Latest HIPAA News

Senate HELP Committee Considers Permanent Changes to Telehealth Policies

The Senate Health, Education, Labor, and Pensions (HELP) Committee is considering which of the 31 recent changes to telehealth policies should be kept in place when the COVID-19 national public health emergency comes to an end.

The temporary changes to policies on telehealth have served to expand access during the COVID-19 public health emergency. These changes were necessary to help prevent the spread of COVID-19 and ensure that Americans are given easy access to medical services. During the COVID-19 crisis, patients have embraced the new approach and many have taken advantage of virtual visits and are using remote monitoring tools.

The June 17, 2020 Senate HELP Committee meeting was convened to explore which of the recent changes should be made permanent or at least be extended once the COVID-19 crisis comes to an end. All members of the committee supported making at least some of the recent changes permanent, with HELP Committee Chairman Sen. Lamar Alexander (R-Tenn.) advocating two permanent changes: The elimination of limitations on originating sites and the expansion of the types of providers who can be reimbursed through Medicare and Medicaid for providing virtual visits.

Sen. Alexander explained that both changes will help providers to achieve better patient outcomes, will improve patient experiences, and will help to reduce the cost of healthcare provision. There is wide support for these two changes to be made permanent. “As dark as this pandemic has been, it creates an opportunity to learn from and act upon these three months of intensive telehealth experiences, specifically what permanent changes need to be made in federal and state policies,” said Sen. Alexander. He suggested that were it not for the pandemic, the recently introduced changes may not have occurred for a further 10 years. It is too early to tell whether the telehealth changes have had any significant effect on patient outcomes, but they have certainly helped to improve access to healthcare services.

The University of Virginia (UVA) experienced a 9,000% increase in virtual visits between February and May, according to Karen Rheuban, M.D., director of the UVA Center for Telehealth. Sen. Alexander explained that Ascension Saint Thomas had gone from providing around 50 telehealth visits a year to more than 30,000 per month between April and May. Between April and May, telehealth accounted for around 45% of all visits.

The HHS’ Office for Civil Rights announced a Notice of Enforcement discretion covering the platforms that could be used for providing telehealth services during the public health emergency. Aside from public-facing platforms, apps that would not normally be permitted under HIPAA could be used for telehealth. While the move was necessary, it is one of the changes that requires closer scrutiny moving forward to ensure the privacy and security of healthcare data is not placed at risk.

The expansion of telehealth services has not proven to be a great equalizer, as many people lack the technology to take advantage of telehealth services. “The disparities in access to technology reflect the underlying inequity that exists throughout society,” said Sen. Tina Smith (D-Minn), a view shared by Karen Rheuban, M.D., who suggested “Congress should provide support for further broadband deployment, including to the home, as appropriate, to reduce geographic and sociodemographic disparities in access to care.”

There was strong support for reimbursement for telephone visits to be continued. At Massachusetts General Hospital and Brigham and Women’s Hospital, 60% of telehealth visits took place over the telephone in the past 3 months. “Telephone visits are important to cross the digital divide. We should continue that level of reimbursement to address this underserved population,” said Joe Kvedar, president of the American Telemedicine Association.

In addition to advocating for permanent changes to originating site limitations, Kvedar recommended giving the HHS the flexibility to expand the list of practitioners and therapy services eligible for telehealth reimbursement and to continue the grant and technical assistance programs and also cover infrastructure needs.

There is a commonly held view among providers that the decision to continue offering telehealth is largely dependent on reimbursement rates for telehealth. If reimbursement is lower for virtual visits, that may prevent providers from continue offering telehealth over in-person visits. Sen. Mike Braun (R-Ind) suggested that there should not be pay parity due to the differences in overheads. Sen. Bill Cassidy (R-La.) also questioned whether reimbursement should be equal when telehealth reduces providers’ overhead costs.

