Attacks on Insurers: Lessons Learned

The latest revelation of a cyber-attack on a health insurer - this time Excellus BlueCross BlueShield - illustrates why it's so important for healthcare organizations to frequently scrutinize systems for intrusions.  The Excellus breach, which potentially exposed information on 10.5 million individuals, was discovered on Aug. 5 but apparently dates back to December 2013. Earlier, insurers Anthem Inc., Premera Blue Cross and CareFirst Blue Cross Blue Shield also reported massive breaches that went undetected for extended periods. The four breaches combined potentially exposed information on more than 100 million individuals.  The frequency of breaches in the healthcare industry shows that cybercriminals are targeting the sector.

Primary Motives

So, what's the likely motivation for the string of attacks on health insurers?

Insurance records are rich in personal health information, making them exploitable for insurance fraud and prescription fraud.  There is more sensitive information being leaked, which in turn provides attacker an added incentive into selling that information. The disclosure of Social Security numbers and other data points such as income, employment status and birth dates allow criminals to create numerous fraudulent credit card accounts, causing the victim additional fallout that can continue for many years to come.

One theory that some experts offer is that over the past 12 to 18 months, attackers operating from China have been hacking multiple sources to build databases of information relating to U.S. residents, potentially for espionage purposes. But others caution that attributing the source of any cyber-attack is tricky.

Excellus Breach

The attack on Excellus was discovered on Aug. 5 after the health insurer, which is based in Rochester, N.Y., hired cybersecurity firm Mandiant to conduct a forensic assessment of the company's IT systems in the wake of multiple health insurers belatedly discovering that their systems had been breached and member data stolen, according to a company spokesman. Forensic experts have determined that the cyber-attack on Excellus began in December 2013, the spokesman says.

Although the affected data was encrypted, the hackers gained access to administrative controls, making the encryption moot, the company spokesman says.

While health plans, especially those affiliated with Blue Cross Blue Shield, appear to be a huge target for hackers, other segments of the healthcare sector are also in the bullseye. For instance, in July, healthcare provider UCLA Health revealed that a cyberattack on parts of its network compromised personal information of 4.5 million patients. UCLA Health says it appears that the attackers may have had network access as early as September 2014.

Healthcare providers are just the latest targets in the information battle with malicious adversaries. Financial service and defense contractors have been battling these adversaries for years. The lessons learned that can be applied to health insurers is to evaluate the value of the information being stored and focus the most stringent security controls around that data. For health insurers that is the personal information of clients.

First and foremost, make certain you are handling the basic blocking and tackling - for example, employee security training, access control and configuration management - before you try to do anything more sophisticated. Many breaches come through phishing, an exploited vulnerability or username/password theft.

Treating Health Information Security as 'Essential'

One of the most important lessons emerging from the recent string of major cyberattacks in the healthcare sector is the need for executives to treat information security as an essential component of business operations.  Healthcare is becoming a bigger target for hackers because hospitals, health insurers and others are rich sources of data.

In recent months, hackers have launched major attacks on a number of healthcare entities. Those include UCLA Health, which on July 17 reported a hacker attack that affected 4.5 million individuals; Anthem, which was hit by a hacker breach affecting nearly 80 million individuals; as well as Premera Blue Cross and CareFirst Blue Cross Blue Shield.

Healthcare organization are being targeted because they have not only treatment information, but you have high levels of personally identifiable information - not just Social Security numbers, but other information that can be used to answer security questions and better pretend to be the victim/consumer.

Another reason hackers are targeting healthcare is that most organizations in the sector have less mature security programs than those in other sectors, such as financial services.

One of the biggest mistakes that healthcare organizations are making is taking too narrow a view of information security, seeing it as only an infrastructure issue. The reality in this evolving electronic information economy is that information technology and information security have become a fundamental component of the day-to-day business. Because of this misunderstanding of information technology and information security, the right mentality and resources are not being applied.

So the change that needs to occur is seeing information security as an essential part of the business operations. And healthcare ... will begin to see that patients will demand better information security, and regulators will begin to punish those institutions that haven't done a good job.

Ultimately, senior executives must develop a better understanding of the importance of information security. Once that happens, then you can start delving into some of the details of what a sound information security program requires, and healthcare can start making some of the fundamental changes we've been seeing in other markets.

Healthcare Resources - Keeping Security Strategy Healthy

As the healthcare industry constantly evolves, every component of operational support must evolve as well. Security is one critical area that must strive to keep pace with industry changes, stay current with regulatory compliance mandates and utilize data to stay ahead of the curve. When intelligence is culled, analyzed and viewed as a source of continuous improvement, proactive security programs are the result.

