Latest HIPAA News

Lawsuit Alleges Sharp Grossmont Hospital Secretly Recorded Patients Having Gynecology Operations

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A lawsuit has been filed against Sharp HealthCare and Sharp Grossmont Hospital which alleges the hospital secretly recorded video footage of female patients undressing and having gynaecological examinations performed.

According to the lawsuit, the hospital installed video cameras in three operating rooms as part of an internal investigation into the theft of the anaesthesia drug, propofol, from drug carts. The cameras were actively recording between July 17, 2012 and June 30, 2013 at its facility on Grossmont Center Drive in El Cajon, San Diego.

During the time that the cameras were recording 1,800 patients were filmed undergoing procedures such as hysterectomies, Caesarean births, dilation and curettage for miscarriages, and other surgical procedures. The motion-activated cameras had been installed on drug carts and continued to record even after motion had stopped.

A spokesperson for Sharp Grossmont Hospital confirmed that three cameras had been installed to ensure patient safety by determining the cause of missing drugs from the carts.

The lawsuit states that, “At times, defendants’ patients had their most sensitive genital areas visible.” The position of the laptop cameras was such that patients’ faces could be seen in the recordings and, as such, patients could be identified from the recordings.

The lawsuit alleges the video recordings could be accessed by multiple individuals including medical and non-medical staff and strangers via desktop computers. Controls had not been implemented to log which users had gained access to the video recordings or why the videos had been viewed.

The plaintiffs allege that many of the computers on which the videos were stored have since been replaced or refreshed and that Sharp has destroyed many of the videos; however, Sharp could not confirm whether those files were securely erased and if they could potentially be recovered.

The lawsuit was originally filed in 2016 but was denied class certification. The case has now been re-filed. 81 women who received surgical procedures in the operating rooms during the period in which the cameras were active have been included in the lawsuit and hundreds more women are expected to join.

The plaintiffs allege their privacy was violated as a result of the unlawful recording of video footage, there was a breach of fiduciary duty, negligent infliction of emotional distress, and that the failure to secure the video footage and ensure it was permanently destroyed amounts to gross negligence.

As a result of the actions of Sharp, “Plaintiffs suffered harm including, but not limited to, suffering, anguish, fright, horror, nervousness, grief, anxiety, worry, shock, humiliation, embarrassment, shame, mortification, hurt feelings, disappointment, depression and feelings of powerlessness,” states the lawsuit.

The plaintiffs are seeking a jury trial.

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CMS Launches Review Program to Assess Compliance with the HIPAA Administrative Simplification Rules

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The HHS’ Centers for Medicare and Medicaid Services (CMS) has launched a compliance review program to assess whether HIPAA covered entities are complying with the HIPAA Administrative Simplification Rules for electronic healthcare transactions. The compliance reviews will commence in April 2019.

The HIPAA Administrative Simplification Rules

The HIPAA Administrative Simplification Rules were introduced to improve efficiency and the effectiveness of the health system in the United States. They require healthcare organizations to adopt national standards for healthcare transactions that are conducted electronically, including the use of standard code sets and unique health identifiers, in addition to complying with the requirements of the HIPAA Privacy and Security Rules.

The HHS’ Office for Civil Rights is responsible for enforcing the HIPAA Privacy, Security, and Breach Notification Rules. The CMS is responsible for administering and enforcing the rules covering transaction and code sets standards, the employer identifier standard, and the national provider identifier standard, as detailed in 45 CFR Parts 160, 162, and 164. The CMS-administered standards are required to be adopted whenever there is an exchange of health information. If the standards are not adopted, healthcare information cannot be exchanged efficiently.

The CMS Compliance Review Program

Starting in April 2019, the CMS will conduct compliance reviews on 9 randomly selected health plans and healthcare clearinghouses, including those that deal with Medicare and Medicaid and those that do not.

The compliance reviews will assess whether HIPAA -covered entities are in compliance with the standards set for:

  • Transaction formats;
  • Code sets; and
  • Unique identifiers

If covered entities selected for a review are found not to be in compliance with the HIPAA Administrative Simplification Rules, they will be provided with a corrective action plan to address any violations and will be given the opportunity to make changes and achieve compliance.

Any covered entity that fails to make the necessary changes and achieve compliance with the HIPAA Administrative Simplification standards will be subjected to “escalating enforcement actions”, which could include civil monetary penalties.