While access to telehealth has been expanded for Medicare and Medicaid patients, changes also need to be made in the private sector. “It would be very difficult to conduct this care model in a world where we got some payment for some things and didn’t get paid for others,” suggested Kvedar. “As much harmonization as possible would be huge incentive for adoption and expansion,” said Rheuban.

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Exploitable ‘Ripple20’ RCE TCP/IP Flaws Affect Hundreds of Millions of Connected Devices

19 zero-day vulnerabilities have been identified in the TCP/IP communication software library developed by Treck Inc. which impact hundreds of millions of connected devices across virtually all industry sectors, including healthcare.

Treck is a Cincinnatti, OH-based company that develops low-level network protocols for embedded devices. The company may not be widely known, but its software library has been used in internet-enabled devices for decades. The code is used in many low-power IoT devices and real-time operating systems due to its high performance and reliability and is used in industrial control systems, printers, medical infusion pumps and many more.

The vulnerabilities were identified by security researchers at the Israeli cybersecurity company JSOF, who named the vulnerabilities Ripple20 because of the supply chain ripple effect.

A vulnerability in small component can have wide reaching consequences and can affect a huge number of companies and products. In the case of Ripple20, companies affected include HP, Schneider Electric, Intel, Rockwell Automation, Caterpillar, B. Braun, and Baxter. JSOF has a list of 66 companies that are also potentially affected.

Four of the vulnerabilities are rated critical, with two (CVE-2020-11896 / CVE-020-11897) receiving the highest possible severity score of 10 out of 10 and the other critical bugs receiving scores of 9.0 (CVE-2020-11901) and 9.1 (CVE-2020-11898). The first three could allow remote code execution and the remaining vulnerability could result in the disclosure of sensitive information.

CVE-2020-11896 could be exploited by sending a malformed IPv4 packet to a device supporting IPv4 tunneling, and CVE-2020-11897 could be triggered by sending multiple malformed IPv6 packets to a device. Both allow stable remote code. CVE-2020-11901 can be triggered by answering a single DNS request made from a vulnerable device. This vulnerability could allow an attacker to take over a device through DNS cache poisoning and bypass all security measures.

The remaining 15 vulnerabilities range in severity from 3.1 to 8.2 and could result in information disclosure, allow a denial of service attack, and some could also potentially lead to remote code execution.

Exploitation of the vulnerabilities is possible from outside the network. An attacker could take full control of a vulnerable internet-facing device or even attack vulnerable networked devices that are not internet-enabled, if a network was infiltrated. An attacker could also broadcast an attack and take control of all vulnerable devices in the network simultaneously. These attacks require no user interaction and could be exploited in a way that bypasses NAT and firewalls. An attacker could take control of devices completely undetected and remain in control of those devices for years.

The vulnerabilities could be exploited by sending specially crafted packets that are very similar to valid packets, making it difficult to detect an attack in progress. JSOF reports that in some cases, completely valid packets could be used, which would make an attack almost impossible to detect.

“The risks inherent in this situation are high,” explained JSOF. “Just a few examples: Data could be stolen off of a printer, an infusion pump behavior changed, or industrial control devices could be made to malfunction. An attacker could hide malicious code within embedded devices for years.”

The video below shows an example of an exploit on a UPS to which several devices are connected, including a drug infusion pump.

Treck is currently reaching out to its clients to warn them about the vulnerabilities. The flaws have been patched in its TCP/IPv4/v6 software, so organizations impacted by the flaws should ensure Treck’s software stack version 6.0.1.67 or higher is used.

You can view the ICS-CERT advisory here

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Guidance on Contacting COVID-19 Patients to Request Blood and Plasma Donations

When patients contract an infectious respiratory disease such as COVID-19, the immune system develops antibodies that provide protection if the pathogen is encountered again. The antibodies in the blood of patients who recover from such an illness are valuable, as not only will they provide protection for the patient, that protection could potentially be transferred to other patients.

