Latest HIPAA News

February 2022 Healthcare Data Breach Report

Posted by HIPAA Journal

For the third successive month, the number of data breaches reported to the HHS’ Office for Civil Rights (OCR) has fallen. 46 healthcare data breaches of 500 or more records were reported to OCR in February – an 8% fall from January. February saw the lowest number of data breaches in the past 5 months. Even with the reduction in breaches, on average, more than 2 healthcare data breaches have been reported each day over the past 12 months. From March 1, 2021, to February 28, 2022, there have been 723 reported data breaches of 500 or more records.

Healthcare data breaches in the past 12 months

Across February’s 46 incidents, the records of 2,525,023 individuals were exposed or compromised – a 2.28% fall from the previous month – which is considerably lower than the 3,506,400 records that have been breached each month, on average, from March 1, 2021, to February 28, 2022. At least 42,076,805 healthcare records were exposed over that period. In February, the average breach size was 48,957 records and the median breach size was 7,014 records.

breached healthcare records over the past 12 months

Largest Healthcare Data Breaches Reported in February 2022

22 HIPAA-regulated entities reported breaches of 10,000 or more healthcare records in February. The largest breach of the month was reported by Morley Companies, which was a hacking incident that resulted in the exposure and possible theft of the protected health information of 521,046 members of its health plan.

Monongalia Health System reported a major hacking incident that potentially resulted in the theft of the PHI of 492,861 individuals. The breach was discovered a few days after the health system announced a previous data breach – a phishing and business email compromise attack – that affected almost 398,164 individuals.

Name of Covered Entity State Covered Entity Type Individuals Affected Type of Breach Cause of Breach
Morley Companies, Inc. MI Business Associate 521,046 Hacking/IT Incident Unspecified hacking incident
Monongalia Health System, Inc. WV Healthcare Provider 492,861 Hacking/IT Incident Unspecified hacking incident
Norwood Clinic AL Healthcare Provider 228,000 Hacking/IT Incident Unspecified hacking incident
Logan Health Medical Center MT Healthcare Provider 213,543 Hacking/IT Incident Unspecified hacking incident
South Shore Hospital Corporation IL Healthcare Provider 115,670 Hacking/IT Incident Unspecified hacking incident
Comprehensive Health Services FL Healthcare Provider 106,752 Hacking/IT Incident Business email compromise
US Radiology Specialists, Inc. NC Business Associate 87,552 Hacking/IT Incident Unknown
Memorial Village ER TX Healthcare Provider 80,000 Hacking/IT Incident Unspecified hacking incident
Montrose Regional Health CO Healthcare Provider 52,632 Hacking/IT Incident Compromised email accounts
Cross Timbers Health Clinics dba AccelHealth TX Healthcare Provider 48,126 Hacking/IT Incident Ransomware attack
Jacksonville Spine Center, P.A. FL Healthcare Provider 38,000 Hacking/IT Incident Ransomware attack
The Puerto Rican Organization to Motivate, Enlighten, and Serve Addicts, Inc. NY Healthcare Provider 30,220 Hacking/IT Incident Compromised email accounts
EPIC Pharmacy Network, Inc. VA Healthcare Provider 28,776 Hacking/IT Incident Compromised email accounts
Ascension Michigan (single affiliated covered entity) ACE MI Healthcare Provider 27,177 Unauthorized Access/Disclosure Unauthorized EHR access by an employee
Bako Diagnostics GA Healthcare Provider 25,745 Hacking/IT Incident Unspecified hacking incident (data exfiltration confirmed)
Ultimate Care, Inc. NY Healthcare Provider 15,788 Hacking/IT Incident Compromised email accounts
Alliance Physical Therapy Group, LLC MI Business Associate 14,970 Hacking/IT Incident Unspecified hacking incident
University Medical Center Southern Nevada NV Healthcare Provider 12,230 Hacking/IT Incident Unknown
Seneca Nation Health System NY Healthcare Provider 12,000 Hacking/IT Incident Unknown
CareOregon Advantage OR Health Plan 10,467 Unauthorized Access/Disclosure Misdirected email
Extend Fertility NY Healthcare Provider 10,373 Hacking/IT Incident Ransomware attack
Houston Health Department TX Healthcare Provider 10,291 Unauthorized Access/Disclosure Misconfigured web portal

Causes of February 2022 Healthcare Data Breaches

As the table above shows, hacking incidents dominated the breach reports in February. 39 of the month’s data breaches were hacking/IT incidents, the majority of which saw unauthorized individuals hack into networks and view and/or exfiltrate sensitive data. It is common for breached entities to disclose hacking incidents but not publicly disclose details about the exact nature of the attacks, such as if they involved malware or ransomware. Across those 39 breaches, the records of 2,184,973 individuals were exposed or compromised. The average breach size was 56,025 records and the median breach size was 6,221 records.

causes of february 2022 healthcare data breaches

There were 6 unauthorized access/disclosure incidents reported in February involving the records of 62,550 individuals. The average breach size was 10,425 records and the median breach size was 8,953 records. There was one loss incident involving a desktop computer that contained the PHI of 4,500 individuals. There were no reported theft or improper disposal incidents.location of breached PHI in February 2022 healthcare data breaches

Healthcare Data Breaches by State

HIPAA-regulated entities in 23 states reported data breaches in February. New York the worst affected state with 6 reported breaches, followed by Florida, Michigan, and New Jersey which each had 5.

