A Deep Dive Into Phishing Scams: Protecting Your Business with SPIN

April was another particularly bad month for healthcare data breaches with 62 reported breaches of 500 or – the same number as March 2021. That is more than 2 reported healthcare data breaches every day, and well over the 12-month average of 51 breaches per month.

High numbers of healthcare records continue to be exposed each month. Across the 62 breaches, 2,583,117 healthcare records were exposed or compromised; however, it is below the 12-month average of 2,867,243 breached records per month. 34.4 million healthcare records have now been breached in the past 12 months, 11.2 million of which were breached in 2021.

Largest Healthcare Data Breaches Reported in April 2021

There were 19 reported data breaches in April that involved more than 10,000 records, including 7 that involved more than 100,000 records with all but one of the top 10 data breaches due to hacking incidents.

Ransomware attacks continue to occur at high levels, with many of the reported attacks affecting business associates of HPAA-covered entities. These incidents, which include attacks on Netgain Technologies, Accellion, and CaptureRX, have affected multiple healthcare provider clients.

The majority of ransomware attacks now involve data theft prior to file encryption, with the stolen data used as leverage to get breach victims to pay. Large quantities of data are stolen in the attacks. The top three data breaches of the month all involved the use of ransomware and involved 1.3 million healthcare records.

There has been some positive news this month. In the wake of the ransomware attack on Colonial Pipeline, multiple ransomware gangs appear to have ceased operations and at least two have now taken the decision not to attack healthcare organizations. This news should naturally be taken with a large pinch of salt, as similar promises were made by certain ransomware gangs at the start of the pandemic and attacks continued at high levels.

Causes of April 2021 Healthcare Data Breaches

Hacking/IT incidents, which include malware and ransomware attacks, dominated the breach reports in April 2021 and accounted for 67.74% of all reported breaches (42 incidents). These incidents involved 85.93% of all breached records in April. The mean breach size was 52,851 records and the median breach size was 6,563 records.

There were 17 incidents classed as unauthorized access/disclosures involving 358,870 records – 13.89% of all records breached in April. The mean breach size was 21,110 records and the median breach size was 2,704 records.

Loss and theft incidents continue but only at very low levels. There were just two reported cases of theft of devices containing PHI and one loss incident reported. 4,500 records were breached in these 3 incidents.

Network server incidents, most of which involved ransomware or malware, have overtaken phishing as the main cause of healthcare data breaches, although it should be noted that phishing emails are often the root cause of many ransomware attacks. There were 19 reported incidents involving PHI in email accounts, the majority of which were due to phishing or other forms of credential theft. One of the largest reported breaches in April was due to phishing and resulted in the exposure and potential theft of the PHI of 221,454 individuals.

According to the Verizon 2021 Data Breach Investigations Report, phishing attacks increased globally by 11% in 2020 and ransomware attacks increased by 6%. The report shows insider breaches in healthcare have continued to fall and are now not even in the top three breach causes. In 2020, 61% of healthcare data breaches were due to external threat actors and 39% were caused by insiders.

April 2021 Healthcare Data Breaches by Covered Entity Type

Healthcare providers were the worst affected covered entity with 30 data breaches of 500 or more records reported by the provider and a further 13 reported by a vendor. Business associate data breaches continue to be reported at high levels. There were 24 breaches involving business associates, with 10 of those breaches reported by the covered entity. 9 branches were reported by health plans in April, with one breach affecting a health plan reported by its business associate.

States Affected by Healthcare Data Breaches

HIPAA-covered entities and business associates based in 28 states reported breaches of protected health information in April. California was the worst affected state with 7 breaches reported followed by Michigan and Texas with 5 breaches. Florida, New York, and Wisconsin had 4 breaches, and there were 3 reported breaches in Massachusetts and Ohio.

Wyoming, the least populated U.S. state, only had one reported breach, but it affected a quarter of state residents.

HIPAA Enforcement Activity in April 2021

It has been a busy year of HIPAA enforcement by the HHS’ Office for Civil Rights with 6 financial penalties imposed to resolve violations of the HIPAA Rules; however, there were no new settlements or civil monetary penalties announced in April, nor any enforcement actions by state Attorneys General.

On May 13, 2021, President Biden signed an expansive Executive Order that aims to significantly bolster cybersecurity protections for federal networks, improve threat information sharing between the government, law enforcement and the private sector, and introduce a cyber threat response playbook to accelerate incident response and mitigation.

The 34-page Executive Order includes short time frames for making significant improvements to cybersecurity, with all elements of the Executive Order due to be implemented within the next 360 days and the first elements due in 30 days.  The Executive Order was penned following a series of damaging cyberattacks that impacted government departments and agencies, such as the SolarWinds Orion Supply chain attack and attacks on Microsoft Exchange Servers. The recent DarkSide ransomware attack on Colonial Pipeline served as yet another reminder of the importance of improving cybersecurity, not just for the Federal government but also the private sector which owns and operates much of the country’s critical infrastructure.

President Biden is planning to lead by example and is urging the private sector and critical infrastructure firms to follow the lead of the Federal government in improving resilience to cyberattacks and preparing for attacks to ensure that disruption to operational capabilities is kept to a minimum.

The key elements of the Executive Order on Improving the Nation’s Cybersecurity are:

• Removing barriers to threat information sharing to make it easier for private sector companies to report threats and data breaches that could potentially have an impact on Federal networks.
• Modernizing and implementing stronger cybersecurity standards in the Federal government. This includes widespread use of multifactor authentication, more extensive use of data encryption, the adoption of a zero-trust architecture, and a more rapid transition to secure cloud services.
• The creation of a standard cyber incident response playbook. Government departments and agencies need to know, in advance, how to respond to threats. The playbook will ensure a rapid and uniform response to any cybersecurity incident.
• Improvements to investigative and remediation capabilities. Detailed security event logs must be maintained by federal departments and agencies to ensure that cyberattacks can be easily investigated and remediated. Breach investigations have previously been hampered due to the lack of robust and consistent logging.
• Improving software supply chain security. All software sold to the U.S. government will need to adhere to new security standards. Developers will be required to maintain greater visibility into their software solutions and make security data publicly available. The government will also launch a pilot “energy star” label program to demonstrate whether software was developed securely.
• A Cybersecurity Safety Review Board will be created that consists of government and private sector leads that will meet following any significant security breach to analyze what has happened. Recommendations can then be made and implemented to ensure similar attacks are prevented in the future.
• Improvements to cyber incident detection capabilities. A government-wide endpoint detection and response system will be implemented, along with robust intra-governmental information sharing.

“This Executive Order makes a significant contribution toward modernizing cybersecurity defenses by protecting federal networks, improving information-sharing between the U.S. government and the private sector on cyber issues, and strengthening the United States’ ability to respond to incidents when they occur,” explained the Biden Administration in a statement about the Executive Order. “It is the first of many ambitious steps the Administration is taking to modernize national cyber defenses.”