Through the donation of blood and plasma two preparations can be made: Convalescent plasma and hyperimmune immunoglobulin. Convalescent plasma and hyperimmune immunoglobulin have both been used to successfully treat patients who have contracted other viral respiratory diseases. Given the severity of COVID-19 and the high mortality rate, these treatments could be vital for patients who are struggling to fight the infection. Research studies are now underway to test whether antibody treatments are effective against COVID-19.

To participate in these programs, patients who have previously been diagnosed with COVID-19 will need to be contacted and asked if they are willing to donate blood and plasma, but is this contact permitted by the HIPAA Privacy Rule?

On June 12, 2020, the Department of Health and Human Services’ Office for Civil Rights issued guidance to healthcare providers on the HIPAA Privacy Rule and contacting COVID-19 patients to request blood and plasma donations.

OCR explained that the HIPAA Privacy Rule does not prohibit healthcare providers from contacting COVID-19 patients to request blood and plasma donations and prior authorization from the patient is not required.

Healthcare providers can contact patients to advise them about the opportunities for donating blood and plasma to support the response to COVID-19 to improve other patents’ chances of beating the disease.

HIPAA covered entities and business associates acting on their behalf can use or disclose PHI for the purpose of treatment, payment, and healthcare operations, without first receiving authorization to do so from a patient. Requesting a donation of blood or plasma does not fall into the category of treatment, as the blood/plasma will not be used to treat the patient, instead it is being used for population-based health care operations to improve health, case management, and care-coordination, which are included in the definition of healthcare operations.

There is some confusion over whether contacting patients to solicit blood donations would constitute marketing communications, which are generally not permitted by the HIPAA Privacy Rule without prior authorization from a patient.

In this case, an exception to the Privacy Rule’s Marketing provision applies. “A covered health care provider is permitted to make such communication for the covered entity’s population-based case management and related health care operations activities, provided that the covered entity receives no direct or indirect payment from, or on behalf of, the third party whose service is being described in the communication (e.g., a blood and plasma donation center),” explained OCR in the guidance.

An authorization is required from a patient before PHI can be disclosed to a third party, such as a blood and plasma donation center, to allow a COVID-19 patient to be contacted to request blood and plasma donations for the donation center’s own purposes.

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Misconfigured Public Cloud Databases are Found and Attacked Within Hours

Misconfigured public cloud databases are often discovered by security researchers. Misconfigurations that leave cloud data exposed could be due to a lack of understanding about cloud security or policies, poor oversight to identify errors, or negligent behavior by insiders to name but a few. A recent report from Trend Micro revealed cloud misconfigurations were the number one cause of cloud security issues.

Security researchers at Comparitech often discover unsecured cloud resources, commonly Elasticsearch instances and unsecured AWS S3 buckets. When the unsecured cloud databases are discovered, the owners are identified and notified to ensure data is secured quickly. Providing the owner can be identified, the databases are usually secured within a matter of hours, but there have been several cases where the database owner has been contacted but no response is received, and it is not always apparent to whom the data belongs.

In these cases, data can be left exposed online for several days or even weeks. During that time, the databases remain unprotected and can be accessed and downloaded by anyone that knows where to find them. Comparitech researchers are well practiced at finding unsecured Elasticsearch databases and AWS S3 buckets, but how quickly can malicious actors sniff out an unsecured database? Comparitech decided to find out. It turns out that it does not take long.

To determine the time it takes for unsecured data to be found, Comparitech’s security team conducted an exercise where they created a simulation of an Elasticsearch instance, similar to the many Elasticsearch instances they have found unsecured. They populated it with fake user data and left it exposed without any access controls. The database was exposed from May 11, 2020 to May 22, 2020.

In a recent blog post detailing the exercise, Comparitech security researcher Paul Bischoff explained that the first access request occurred 8 hours and 35 minutes after the database was created. During the 11 days that the database was exposed, there were 175 access requests. Their honeypot averaged 18 requests a day.

Exposed databases are usually located using an IoT search engine such as Shodan. It takes time for the data to be indexed by the search engines, in this case, Shodan indexed the database on May 16, five days after the database was created. Even though the database was not indexed until May 16, by the time it was there had been 3 dozen attempts to access the data. As soon as the database was indexed, the attacks spiked. Two access attempts were made within a minute of the database being indexed, with a further 20 access requests made that same day.