State Number of reported breaches
New York 6
Florida, Michigan, and New Jersey 5
Texas and Virginia 3
Pennsylvania and West Virginia 2
Alabama, Arizona, Colorado, Connecticut, Georgia, Illinois, Massachusetts, Montana, Nevada, North Carolina, Oklahoma, Oregon, Rhode Island, Utah, and Washington 1

Healthcare Data Breaches by HIPAA-Regulated Entity Type

Healthcare providers were the worst affected entity in February 2022 having reported a total of 35 data breaches involving the records of 1,597,155 individuals. There were 6 data breaches reported by health plans involving 21,284 records, and 5 data breaches were self-reported by business associates of HIPAA-covered entities, which involved the records of 633,584 individuals.

10 breaches occurred at business associates but were reported by the affected covered entity, with the adjusted figures shown in the chart below.

February 2022 healthcare data breaches by HIPAA-regulated entity type

HIPAA Enforcement Actions in February 2022

There were no announcements by the HHS’ Office for Civil Rights or state Attorneys General about HIPAA enforcement actions in February. In fact, there have been no financial penalties imposed for HIPAA violations so far in 2022.

OCR Director, Lisa J. Pino, has confirmed that the Department of Health and Human Services has an ambitious regulatory agenda for 2021, which will include strong enforcement of HIPAA compliance, including the continuation of its enforcement initiative targeting healthcare providers that violate the HIPAA Right of Access and fail to provide individuals with timely access to their medical records.

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JDC Healthcare Management Data Breach Affects More than 1 Million Texans

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On March 17, 2022, Dallas, TX-based JDC Healthcare Management, which runs more than 70 Jefferson Dental & Orthodontics practices throughout the state of Texas, reported a security breach to the Office of the Attorney General of Texas that has affected more than 1 million Texans.

As previously reported on this site, JDC Healthcare Management detected malware within its IT network on or around August 9, 2021, with the forensic investigation into the security breach confirming the malware was downloaded onto its systems on July 27, 2021.

Further information on the data breach has now been obtained. JDC Healthcare Management explained that the malware gave unauthorized individuals access to its IT systems from July 27, 2021, to August 16, 2021, and its forensic investigation confirmed the attackers viewed or copied files on its systems that contained patients’ electronic protected health information (ePHI).

JDC Healthcare Management explained in its March 2022 breach notification letters that the comprehensive review of the impacted files is ongoing, but it has been confirmed that the types of exposed and compromised ePHI included names, dates of birth, Social Security numbers, driver’s license numbers, financial information, health insurance information, and medical information.

In its breach notification letters, JDC Healthcare Management said, “Upon learning of this incident, we moved quickly to investigate and respond to this incident, assess the security of our systems, restore functionality to our environment, and notify potentially affected individuals.”

JDC Healthcare Management said it is reviewing and enhancing its existing policies and procedures to reduce the likelihood of further security breaches. Affected individuals have been advised to check their accounts, explanation of benefits statements, and free annual credit reports, although there is no mention in the breach notification letters about credit monitoring and identity theft protection services being offered.  JDC Healthcare Management said that at the time of issuing notification letters, it was unaware of any actual or attempted misuse of patient data.

Notification letters are now being sent and the incident will be reported to the HHS’ Office for Civil Rights. The breach report submitted to the Texas Attorney General indicates the ePHI of 1,026,820 Texans was potentially compromised.

Wheeling Health Right Inc. Suffers Ransomware Attack

Wheeling Health Right Inc. in West Virginia has announced it was the victim of a ransomware attack in January 2022. The security breach was detected on January 18, 2022, when access to files on its IT systems was prevented. Wheeling Health Right said it engaged legal counsel and a data breach remediation firm to investigate the attack and determine the extent to which its systems had been compromised.

A review of all files on the affected parts of its systems confirmed they contained sensitive patient and employee information such as full names, addresses, email addresses, phone numbers, driver’s license numbers, medical record numbers, Social Security numbers, tax information, income information, and health information of patients who applied for or received services from Wheeling Health Right.

Wheeling Health Right said its information technology service provider decrypted, recovered, and rebuilt its systems, initiated a password reset for all system end-users, implemented multi-factor authentication for employee email accounts, and installed additional endpoint detection and response software. Further privacy and security measures have also been implemented, including providing additional cybersecurity training to the workforce.

