disabling tools to support identity and privileged access management
  • Implementing and enforcing backup and restoration policies and procedures

The alert, TTPs, and mitigations can be found here.

The post Alert Issued About Ongoing BlackMatter Ransomware Attacks appeared first on HIPAA Journal.