There are several reasons why attempts are made to find unsecured cloud resources. Databases often contain sensitive data, which can be used for identity theft and fraud or sold on underground forums. Databases can be hijacked and ransom demands issued to extort money from the data owners, but not all attacks were concerned with obtaining data. Several attempts were made to hijack the servers and download cryptomining scripts. In one case, an attacker attempted to switch off the firewall and delete the database.

While the test was concluded on May 22, 2020 and the data was mostly deleted, an further attack occurred on May 29. A malicious bot detected the honeypot and deleted the database, leaving a message demanding payment of 0.06 BTC to recover the data. That attack took 5 seconds from start to finish.

The exercise showed that even if databases are only exposed for a short period of time, it is highly likely that they will be found. While many companies say their data was not left unsecured for long when they are notified by Comparitech of an exposed cloud instance, it is probable that data has already been compromised unless data was only exposed for a few hours.

Comparitech pointed out that if the person setting up an Elasticsearch instance fails to put access controls in place, it is reasonable to assume that logging has also not been enabled. When companies report that no evidence was found to suggest data was accessed or exfiltrated, that does not mean data has not been accessed and stolen, only that there is a lack of evidence.   A 2019 report from McAfee suggested 99% of misconfigurations in the cloud go unreported when they are discovered. It is probable that data theft from cloud resources is far more likely than breach reports would lead you to believe.

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Proof of Concept Exploit Released for Critical SMBGhost Windows 10 SMBv3 Vulnerability

A functional proof of concept (PoC) exploit for a critical remote code execution vulnerability in the Microsoft Server Message Block 3.1.1 (SMBv3) protocol has been released and is being used by malicious cyber actors to attack vulnerable systems, according to an alert issued by the DHS Cybersecurity and Infrastructure Security Agency (CISA).

The vulnerability, referred to as SMBGhost, is due to the way the SMBv3 protocol handles certain requests. If exploited, a malicious cyber actor could remotely execute code on a vulnerable server or client by sending a specially crafted packet to a targeted SMBv3 server. An attack against a client would also be possible if an attacker configured a malicious SMBv3 server and convinced a user to connect to it.

The vulnerability could be exploited to spread malware from one vulnerable system to another in a similar fashion to the SMBv1 vulnerability that was exploited in the 2017 WannaCry ransomware attacks. No user interaction is required to exploit the flaw on vulnerable SMBv3 servers.

The flaw – tracked as CVE-2020-0796 – is present in Windows 10 versions 1909 and 1903 and was the subject of a Microsoft security advisory in early March. The flaw received a maximum CVSS v3 severity rating of 10 out of 10.

Microsoft released a patch to correct the flaw in early March; however, almost three months on and many organizations have yet to apply the patch and are vulnerable to attack. Microsoft also released details of a workaround to prevent exploitation, which involves disabling SMBv3 compression.

While the workaround would prevent the flaw from being exploited on a SMBv3 server, it would not prevent an attack on a client. The workaround involves running a simple PowerShell command. No reboot is required after the command has been executed. Details are available here. Scanners are available on GitHub that can be used to check for the CVE-2020-0796 vulnerability.

Security researchers developed exploits for the flaw with limited success, but the PoC exploit now available would allow an attacker to escalate local privileges and deliver malware. The PoC exploit is not 100% reliable, but more refined exploits are expected to be released. In its current form it could be used to successfully attack a vulnerable SMBv3 server. If the exploit were to fail, an attacker could simply keep on trying until it worked.

CISA strongly recommends that all organizations apply the patch to prevent exploitation. If the patch cannot be applied, the workaround should be used and SMB ports should be blocked from the internet using a firewall until the patch can be applied.