Wheeling Health Right said affected individuals were notified on March 18, 2022, and have been offered identity monitoring to affected individuals at no cost for 12 months. The incident has not yet appeared on the HHS’ Office for Civil Rights breach portal, so it is currently unclear how many individuals have been affected.

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OCR: HIPAA Security Rule Compliance Can Prevent and Mitigate Most Cyberattacks

Posted by HIPAA Journal

Healthcare hacking incidents have been steadily rising for a number of years. There was a 45% increase in hacking/IT incidents between 2019 and 2020, and in 2021, 66% of breaches of unsecured electronic protected health information were due to hacking and other IT incidents. A large percentage of those breaches could have been prevented if HIPAA-regulated entities were fully compliant with the HIPAA Security Rule.

The Department of Health and Human Services’ Office for Civil Rights explained in its March 2022 cybersecurity newsletter that compliance with the HIPAA Security Rule will prevent or substantially mitigate most cyberattacks. Most cyberattacks on the healthcare industry are financially motivated and are conducted to steal electronic protected health information or encrypt patient data to prevent legitimate access. The initial access to healthcare networks is gained via tried and tested methods such as phishing attacks and the exploitation of known vulnerabilities and weak authentication protocols, rather than exploiting previously unknown vulnerabilities.

Prevention of Phishing

Phishing is one of the commonest ways that cyber actors gain a foothold in healthcare networks. Coveware’s Q2, 2021 Quarterly Ransomware Report suggests 42% of ransomware attacks in the quarter saw initial network access gained via phishing emails. Phishing attacks attempt to trick employees into visiting a malicious website and disclosing their credentials or opening a malicious file and installing malware.

Anti-phishing technologies such as spam filters and web filters are key technical safeguards to prevent phishing attacks. They stop emails from being delivered from known malicious domains, scan attachments and links, and block access to known malicious websites where malware is downloaded or credentials are harvested. These tools are important technical safeguards for ensuring the confidentiality, integrity, and availability of ePHI.

OCR reminded HIPAA-regulated entities that “The Security Rule requires regulated entities to implement a security awareness and training program for all workforce members,” which includes management personnel and senior executives. “A regulated entity’s training program should be an ongoing, evolving process and be flexible enough to educate workforce members on new and current cybersecurity threats (e.g., ransomware, phishing) and how to respond,” said OCR.

The Security Rule also has an addressable requirement to send periodic security reminders to the workforce. OCR said one of the most effective forms of “security reminders” is phishing simulation emails. These exercises gauge the effectiveness of the training program and allow regulated entities to identify weak links and address them. Those weak leaks could be employees who have not fully understood their training or gaps in the training program.

“Unfortunately, security training can fail to be effective if it is viewed by workforce members as a burdensome, “check-the-box” exercise consisting of little more than self-paced slide presentations,” suggested OCR. “Regulated entities should develop innovative ways to keep the security trainings interesting and keep workforce members engaged in understanding their roles in protecting ePHI.”

Prevention of Vulnerability Exploitation

Some cyberattacks exploit previously unknown vulnerabilities (zero-day attacks) but it is much more common for hackers to exploit known vulnerabilities for which patches are available or mitigations have been made public. It is the failure to patch and update operating systems promptly that allows cyber actors to take advantage of these vulnerabilities.

The continued use of outdated, unsupported software and operating systems (legacy systems) is common in the healthcare industry. “Regulated entities should upgrade or replace obsolete, unsupported applications and devices (legacy systems),” said OCR. “However, if an obsolete, unsupported system cannot be upgraded or replaced, additional safeguards should be implemented or existing safeguards enhanced to mitigate known vulnerabilities until upgrade or replacement can occur (e.g., increase access restrictions, remove or restrict network access, disable unnecessary features or services”

The HIPAA Security Rule requires regulated entities to implement a security management process to prevent, detect, contain, and fix security violations. A risk analysis must be conducted and risks and vulnerabilities to ePHI must be reduced to a reasonable and appropriate level. The risk analysis and risk management process should identify and address technical and non-technical vulnerabilities.

To help address technical vulnerabilities, OCR recommends signing up for alerts and bulletins from CISA, OCR, the HHS Health Sector Cybersecurity Coordination Center (HC3), and participating in an information sharing and analysis center (ISAC). Vulnerability management should include regular vulnerability scans and periodic penetration tests.

Eradicate Weak Cybersecurity Practices

Cyber actors often exploit poor authentication practices, such as weak passwords and single-factor authentication. The 2020 Verizon Data Breach Investigations Report suggests over 80% of breaches due to hacking involved compromised or brute-forced credentials.

“Regulated entities are required to verify that persons or entities seeking access to ePHI are who they claim to be by implementing authentication processes,” explained OCR. The risk of unauthorized access is higher when users access systems remotely, so additional authentication controls should be implemented, such as multi-factor authentication for remote access.