What trends and data do healthcare security professionals need to assess?

Trade Associations: The International Association for Healthcare Security & Safety (IAHSS) and ASIS are key drivers in establishing protocol to assess measure and implement healthcare security strategy; and provide information and resources.

National Resources: Workplace violence in healthcare is a growing concern. According to the Bureau of Labor Statistics, nearly 60 percent of all nonfatal assaults and violent acts in the workplace occurred in the healthcare and social assistance industry. The Occupational Safety and Health Administration (OSHA) offers Workplace Violence Safety and Health Topics Page with information that can help security professionals effectively evaluate their workplace.

Regulatory Agencies: An effective healthcare security program must be in-tune with and apply the direction of a variety of accrediting bodies including OSHA, The Joint Commission, CMS, DNV, and NFPA, as well as state and local regulators.

Local Data: Analysis of what is happening in the community is essential. Crime statistics, population trends, community events, and anticipated weather events can help the facility’s security team be more prepared.

On-site Trends: Ongoing review of security trends can aid in the evolution of security strategy and security officer deployment that is predictive, rather than reactive. Frequent incidents in particular area of a hospital could be addressed with a change in procedure or staffing.

Security Best Practices: In addition to industry benchmarks, information and best practices shared among peers creates additional opportunities for continuous improvement and success.

A data-driven approach to security must be comprehensive and cognizant of the evolving nature of the industry and the facility. Review and then ask yourself… what additional information do I need to continue to move my security program forward?

Social Engineering in HealthCare

The weakest link in an information security program is people. Hackers have known this for a long time and have refined the art of social engineering. By convincing someone to do something that isn’t in their best interest, malicious individuals are able to launch devastating attacks on organizations.

One method in which the hackers prey on their victims is through phishing. This attack vector utilizes electronic communication that appears to be trustworthy. Through this vehicle, hackers attempt to obtain sensitive information about their victims such as credentials, credit card information, and even more coveted protected health information.

The healthcare industry has always been about helping people; however, when it comes to privacy and security, being too helpful isn’t always a good thing. Partners Healthcare realized this when a group of their employees fell victim to phishing emails. Hackers were able to convince some of Partners’ employees to engage with them through an email on November 25, 2014 allowing the hackers to gain access to the employees’ email accounts. This eventually led to the compromise of approximately 3,300 patient records.

In another unfortunate example, Texas-based Seton Healthcare Family, a part of Ascension Health System, became a victim of a compromise of protected health information on 39,000 patients when an employee opened an email that turned out to be a phishing scam. This wasn’t the first time Seton Healthcare had been breached; in 2013 the health system reported the theft of an unencrypted laptop. Since 2007, they had two additional breaches: one again involving a stolen laptop affecting 10,300 patients and a breach by a third-party vendor involving more than 500 patients where member cards were sent out to the wrong members.

St. Vincent Medical Group fell victim to a phishing attack targeting employees. A statement posted on their website indicated that they discovered an employee’s email account had been compromised around December 3, 2014. As of March 12, 2015, they uncovered the compromised email account that contained personal health information on approximately 760 patients.

With the ease of phishing and the high returns that can be achieved by using this technique, security professionals fear that these types of threats will increase in 2015. With health data becoming more valuable to hackers on the black market and the belief that the healthcare industry is not ‘up to par’ with security as other industries, the healthcare industry will continue to see an increase in attacks. 

Protecting Patient Records in an App-Happy Healthcare World

Medical identity theft is the fastest growing type of identity theft. It is more lucrative from the bad guy's point of view, and it's also very hard to detect.  Detection is a growing problem for those IT and security operations centers working within healthcare organizations. By law, they must protect patients' and providers' electronic records. At the same time, there's growing pressure to expand the security architecture to accommodate more access to on-demand services.  This is particularly true when it comes to mobile devices, where a loss or theft can carry serious consequences.

Healthcare IT, in general, is typically slower to adopt new platforms to support emerging technologies, in part because potential disruptions in services could mean life or death. They also have a highly fluid user base. But the proliferation of on-demand patient portals, healthcare exchanges, fitness-related wearable technologies and health-oriented mobile applications are pressing forward, with or without IT's blessings.

The whole issue with security portals and making sure we have the appropriate security around them is absolutely paramount.  All regulated industries struggle continually to meet consumer demands and compliance mandates.

Medical records are under more intense scrutiny today in part because of two recent breaches: Anthem, the largest for-profit managed care company in the Blue Cross Blue Shield portfolio; and Premara Blue Cross, headquartered in Washington. Between the two, almost 100 million customers are now at risk of identity theft.