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Voicemail Phishing Scam Identified Targeting Remote Healthcare Workers

The COVID-19 pandemic has forced many companies to change working practices and allow large numbers of employees to work remotely from home. In healthcare, employees have been allowed to work remotely and provide telehealth services to patients. While this move is important for virus control and to ensure patients still have access to the medical services they need, remote working introduces cybersecurity risks and cybercriminals are taking advantage. There has been a significant rise in cyberattacks targeting remote workers over the past three months.

A variety of tactics are being used to trick remote workers into installing malware or divulging credentials, including a new tactic that has recently been uncovered by cybersecurity firm IRONSCALES.

In a recent report, IRONSCALES revealed threat actors are spoofing messages automatically generated by Private Branch Exchange (PBX) systems to steal credentials. PBX is a legacy phone system used by many enterprises to automate the handling of calls. One of the features of these systems is the ability to record voicemail messages and send recordings directly to users’ inboxes. These systems have been hugely beneficial during the COVID-19 pandemic, as they ensure that employees never miss important voicemail messages while working remotely. They have also given cybercriminals another way of conducting an attack.

In this campaign, the attackers spoof messages from the PBX system and inform an employee that they have a new voicemail message. The emails are personalized and include the user’s name or company name to make it appear that the messages are genuine. Subject lines in the messages are also carefully crafted to spoof the messages sent by real PBX systems.

To hear the messages, users are directed to a website that spoofs PBX integrations with the aim of stealing credentails. “It may seem odd for attackers to create phishing websites spoofing PBX integrations as most voicemails are quite benign in the information shared. However, attackers know that the credentials could be used for multiple other logins, including for websites with valuable PII or business information,” explained IRONSCALES. “In addition, any sensitive information that is left in the voicemail could potentially be used for a social engineering attack.”

IRONSCALES detected this voice phishing (vishing) campaign in mid-May. According to the report, the campaign is being conducted globally and at least 100,000 mailboxes have been targeted.

“If your organization automatically sends voicemails to workers inboxes, then your company is at risk of falling victim to this scam. As we know, if an email looks real then someone will fall for it,” explained IRONSCALES.

IRONSCALES suggests raising awareness of this scam with remote workers and implementing an email security system capable of detecting and blocking email security threats such as this, which have so far been effective at bypassing DMARC anti-spoofing measures.

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Bipartisan Bill Introduced to Protect Privacy of COVID-19 Contact Tracing and Exposure Notification Apps

A bipartisan group of Senators have introduced a bill that aims to regulate contact tracing and exposure notification apps that will be used to control the spread of COVID-19.

The Exposure Notification Privacy Act is one of three bills that aim to regulate contact tracing apps to protect the privacy of Americans. The other two bills failed to gather enough support. It is hoped a bipartisan bill will have a greater chance of being passed.

Contact tracing and exposure notification technologies are currently being explored as a way of controlling the spread of COVID-19. Google and Apple have both developed the technology to support contact tracing via mobile phones using low energy Bluetooth. When a user downloads a contact tracing app it will log encounters with other individuals who have also downloaded the app. When someone is diagnosed with COVID-19, the encounter data in the app is used to notify all individuals who may have been infected by that person.

Contact tracing and exposure notification apps have been used in other countries and have helped reduce the spread of COVID-19, but there are privacy risks associated with the apps that the new bill aims to address.

The Exposure Notification Privacy Act was introduced by Sens. Maria Cantwell (D-Washington) and Bill Cassidy (R-Louisiana) and has been co-sponsored by Amy Klobuchar (D-Minnesota). The bill aims to give Americans control over their personal data and “will place public health officials in the driving seat of exposure notification development.”

The bill requires the use of contact tracing and exposure notification apps to be voluntary and for developers of the apps to implement measures that give consumers strong controls over their personal data. The bill limits the types of data that the apps can collect and places a time limit on how long personal data can be used.

In order for the apps to achieve their purpose, they will need to be downloaded by large numbers of people. For that to happen, Americans will need to be confident that their privacy is protected and their personal data will not be misused.