Since privileged accounts provide access to a wider range of systems and data, steps should be taken to bolster the security of those accounts. “To reduce the risk of unauthorized access to privileged accounts, the regulated entity could decide that a privileged access management (PAM) system is reasonable and appropriate to implement,” suggests OCR. “A PAM system is a solution to secure, manage, control, and audit access to and use of privileged accounts and/or functions for an organization’s infrastructure.  A PAM solution gives organizations control and insight into how its privileged accounts are used within its environment and thus can help detect and prevent the misuse of privileged accounts.”

OCR reminds regulated entities that they are required to periodically examine the strength and effectiveness of their cybersecurity practices and increase or add security controls to reduce risk as appropriate, and also conduct periodic technical and non-technical evaluations of implemented security safeguards in response to environmental or operational changes affecting the security of ePHI.

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Russian State-Sponsored Actors are Exploiting MFA and the PrintNightmare Vulnerability

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The Federal Bureau of Investigation (FBI) and the Cybersecurity and Infrastructure Security Agency (CISA) have issued a joint cybersecurity advisory warning that Russian state-sponsored actors are exploiting default multi-factor authentication protocols and the PrintNightmare vulnerability to gain access to networks to steal sensitive data.

These tactics have been used by Russian state-sponsored cyber actors from as early as May 2021, when a non-governmental organization (NGO) was attacked using these tactics. The threat actors were able to gain access to the network by exploiting default multi-factor authentication protocols (Cisco’s Duo MFA) on an account. The threat actors then exploited the PrintNightmare vulnerability to execute code with system privileges and were able to move laterally to the NGO’s cloud and email accounts and exfiltrated documents. PrintNightmare is a critical remote code execution vulnerability (CVE-2021-34527) in the print spooler service of Microsoft Windows.

The attackers were able to enroll a new device in the NGO’s Duo MFA using compromised credentials, which were obtained in a brute force attack that guessed a simple, predictable password. The account had been unenrolled from Duo after a long period of inactivity but had not been disabled in Active Directory. In the default setting, Duo allows the re-enrollment of new devices for dormant accounts, which allowed the attackers to enroll a new device, complete the authentication requirements, and gain access to the network. The PrintNigthtmare vulnerability was then exploited and privileges were elevated to admin level.

The threat actors were able to change the configuration of Duo MFA to call localhost rather than the Duo server, which disabled multi-factor authentication for active domain accounts, as the default policy of Duo on Windows is to Fail open if the MFA server cannot be reached. Using compromised credentials without MFA enforced allowed the threat actors to move laterally to the NGO’s cloud environment and email accounts.

Russian state-sponsored actors are adept at exploiting poorly configured MFA systems to gain access to networks to steal sensitive data. These tactics can be used on other misconfigured MFA systems. These tactics do not depend on a victim using Cisco’s Duo MFA.

CISA and the FBI have provided a list of mitigations to prevent these tactics from succeeding. It is important to set strong, unique passwords for all accounts and passwords should not be stored on a system where an adversary may have access. Consider using a password manager. These solutions have strong password generators which can help to prevent users from setting vulnerable passwords. To make it harder for brute force attacks to succeed, organizations should implement time-out and lock-out features after a set number of failed login attempts.

The FBI and CISA say MFA should be enforced for all users, without exception. However, before implementing MFA, configuration policies should be reviewed to protect against fail open and re-enrollment scenarios. Inactive accounts in Active Directory and MFA systems should be disabled, network logs should be monitored for suspicious activity and unauthorized or unusual login attempts, and software and operating systems should be kept up to date, with patching prioritized to address known exploited vulnerabilities first.

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Breach Barometer Report Shows Over 50 Million Healthcare Records Were Breached in 2021

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Protenus has released its 2022 Breach Barometer Report which confirms 2021 was a particularly bad year for healthcare industry data breaches, with more than 50 million healthcare records exposed or compromised in 2021.

The report includes healthcare data breaches reported to regulators, as well as data breaches that have been reported in the media, incidents that have not been disclosed by the breached entity, and data breaches involving healthcare data at non-HIPAA-regulated entities. The data for the report was provided by databreaches.net.

Protenus has been releasing annual Breach Barometer reports since 2016, and the number of healthcare data breaches has increased every year, with the number of breached records increasing every year since 2017. In 2021, it has been confirmed that at least 50,406,838 individuals were affected by healthcare data breaches, a 24% increase from the previous year. 905 incidents are included in the report, which is a 19% increase from 2020.

The largest healthcare data breach of the year occurred affected Florida Healthy Kids Corporation, a Tallahassee, FL-based children’s health plan. Vulnerabilities in its website had not been addressed by its business associate since 2013 and those vulnerabilities were exploited by hackers who gained access to the sensitive data of 3,500,000 individuals who applied for health insurance between 2013 and 2020.