The 2019 CMS Compliance Review Program follows on from a pilot review program conducted in 2018 on three health plans and three healthcare clearinghouses that volunteered to participate. A separate program will take place in 2019 in which providers will also be able to volunteer for compliance reviews.

After the latest round of 9 compulsory compliance reviews have been completed, the CMS will conduct an ongoing campaign involving periodic reviews of randomly selected covered entities to assess compliance with the HIPAA Administrative Simplification Rules.

These will be in addition to the normal procedure for enforcing compliance, which currently operates on a complaint basis.

Organizations can use the web-based Administrative Simplification Enforcement and Testing Tool (ASETT) to test transactions to determine whether they are compliant and to submit complaints about HIPAA Administrative Simplification Rules violations.

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$1.6 Million Settlement Agreed with Texas Department of Aging and Disability Services Over 2015 Data Breach

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The Department of Health and Human Services’ Office for Civil Rights has agreed to settle a HIPAA violation case with the Texas Department of Aging and Disability Services (DADS) to resolve HIPAA violations discovered during the investigation of a 2015 data breach that exposed the protected health information of 6,617 Medicaid recipients.

The breach was caused by an error in a web application which made ePHI accessible over the internet for around 8 years. DADS submitted a breach report to OCR on June 11, 2015.

OCR launched an investigation into the breach to determine whether there had been any violation of HIPAA Rules. On July 2015, OCR notified DADS that the investigation had revealed there had been multiple violations of HIPAA Rules.

DADS was deemed to have violated the risk analysis provision of the HIPAA Security Rule – 45 C.F.R. § 164.308(a)(1)(ii)(A) – by failing to conduct a comprehensive, organization-wide risk analysis to identify potential risks to the confidentiality, integrity, and availability of ePHI.

There had also been a failure to implement appropriate technical policies and procedures for systems containing ePHI to only allow authorized individuals to access those systems, in violation of 45 C.F.R. § 164.308(a)(4) and 45 C.F.R. § 164.312(a)(1).

Appropriate hardware, software, and procedural mechanisms to record and examine information system activity had not been implemented, which contributed to the duration of exposure of ePHI – A violation of 5 C.F.R. § 164.312(b).

As a result of these violations, there was an impermissible disclosure of ePHI, in violation of 45 C.F.R. § 164.502(a).

The severity of the violations warranted a financial penalty and corrective action plan. Both were presented to the State of Texas and DADS was given the opportunity to implement the measures outlined in the CAP to address the vulnerabilities to ePHI.

The functions and resources that were involved in the breach have since been transferred to the Health and Human Services Commission (HHSC), which will ensure the CAP is implemented.

The State of Texas presented a counter proposal for a settlement agreement to OCR which will see the deduction of $1,600,000 from sums owed to HHSC from the CMS. The settlement releases HHSC from any further actions related to the breach and HHSC has agreed not to contest the settlement or CAP.

The settlement has yet to be announced by OCR, but it has been approved by the 86th Legislature of the State of Texas. This will be the first 2019 HIPAA settlement between OCR and a HIPAA covered entity.

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350,000 Affected by Oregon Department of Human Services Phishing Attack

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Oregon Department of Human Services (ODHS) has experienced a phishing attack that has potentially allowed unauthorized individuals to view or obtain the protected health information of more than 350,000 individuals.

ODHS learned on January 28, 2019 that unauthorized individuals had gained access to email accounts containing clients’ personal information. Third-party forensics experts from IDExperts were called in to determine the number of individuals affected, the types of data that could have been accessed, and whether clients’ personal information had been extracted.

The investigation conformed that nine employees had clicked links in phishing emails and divulged their login credentials, which allowed the attackers to gain access to their email accounts. The first account was compromised on January 8, 2019.

The compromised email accounts contained almost 2 million emails. Checks are still being performed to find out which individuals have been affected. ODHS has confirmed that emails in the account contained information such as clients’ first and last names, addresses, birth dates, case numbers, Social Security numbers, and information used to administer ODHS programs.

The investigation did not uncover any evidence to suggest the attackers viewed or copied any protected health information, but the possibility of data access/theft could not be ruled out.

The exact number of individuals affected by the phishing attack has not yet been finalized. When all individuals have been identified, IDExperts will be sending breach notification letters by mail and will provide further information on the steps that should be taken to protect against identity theft and fraud.

ODHS is offering complimentary credit monitoring and identity theft recovery services to all individuals affected by the breach.

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UCLA Health Settles Class Action Data Breach Lawsuit for $7.5 Million

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UCLA Health has settled a class action lawsuit filed on behalf of victims of data breach that was discovered in October 2014. UCLA Health has agreed to pay $7.5 million to settle the lawsuit.