“Public health needs to be in charge of any notification system so we protect people’s privacy and help them know when there is a warning that they might have been exposed to COVID-19,” said Senator Cantwell. “This bill defends privacy when someone voluntarily joins with others to stop the spread of Covid-19.”

The bill requires exposure notification systems to only allow medically authorized diagnoses to ensure that false reports are avoided. The bill requires personal data collected through the apps to only be used for the purpose of controlling the spread of COVID-19 and personal data is prohibited from being used for commercial purposes. In addition to participation being voluntary, the bill will give Americans the right to opt out and have their personal data deleted at any time.

Strong security controls must be put in place to protect personal data collected through the apps and in the event of a data breach, the bill calls for all affected individuals to be notified. There will also be strict enforcement measures to ensure consumer rights are protected. Federal and state authorities will be given the right to impose financial penalties in cases of noncompliance.

“As we continue to confront the coronavirus pandemic, Americans should not have to worry about the privacy and security of their personal health data,” said Senator Klobuchar. “While contact tracing can play a critical role in helping prevent the spread of the coronavirus, this crucial innovation cannot come at the expense of consumers’ privacy.”

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H-ISAC Publishes Framework for Managing Identity in Healthcare

The Health Information Sharing and Analysis Center (H-ISAC) has published a framework for CISOs to manage identity and defend their organization against identity-based cyberattacks. This is the second white paper to be published by H-ISAC covering the identity-centric approach to security. The first white paper explains why an identity-centric approach to cybersecurity is now needed, with the latest white paper detailing how that approach can be implemented.

By adopting the framework, CISOs will be able to manage the full identity lifecycle of employees, patients, practitioners, and business partners in a way that guards against cyberattacks on identity, lowers risk, and increases operational efficiencies.

The framework has been developed for CISOs at healthcare organizations of all sizes. As such, it does not offer a one-size-fits-all approach. Instead, components of the framework can be applied differently based on different environments and use cases. CISOs will need to assess the resources available and their unique risks and decide how best to apply the framework.

The framework details the different components that are required in a modern identity-centric approach to cybersecurity and outlines how those components integrate and inter-relate to secure the enterprise.

The central concept of the framework is simple. How to allow users to access resources in a way that protects against cyberattack. At the heart of the framework is an identity governance and administration system, which serves as the central nervous system that ties in all the other components and ensures they work seamlessly together.

The identity governance and administration system allows organizations to establish set rules and processes related to the creation, removal, and updating of accounts, manage policies and processes of all aspects of their identity and access management (IAM) system, manage privilege escalation requests, conduct audits for compliance purposes, and take actions to remediate any misuses of the IAM system.

The framework uses identity directories as an authoritative identity store for an organization, which detail roles, accounts, attributes, and the privileges associated with different roles and accounts. The white paper details three guiding principles for authorization: Granting privileges, managing privileges, and reviewing privileges. Privileges must be tightly controlled and assigned based on roles, rights, and responsibilities. Processes must be defined to manage privileges and update them as circumstances change. Reviews should also be conducted to ensure that users have only been assigned rights that are appropriate for their role and responsibilities.

A few years ago, all that was required to gain access to resources was a password, but threat actors are now adept at stealing passwords and as a result the security utility of passwords has diminished. H-ISAC therefore recommends multi-factor authentication. The framework takes MFA one step further and includes device authentication, human authentication, analytics, and privileged access management to enable continuous, risk-based authentication.

Device authentication ensures only trusted devices are granted access to resources. Human authentication is then required to ensure that the correct person is using that device. Analytics are then used to identify anomalies that could indicate attempts by unauthorized individuals to access resources, such as a device being used to access resources from California and then five minutes later being used in New York. Privileged access management solutions should also be used for session monitoring and to implement additional layers of authentication to prevent credential compromise and limit privilege escalation.

The framework also outlines four different use cases: On-boarding new employees, managing users and changing privileges when an employee’s role changes, credentialing a third-party business partner for limited systems access, and credentialing new patients.