Hacking incidents increased for the 6th successive year, with 678 breaches – 75% of the year’s total number of breaches- attributed to hacking incidents, which include malware, ransomware, phishing and email incidents.  Those breaches resulted in the records of 43,782,811 individuals being exposed or stolen – 87% of all breached records in 2021.

There has been a general trend over the past 6 years that has seen the number of insider incidents fall, albeit with an increase in 2020. There were 111 insider incidents in 2021, similar to the 110 incidents in 2019, which is a 26% decrease from 2020. The increase in 2020 is believed to be pandemic-related, with Protenus suggesting the 2020 spike was driven by a pandemic-related increase in insider curiosity or organizational detection of impropriety that has since subsided.

There were 32 theft-related breaches involving at least 110,6656 records and 11 cases of lost or missing devices or paperwork containing the records of at least 30,922 individuals. 73 incidents could not be classified due to a lack of information.

Healthcare providers continue to be the worst affected HIPAA-covered entity type, but business associate data breaches have increased to almost double the level of 2019. 75% of those incidents were hacking-related, 12% were due to insider error, and 1% were due to insider wrongdoing. Across those incidents, 20.986,509 records were breached. Protenus says that the average number of records breached in business associate data breaches is higher than any other breach.

The time taken to discover a data breach decreased by 30% since 2020. The average time from the date of the breach to discovery is now 132 days; however, it is taking much longer for organizations to disclose data breaches than in 2020. In 2021, the average time to report a data breach was 118 days, which is well over the 60 days stipulated by the HIPAA Breach Notification Rule. In 2020, the time from discovery to reporting was 85 days. The median time for reporting breaches was 62 days in 2021, which is also over the Breach Notification Rule reporting deadline.

“The need for proactive patient privacy monitoring has never been greater. The threats we’re seeing today are much more intrusive than in years past and can come from multiple sources — a random employee snooping or a sophisticated cybersecurity hacker that gains access through an employee channel,” said Nick Culbertson, CEO of Protenus. “Once a breach erodes patient trust in your organization, that’s extremely difficult to recover from.”

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Warning Issued About Access:7 Vulnerabilities Affecting IoT and Medical Devices

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A group of vulnerabilities dubbed Access:7 have been identified in the web-based technologies PTC Axeda and Axeda Desktop Server which are used to allow one or more people to securely view and operate the same remote desktop via the Internet. If exploited, an attacker could gain full system access, remotely execute code, trigger a denial-of-service condition, read and change configurations, and obtain file system read access and log information access. Three of the vulnerabilities are rated critical and have a CVSS severity score of 9.8 out of 10.

PTC Axeda and Axeda Desktop Server are remote asset connectivity software solutions that are used as part of a cloud-based IoT platform. The software is extensively used in medical and Internet-of-Things (IoT) devices to manage and remotely access connected devices, including multiple medical imaging and laboratory devices. At present, none of the vulnerabilities are believed to have been exploited in the wild.

The vulnerabilities affect all versions of the software. They are:

  • CVE-2022-25246 – Hard-coded credentials – CVSS Severity Score 9.8/10
  • CVE-2022-25247 – Missing authentication for critical function – CVSS Severity Score 9.8/10
  • CVE-2022-25251 – Missing authentication for critical function – CVSS Severity Score 9.8/10
  • CVE-2022-25249 – Improper limitation of a pathname to a restricted directory – CVSS Severity Score 7.5/10
  • CVE-2022-25250 – Missing authentication for critical function – CVSS Severity Score 7.5/10
  • CVE-2022-25252 – Improper check or handling of exceptional conditions – CVSS Severity Score 7.5/10
  • CVE-2022-25248 – Exposure of sensitive information to unauthorized individuals – CVSS Severity Score 5.3/10

The vulnerabilities were identified by researchers at Forescout’s Vedere Labs and CyberMDX. The vulnerabilities are known to affect more than 150 devices from over 100 vendors, which amounts to hundreds of thousands of devices globally with over half of the vulnerable devices used by healthcare organizations.  The vulnerabilities also affect a range of other devices such as ATMs, IoT gateways, label printers, SCADA systems, barcode scanners, vending machines, and asset monitoring and tracking solutions.

Patching the vulnerabilities is not straightforward and these are supply chain vulnerabilities. These vulnerable components are used in several different ways by device manufacturers, and healthcare organizations will be required to wait for fixes to be issued by the device manufacturers.