UCLA Health detected suspicious activity on its network in October 2014 and contacted the FBI to assist with the investigation. The forensic investigation confirmed that hackers had succeeded in gaining access to its network, although at the time it was thought that they did not access the parts of the network where patients’ medical information was stored. However, on May 5, 2015, UCLA confirmed that the hackers had gained access to parts of the network containing patients’ protected health information and may have viewed/copied names, addresses, dates of birth, Medicare IDs, health insurance information, and Social Security numbers. In total, 4.5 million patients were affected by the breach.

The Department of Health and Human Services’ Office for Civil Rights investigated the breach and was satisfied with UCLA Health’s breach response and the technical and administrative safeguards that had been implemented post-breach to improve security.

UCLA Health avoided a financial penalty, but a class action lawsuit was filed on behalf of patients affected by the breach. The plaintiffs alleged UCLA Health failed to inform them about the breach in a timely manner, there had been breach of contract, violations of California’s privacy laws, and that UCLA Health’s failure to protect the privacy of patients constituted negligence.

UCLA Health notified patients about the breach on July 15, 2015, and while this was in line with HIPAA requirements – under 60 days from the discovery that PHI had been compromised – the plaintiffs believed they should have been notified more quickly, given the fact that the breach had occurred 9 months previously.

Under the terms of the settlement, all patients affected by the breach can claim two years of free credit monitoring and identity theft protection services. Patients will also be allowed to submit a claim to recover costs that have been incurred protecting themselves against unauthorized use of their personal and health information and they can also submit a claim to recover losses from fraud and identity theft.

Patients can claim up to $5,000 to cover the costs of protecting their identities and up to $20,000 for any losses or damage caused by identity theft and fraud. $2 million of the $7.5 million settlement has been set aside to cover patients’ claims.  The remaining $5.5 million will be paid into a cybersecurity fund which will be used to improve cybersecurity defenses at UCLA Health.

Patients have until May 20, 2019 to submit an objection or exclude themselves from the settlement. Preventative measure claim forms must be submitted by June 18, 2019 and patients must enroll in the free credit monitoring and identity theft protection services by September 16, 2019. The deadline for submitting claims for the reimbursement of losses is June 18, 2021. The final court hearing on the settlement is scheduled for June 18, 2019.

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Potentially Massive Breach of Protected Health Information Discovered

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Sacramento, CA-based medical software provider Meditab Software Inc., and it’s San Juan, PR-based affiliate, MedPharm Services have suffered a massive breach of protected health information.

Meditab provides electronic medical record (EMR) and practice management software to hospitals, physician’s offices, and pharmacies. According to the company website, its software is used by more than 2,200 healthcare clients.

Meditab also provides a fax processing service and one of the servers used for processing faxes has been discovered to be leaking data and could be accessed over the internet without the need for any authentication.

The unprotected fax server was discovered by the Dubai-based cybersecurity firm SpiderSilk. The fax server was hosted on a subdomain of MedPharm Services and housed an Elastisearch database containing fax communications. Those faxes could be accessed in real time. The database was created in March 2018 and housed more than 6 million records. It is currently unclear how many of those records contained protected health information.

According to a recent report on TechCrunch, a brief review of the faxes in the database revealed they contained highly sensitive information such as names, addresses, dates of birth, insurance information, payment information, Social Security numbers, doctor’s notes, prescription details, diagnoses, lab test results, and medical histories. None of the information was encrypted.

Meditab Software and MedPharm Services were both founded by Kalpesh Patel, who TechCrunch contacted about the breach. After being alerted to the breach, the fax server was taken offline, and an investigation was launched to identify the cause of the breach.

Database logs are currently being assessed to determine the extent of the breach, which patients have been affected, and whether the database was accessed by unauthorized individuals or downloaded.

It is unclear for how long the server was left unprotected and how many patients have been affected by the breach. Considering the number of records in the database, this breach has potential to be one of the largest ever healthcare data breaches in the United States.

Further information will be posted as and when it becomes available.

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February 2019 Healthcare Data Breach Report

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Healthcare data breaches continued to be reported at a rate of more than one a day in February. February saw 32 healthcare data breaches reported, one fewer than January.

Healthcare data breaches by month

The number of reported breaches may have fell by 3%, but February’s breaches were far more severe. More than 2.11 million healthcare records were compromised in February breaches – A 330% increase from the previous month.