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April 2020 Healthcare Data Breach Report

There were 37 healthcare data breaches of 500 or more records reported in April 2020, up one from the 36 breaches reported in March. As the graph below shows, the number of breaches reported each month has been fairly consistent and has remained well below the 12-month average of 41.9 data breaches per month.

Healthcare data breaches by month (2019-2020)

While the number of breaches increased slightly, there was a significant reduction in the number of breached healthcare records in April. 442,943 healthcare records were breached in April, down 46.56% from the 828,921 records breached in March. This is the second successive month where the number of exposed records has fallen. While this is certainly good news, it should be noted that in the past 12 months, 39.92 million healthcare records have been breached.

Healthcare records breached in the past 6 months

Largest Healthcare Data Breaches in April 2020

 

Name of Covered Entity Covered Entity Type Individuals Affected Type of Breach Location of Breached Information
Beaumont Health Healthcare Provider 112,211 Hacking/IT Incident Email
Meridian Health Services Corp. Healthcare Provider 111,372 Hacking/IT Incident Email
Arizona Endocrinology Center Healthcare Provider 74,122 Unauthorized Access/Disclosure Electronic Medical Record
Advocate Aurora Health Healthcare Provider 27,137 Hacking/IT Incident Email, Network Server
Doctors Community Medical Center Healthcare Provider 18,481 Hacking/IT Incident Email
Andrews Braces Healthcare Provider 16,622 Hacking/IT Incident Network Server
UPMC Altoona Regional Health Services Healthcare Provider 13,911 Hacking/IT Incident Email
Colorado Department of Human Services, Office of Behavioral Health Healthcare Provider 8,132 Unauthorized Access/Disclosure Network Server
Agility Center Orthopedics Healthcare Provider 7,000 Hacking/IT Incident Email
Beacon Health Options, Inc. Business Associate 6,723 Loss Other Portable Electronic Device

 

Causes of Healthcare Data Breaches in April

As was the case in March, hacking and IT incidents were the leading causes of healthcare data breaches. Unauthorized access/disclosure incidents were the next most common causes of breaches, an increase of 77.77% from the previous month.

333,838 records were compromised in the 18 reported hacking/IT incidents, which account for 75.37% of all records breached in April. The average breach size was 18,547 records and the median breach size was 4,631 records. There were 16 reported unauthorized access/disclosure incidents in April. The average breach size was 6,171 records and the median breach size was 1,122 records. In total, 98,737 records were breached across those 16 incidents.

There were two theft incidents reported in April, both involving portable electronic devices. The records of 3,645 individuals were stored on those devices. There was also one lost portable electronic device containing the records of 6,723 patients.

causes of healthcare data breaches in April 2020

The bar chart below shows the location of breached protected health information. The chart shows email is by far the most common location of breached health information. 48.65% of all reported breaches in April involved PHI stored in emails and email attachments. The majority of those breaches were phishing attacks. Most healthcare data breaches involve electronic data, but one in five breaches involved PHI in paper files and charts.

Location of breached PHI in April 2020

Healthcare Data Breaches by Covered Entity Type

Healthcare providers were the worst affected covered entity type in April with 30 breaches reported. 4 health plans reported a breach in April, and three breaches were reported by business associates of HIPAA-covered entities. A further 8 breaches had some business associate involvement.

Healthcare Data Breaches by State

April’s data breaches were reported by covered entities and business associates in 22 states. Florida and Texas were the worst affected with 4 breaches each. There were three data breaches reported in Michigan and Pennsylvania, and two breaches affecting covered entities and business associates based in California, Connecticut, Minnesota, Missouri, and Wisconsin. One breach was reported by entities based in Arkansas, Arizona, Colorado, Delaware, Indiana, Massachusetts, Maryland, North Carolina, New Mexico, Nevada, Tennessee, Utah, and Washington.

HIPAA Enforcement Activity in April

There were no financial penalties imposed on covered entities or business associates by state Attorneys General or the HHS’ Office for Civil Rights in April.

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