PTC has made the following recommendations:

  • Upgrade to Axeda agent Version 6.9.2 build 1049 or 6.9.3 build 1051 when running older versions of the Axeda agent.
  • Configure Axeda agent and Axeda Desktop Server (ADS) to only listen on the local host interface 127.0.0.1.
  • Provide a unique password in the AxedaDesktop.ini file for each unit.
  • Never use ERemoteServer in production.
  • Make sure to delete ERemoteServer file from host device.
  • Remove the installation file, for example: Gateway_vs2017-en-us-x64-pc-winnt-vc14-6.9.3-1051.msi
  • When running in Windows or Linux, only allow connections to ERemoteServer from trusted hosts and block all others.
  • When running the Windows operating system, configure Localhost communications (127.0.0.1) between ERemoteServer and Axeda Builder.
  • Configure the Axeda agent for the authentication information required to log in to the Axeda Deployment Utility.

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Video: Why HIPAA Compliance is Important for Healthcare Professionals

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Many sources explaining why HIPAA compliance is important for healthcare professionals tend to focus on the purpose of HIPAA regulations rather than the benefits of compliance for healthcare professionals. The same sources also tend to focus on how noncompliance affects patients and employers, rather than the impact it can have on healthcare professionals´ lives.

This article discusses why HIPAA compliance is important for healthcare professionals from a healthcare professional´s perspective. It explains why healthcare professionals cannot avoid HIPAA; and that, by complying with HIPAA, healthcare professionals can foster patient trust, keep patients safer, and contribute towards better patient outcomes. This is turn raises morale, creates a more rewarding work experience, and enables healthcare professionals to get more from their vocation.

Conversely, the failure to comply with HIPAA can have significant professional and personal consequences. Yet the failure to comply with HIPAA is not always a healthcare professional´s fault. Sometimes it can be due to insufficient training or cultural norms. We look at why Covered Entities might not always be able to provide sufficient training or monitor HIPAA compliance, why they may not accept responsibility when an avoidable HIPAA violation occurs, and how you can avoid HIPAA violations due to a lack of knowledge.

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Why Healthcare Professionals Cannot Avoid HIPAA

One of the objectives of HIPAA is to provide a federal floor of privacy protections for individuals´ identifiable health information held by Covered Entities. To achieve this objective, the Privacy and Security Rules imposes standards Covered Entities must comply with in order to protect the privacy of “Protected Health Information” (PHI). The failure to comply with the HIPAA standards can result in substantial financial penalties – even when no data breach occurs and PHI is not compromised.

Most healthcare organizations are Covered Entities and, as such, are required to implement policies and procedures to comply with the Privacy and Security Rule standards. As employees of Covered Entities, healthcare professionals are required to comply with their employer´s policies and procedures. This is why healthcare professionals cannot avoid HIPAA. However, this is not the only reason why HIPAA compliance is important for healthcare professionals.

The Benefits of HIPAA Compliance for Healthcare Professionals

There is little doubt the most important element of a patient/healthcare professional relationship is trust. Patients trust their healthcare professionals with intimate details of their lives because they trust healthcare professionals work in their best interests to achieve optimal health outcomes. However, trust can be a fragile commodity. If their intimate details are exposed due to a HIPAA violation, patients may withhold information crucial to the delivery of care despite the potential long-lasting consequences for their health.

Healthcare professionals can mitigate the risk of trust being broken by complying with the policies and procedures implemented by their employer to prevent HIPAA violations. When patients are confident their privacy is being respected, this fosters trust – which contributes to the delivery of better care in order to achieve optimal health outcomes. Better patient outcomes raise the morale of healthcare professionals and result in a more rewarding work experience.

The Professional and Personal Consequences of Noncompliance

One of the policies a Covered Entity is required to implement is a sanctions policy for when members of its workforce do not comply with HIPAA policies and procedures. Covered Entities are required to enforce the sanctions policy and act on HIPAA violations by healthcare professionals because, if they don´t enforce the sanctions policy, the Covered Entity will be in violation of HIPAA. Furthermore, if the Covered Entity fails to act, noncompliance can deteriorate into a cultural norm.

Being sanctioned for a HIPAA violation can have professional and personal consequences for healthcare professionals. Penalties can range from verbal warnings to the loss of professional accreditation – which will make it difficult for a healthcare professional to get another job – and, if a criminal conviction results from the noncompliance, it will likely be reported in the media which will have repercussions for a healthcare professional´s personal reputation.

Who is Responsible for HIPAA Violations?

As mentioned previously, the failure to comply with HIPAA is not always the healthcare professional´s fault. Although Covered Entities are required to provide training on policies and procedures that relate to healthcare professionals´ functions, they may not have the resources to provide training on every conceivable scenario a healthcare professional may encounter, or to monitor compliance 24/7 in order to prevent the development of cultural norms.

Consequently, unintentional violations of HIPAA can occur due to a lack of knowledge. However, Covered Entities are not always willing to accept responsibility for unintentional violations due to a lack of knowledge because it implies they failed to conduct a thorough risk assessment, overlooked a threat to the privacy of PHI, and failed to provide “necessary and appropriate” training – or, when a cultural norm has developed, failed to monitor compliance with policies and procedures.