Records exposed in Healthcare data breaches by month

Causes of Healthcare Data Breaches in February 2019

Commonly there is a fairly even split between hacking/IT incidents and unauthorized access/disclosure incidents; however, in February, hacking and IT incidents such as malware infections and ransomware attacks dominated the healthcare data breach reports.

75% of all reported breaches in February (24 incidents) were hacking/IT incidents and those incidents resulted in the theft/exposure of 96.25% of all records that were breached. All but one of the top ten healthcare data breaches in February were due to hacks and IT incidents.

There were four unauthorized access/disclosure incidents and 4 cases of theft of physical or electronic PHI. The unauthorized access/disclosure incidents involved 3.1% of all compromised records and 0.65% of records were compromised in the theft incidents.

Causes of Healthcare data breaches in February 2019

Largest Healthcare Data Breaches in February 2019

The largest healthcare data breach reported in February involved the accidental removal of safeguards on a network server, which allowed the protected health information of more than 973,000 patients of UW Medicine to be exposed on the internet. Files were indexed by the search engines and could be found with simple Google searches. Files stored on the network server were accessible for a period of more than 3 weeks.

The second largest data breach was due to a ransomware attack on Columbia Surgical Specialist of Spokane. While patient information may have been accessed, no evidence was found to suggest any ePHI was stolen by the attackers.

The 326,629-record breach at UConn Health was due to a phishing attack that saw multiple employees’ email accounts compromised, and one email account was compromised in a phishing attack on Rutland Regional Medical Center that contained the ePHi of more than 72,000 patients.

Rank Name of Covered Entity Covered Entity Type Individuals Affected Type of Breach
1 UW Medicine Healthcare Provider 973,024 Hacking/IT Incident
2 Columbia Surgical Specialist of Spokane Healthcare Provider 400,000 Hacking/IT Incident
3 UConn Health Healthcare Provider 326,629 Hacking/IT Incident
4 Rutland Regional Medical Center Healthcare Provider 72,224 Hacking/IT Incident
5 Delaware Guidance Services for Children and Youth, Inc. Healthcare Provider 50,000 Hacking/IT Incident
6 Rush University Medical Center Healthcare Provider 44,924 Unauthorized Access/Disclosure
7 AdventHealth Medical Group Healthcare Provider 42,161 Hacking/IT Incident
8 Reproductive Medicine and Infertility Associates, P.A. Healthcare Provider 40,000 Hacking/IT Incident
9 Memorial Hospital at Gulfport Healthcare Provider 30,642 Hacking/IT Incident
10 Pasquotank-Camden Emergency Medical Service Healthcare Provider 20,420 Hacking/IT Incident

 

Location of Breached Protected Health Information

Email is usually the most common location of compromised PHI, although in February there was a major rise in data breaches due to compromised network servers. 46.88% of all breaches reported in February involved ePHI stored on network servers, 25% involved ePHI stored in email, and 12.5% involved ePHI in electronic medical records.

Location of breached PHI

Healthcare Data Breaches by Covered Entity Type

Healthcare providers were the worst affected by data breaches in February 2019 with 24 incidents reported. There were five breaches reported by health plans, and three breaches reported by business associates of HIPAA-covered entities. A further seven breaches had some business associate involvement.

February 2019 healthcare data breaches by covered entity

Healthcare Data Breaches by State

The healthcare data breaches reported in February were spread across 22 states. California and Florida were the worst affected states with three breaches apiece. Two breaches were reported in each of Illinois, Kentucky, Maryland, Minnesota, Texas, and Washington, and one breach was reported in each of Arizona, Colorado, Connecticut, Delaware, Georgia, Kansas, Massachusetts, Mississippi, Montana, North Carolina, Virginia, Wisconsin, and West Virginia.

HIPAA Enforcement Actions in February 2019

2018 was a record year for HIPAA enforcement actions, although 2019 has started slowly. The HHS’ Office for Civil Rights has not issued any fines nor agreed any HIPAA settlements so far in 2019.

There were no enforcement actions by state attorneys general over HIPAA violations in February. The only 2019 penalty to date is January’s $935.000 settlement between California and Aetna.

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Internet of Things Improvement Act Requires Minimum Security Standards for IoT Devices

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U.S. Sens. Mark R. Warner (D-VA) and Cory Gardner (R-CO), co-chairs of the Senate Cybersecurity Caucus, and Sens. Maggie Hassan (D-NH) and Steve Daines (R-MT) have introduced The Internet of Things Improvement Act, which requires all IoT devices purchased by the U.S. government to meet minimum security standards. A companion bill has been introduced in the House by Representatives by Reps. Robin Kelly (D-IL) and Will Hurd (R-TX).

Ericcson has predicted there will be 18 billion IoT devices in use by 2022 and IDC predicts IoT spending will reach $1.2 trillion the same year. As the number of IoT devices in use grows, so does concern about the security risk posed by the devices.

Sen. Warner wants to make sure that a baseline for security is achieved before any IoT device is allowed to connect to a government network and wants to use the purchasing power of the U.S. government to help establish minimum standards of security for IoT devices.

Currently IoT devices are coming to market with scant cybersecurity protections. When cybersecurity measures are integrated into IoT devices, it is often as an afterthought. Most IoT devices have not been designed with security in mind and the market encourages device manufacturers to prioritize convenience and cost over security.

The bill calls for NIST to issue recommendations for IoT device manufacturers on secure development, identity management, configuration management, and patching throughout the life-cycle of the devices. NIST will also be required to work with cybersecurity researchers and industry experts to develop guidance on coordinated vulnerability disclosures to ensure flaws are addressed when they are discovered.

The Internet of Things Improvement Act calls for the Office of Management and Budget (OMB) to issue guidelines for each agency that is consistent with NIST recommendations and for policies to be reviewed at least every five years.

Any IoT device used by the federal government will be required to meet the security standards set by NIST and contractors and vendors that provide IoT devices to the government will be required to adopt coordinated vulnerability disclosure policies to ensure information on vulnerabilities is disseminated.

It is important that IoT devices do not give hackers a backdoor into government networks. Without minimum security standards, the government will be vulnerable to attack and critical national security information will be placed at risk.

The Internet of Things Improvement Act will see the U.S. government lead by example and better manage cyber risks.

The bill is supported by many software and security firms and industry associations, including BSA, Symantec, Tenable, Mozilla, CloudFlare, Rapid7, and CTIA.

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25% of Healthcare Organizations Have Experienced a Mobile Security Breach in Past 12 Months

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Implementing technical safeguards to prevent the exposure of electronic protected health information is a major challenge in healthcare, especially when it comes to securing mobile devices.

According to the Verizon Mobile Security Index 2019 report, 25% of healthcare organizations have experienced a security breach involving a mobile device in the past 12 months.

All businesses face similar risks from mobile devices, but healthcare organizations appear to be addressing risks better than most other industry sectors. Out of the eight industry sectors surveyed, healthcare experienced the second lowest number of mobile security incidents behind manufacturing/transportation.

Healthcare mobile security breaches have fallen considerably since 2017 when 35% of surveyed healthcare organizations said they had experienced a mobile security breach in the past 12 months.

While the figures suggest that healthcare organizations are getting better at protecting mobile devices, Verizon suggests that may not necessarily be the case. Healthcare organizations may simply be struggling to identify security incidents involving mobile devices.

85% of surveyed healthcare organizations were confident that their security defenses were effective and 83% said they believed they would be able to detect a security incident quickly. That confidence may be misplaced as a quarter of healthcare organizations have experienced a breach involving a mobile device and 80% of those entities learned about the breach from a third party.

Since mobile devices are often used to access or store ePHI, a security incident could easily result in a breach of ePHI. Two thirds (67%) of healthcare mobile security incidents were rated major breaches. 40% of those breaches had major lasting repercussions and, in 40% of cases, remediation was said to be difficult and expensive.

67% of mobile device security incidents saw other devices compromised, 60% of organizations said they experienced downtime as a result of the breach, and 60% said data was lost. 40% of healthcare organizations that experienced such a breach said multiple devices were compromised, downtime was experienced, and they lost data. 30% of breached entities said that cloud services had been compromised as a result of a mobile security breach.

The main security risks were seen to be how devices were used by employees. 53% of respondents said personal use of mobile devices posed a major security risk and 53% said user error was a major problem.

65% of healthcare organizations were less confident about their ability to protect mobile devices than other IT systems. Verizon notes that this could be explained, in part, by the lack of effective security measures in place. For instance, just 27% of healthcare organizations were using a private mobile network and only 22% had unified endpoint management (UEM) in place.

The survey also confirmed that users are taking major risks and are breaching company policies. Across all industries, 48% of respondents said they sacrificed security to get tasks completed compared to 32% last year. 81% said they use mobile devices to connect to public Wi-Fi even though in many cases doing so violates their company’s mobile device security policy.

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