How You Can Avoid Unintentional Violations of HIPAA

The best way to avoid unintentional HIPAA violations and the professional and personal consequences of noncompliance – even when they are not your fault – is to ensure your knowledge of HIPAA covers every area of your role and the scenarios you may encounter. To achieve this level of knowledge, you should take advantage of third-party HIPAA training courses that provide you with an in-depth knowledge of HIPAA and its rules and regulations.

Taking responsibility for your own knowledge of HIPAA – and using that knowledge to work in a HIPAA-compliant manner – protects your career, improves your job prospects, and enables you to get more from your vocation. Given the choice, most healthcare professionals would prefer to work in an environment which operates compliantly to delivery better patient outcomes, in which morale is high, and in which the healthcare professional enjoys a more rewarding work experience.

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HC3 Report Reveals Cyberattack Trends and Provides Insights to Improve Healthcare Cybersecurity

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The HHS’ Health Sector Cybersecurity Coordination Center has released a new report – Health Sector Cybersecurity: 2021 – Retrospective and 2022 Look Ahead – that provides a retrospective look at healthcare cybersecurity over the past 3 decades, detailing some of the major cyberattacks to hit the healthcare industry starting with the first-ever ransomware attack in 1989.

That incident saw Biologist Joseph Popp distribute 20,000 floppy disks at the World Health Organization AIDS conference in Stockholm. When used, the disks installed malicious code which tracked reboots. After 90 reboots, a ransom note was displayed that claimed the software lease had expired and a payment of $189 was required to regain access to the system.

The report shows how adversaries stepped up their attacks on the healthcare industry from 2014 through 2017. In 2014, Boston Children’s Hospital suffered a major distributed Denial of Service (DDoS) attack, there was a massive cyberattack on Anthem Inc. in 2015 that resulted in the unauthorized accessing of the records of 80 million health plan subscribers, Hollywood Presbyterian Medical Center paid an unheard-of ransom of $17,000 in 2016 following a ransomware attack, and the WannaCry exploits affected more than 200,000 systems in 2017.

In 2019, ransomware started to be extensively used in attacks on healthcare organizations with the Ryuk ransomware gang one of the most prolific ransomware operators. One of the gang’s attacks was conducted on a managed service provider and affected around 400 dental offices. Attacks continued, and more actors started using ransomware to extort businesses, with the attacks reaching epidemic proportions in 2020. In 2020, cybercriminals took advantage of the COVID-19 pandemic and used COVID-19 lures in their phishing attacks which continued throughout 2021. McAfee observed an average of 375 COVID-themed threats every minute in 2020.

2020 saw massive cyberattacks reported by SolarWinds, Accellion, CaptureRX, Scripps Health, and Universal Healthcare Services, with Emsisoft reporting $18.6 billion had been paid globally in ransoms to ransomware gangs, although it was estimated that the actual total was most likely closer to $75 billion.

The prolific Maze ransomware gang shut down its operation in 2020, but threats came from many other cyber actors including REvil, Avaddon, and BlackMatter. 2021 saw a massive ransomware attack on the Health Service Executive in Ireland by the Conti ransomware gang. The attack impacted 54 public hospitals and others that depended on HSE infrastructure and it took 4 months to bring all systems back online.

The report makes it clear that cyberattacks targeting healthcare organizations are nothing new. The industry has been targeted for many years and the industry will continue to be targeted for years to come. HC3 recommends healthcare organizations should continue to take steps to improve their defenses against the most common threats such as ransomware, malware, and phishing. Security teams should provide ongoing security awareness training for employees, run phishing simulation exercises to test the effectiveness of training, implement gateway/mail server filtering, blacklisting and whitelisting, and operationalize indicators of compromise.

It is also important to lock down remote access technologies, which are frequently abused to gain access to systems. Virtual Private Networks and technologies leveraging the Remote Desktop Protocol should be operationally minimized, services should be turned off if they are not used, and logs of activity should be maintained and regularly reviewed.

Vulnerability management is essential and needs to be systematic, comprehensive, and repeatable, and there must be mechanisms of enforcement. It is important to maintain situational awareness of applicable vendor updates and alerts and to develop repeatable testing, patching, and update deployment procedures.

It is important for healthcare organizations to understand the value of what the organization has to offer an adversary. That includes protected health information, which carries a high price on the black market, and intellectual property, which is often sought by foreign countries. Once assets have been identified, steps must be taken to ensure that those assets are protected.

In addition to implementing safeguards to protect against attacks, it is important to understand that there will still be a high probability of compromise and to prepare for an attack and plan and test the response in advance to ensure that the business can continue to operate.

It is also recommended that healthcare organizations consider relatively new-ish ways of thinking about defense, and to consider that adversaries are now thinking in terms of maximizing the number of victims and are targeting managed service providers and the supply chain. Healthcare organizations need to think about how they can prevent and mitigate attacks on third parties.

HC3 says situational awareness will continue to be more and more important in 2022 and beyond. There will be new threats, the tactics, techniques, and procedures of threat actors will evolve, and there will be new vulnerabilities. It is important to keep up-to-date with new threats and vulnerabilities and how they can be corrected and mitigated.

It is vital to maintain trusted defense measures and to defend against distributed attacks and other avenues of compromise. HC3 has provided several resources in the report that healthcare organizations can use to develop their defenses and block current and new attack methods.

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Poor Employee Cyber Hygiene is Putting Healthcare Cybersecurity at Risk

Posted by HIPAA Journal

There have been calls for healthcare organizations to take steps to improve security due to a major rise in hacking incidents, ransomware attacks, and vulnerability disclosures in 2021. Record numbers of healthcare data breaches were reported last year, and tens of millions of healthcare records were compromised.

Adhering to the minimum requirements of the HIPAA Security Rule and conducting risk analyses, having robust risk management practices, conducting vulnerability scans, and implementing technical safeguards such as intrusion prevention systems, next-generation firewalls, and spam filters are all important measures to improve cybersecurity and ensure HIPAA compliance, but it is also important to improve the human aspect of cybersecurity. Risky employee behaviors need to be eradicated and the workforce needs to be trained to be more security-aware and taught how to recognize common attacks that target individuals, such as phishing and social engineering.

The human aspect of cybersecurity is often one of the weakest links in the security chain, which has been highlighted by a recent study commissioned by New Zealand-based Mobile Mentor and conducted by the Austin, TX-based Center for Generational Kinetics. The aim of the study was to explore the Endpoint Ecosystem to understand how employees perceive privacy, productivity, and personal well-being in the modern workplace. The Endpoint Ecosystem is the combination of all devices, applications, and tools that are used by employees coupled with the experiences of employees using technologies.

The survey was conducted on 1,500 employees in highly regulated industries such as government, healthcare, education, and finance in the United States and Australia, and the findings are detailed in the Mobile Mentor report, The Endpoint Ecosystem – 2022 National Study.

Employees are Taking Security Risks

The survey confirmed what other studies have found – The pandemic has led to the workforce becoming much more distributed and employers have had difficulty adapting to this new way of working and ensuring security policies are implemented and enforced that are well suited to the change in how employees are working.

One of the major findings was a lack of awareness about security policies and a failure of employers to provide security awareness training to the workforce. 27% of employees said they saw security policies less than once a year and 39% said they receive security awareness training less than once a year. Healthcare and education employees were the least likely to see security policies and employees often felt they were not adequately trained to protect company data.

41% of respondents said security policies implemented by their employers restricted the way they work, and 36% of employees said they had found a way to work around security policies. The use of shadow IT – applications and services that have not been authorized by the IT department – was found to be out of control. Workers are routinely using unregulated apps and services for work activities, which can involve regulated data.  Employees commonly used services such as Gmail and Dropbox because they believe it makes them more efficient, even though the use of those services has an impact on security.

Interestingly, while remote working is viewed as a security risk, remote workers appeared to be much more tech-savvy, were more aware of security and privacy policies, and were more careful with their passwords. That said, workers are allowing family members to use their work devices – 46% of younger workers said other family members use their work devices.

The lines are getting blurred between device use for personal and work purposes. Overall, 64% of respondents said they use personal devices for work, but only 31% had a secure BYOD program.  57% of younger workers said they use work devices for personal use and 71% said they used personal devices for work. Many employers are failing to address the security risks associated with the use of personal devices for work purposes and work devices for personal use.

Poor Password Hygiene is a Major Security Risk

One of the main security risks identified in the study related to passwords. Poor password hygiene is a major security risk. 80% of cyberattacks start with a compromised password. One of the findings, mirrored by a recent IDC survey, is employees have too many passwords to remember. While password policies may be in place – and enforced – they are often circumvented. 69% of respondents said they choose passwords that are easy to remember, 29% of employees said they write down their passwords in a personal journal, and 24% said they store work passwords on their phones. While many of the security problems associated with passwords can be solved by using a password manager, only 31% of respondents used one.

The survey revealed employees are much more concerned about personal privacy than security, with healthcare employees the most concerned about protecting personal privacy. Mobile Mentor suggests that healthcare employers looking to improve security need to teach employees that privacy and security are two sides of the same coin.

“When the endpoint ecosystem works well, you have a secure, productive, and happy workforce. It’s always been important, but it became urgent over the last two years when the pandemic forced more people to work remotely, cybersecurity attacks increased, and the Great Resignation forced employers to rethink how they support their employees,” said Denis O’Shea, founder of Mobile Mentor. “Until employers prioritize the importance of each component within the Endpoint Ecosystem, their company security and employee productivity are going to be exposed to serious risk.”

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