A stolen record may be worth $1 on the black market, whereas a stolen health record may fetch $5. Why?  It's got all the information on someone to steal their identity and use it to get at a lot of other areas.

Like many other security issues, education and awareness are key to improving the security posture of any organization. For health IT, helping patients, caregivers and providers understand mobile device security best practices is a good start. Consider training and requiring users on the following safeguards to minimize risks:

Authentication. As a policy, users should set up multi-factor authentication to access apps holding personal health information and credentials. Make sure those who use PINs or passwords are set up to mask the codes as they are entered to reduce the chance of visual hacking.

Encryption. Show mobile users how to install encryption to protect healthcare and financial data stored on their smartphones, tablets and laptops.

Enable Remote wipe. If the device is company-owned, consider installing technology to remotely erase data or disable an app if you believe it is at substantial risk of a compromise.

Block downloads. This is a little tougher for healthcare organizations, which may need to share files for legitimate purposes. But consider as a policy disabling non-essential applications to narrow the risk of exposure.

Install security software. Many consumers realize the need on their desktops or laptops but fail to install antimalware software, firewalls, VPNs or other security basics on their mobile phones. A little encouragement can go a long way. So does accepting security updates when a request pops up on their phones or tablets.

Discourage public Wi-Fi use.  Password-protect a facility's wireless network and warn people to avoid accessing, receiving or transmitting private patient data in places with unsecured Wi-Fi. Similarly, if you are in a public setting or where there's public access, a screen shield will keep private patient health data away from prying eyes.

Lock the device when not in use. And use automatic log-off.   For many years, I used to tell my people, You are in healthcare. You aren't working for IBM or Symantec. At the end of that server or PC is someone's life, and that changes their whole perspective.

Raising Cyber Security Awareness for Healthcare Professionals

A large percentage of the reported breaches can be traced back to human error. Physical security controls break down because a door is left open. Technical controls break down because a user ID or password is posted via a sticky note on a computer monitor or because account credentials are shared and the task at hand absolutely positively need to be done right now.

Professionals working in the healthcare industry possess a zeal for protecting the health of their patients and improving how that support is provided. No legitimate employee wants to intentionally do something to adversely impact the health of a patient.

Health IT is about promoting the use of IT to support the healthcare mission. Health IT is all about providing high-quality care more efficiently, faster and cost effectively by using software and hardware technologies that have transformed countless other industries. However, these technologies cannot be deployed without considering the potential new cyber risks introduced to an organization.

An obvious manifestation of healthcare IT is the continuing transition from paper-based records to digital health records. But it does not end there, as wireless technologies have enabled medical devices to become extended diagnostic and reporting nodes on an increasingly networked IT infrastructure that shares patient medical records, billing records, financial records and burgeoning software applications—all accessing databases housed in common server structures.

How can this extended enterprise be protected? One approach can be extracted from the "Stop. Think. Connect" campaign administered by the U.S. Department of Homeland Security (DHS). The intent is not to make everyone a cyber security expert or to unduly raise fear, uncertainty and doubt—the intent is to bring some sense of awareness of cyber security to the general population. The goal of this campaign is to make someone think—even for half a second—before they take action online.

Do you have a secure connection to the server where you are about to input your credit card information? Are you authorized to access the data records you are about to request? Should you post personal information online for anyone to see? Simply hesitating to consider your actions before blindly clicking on that link can help prevent obvious human errors from occurring.

The board of directors of a healthcare organization has a myriad of concerns—providing sound patient care, maintaining financial viability and leveraging IT to enhance their operations. Just like healthcare professionals run their departments, the IT infrastructure should utilize cyber security experts cognizant of the constantly evolving threats and mitigating the resultant risks to the organization. As there is never enough budget or staff to throw at a non- mission essential, yet critical, area such as cyber security—how can the board cope?

Raise the cyber security awareness of the overall organization with role-appropriate cognizance of the consequences of individual actions and how easily one click on an inappropriate link can compromise an entire network—ultimately leading to the compromise of personal health records.

What is one effective way to overcome this challenge? Establish a cyber security awareness program.

Creating and operating a cyber security awareness program to have individuals realize that they play key roles in protecting the digital health of patients—just as they play direct roles in protecting the physical health of patients. 

What will it take to prioritize security in HealthCare?

With security breaches dominating news headlines daily, those responsible for securing our systems, networks, and devices are struggling to keep pace with the evolving threat landscape. Perhaps some of the most concerning potential breach data comes from the healthcare industry where we entrust our most personal information—social security number, birth date, medical history—as well as our immediate family members’ sensitive information to medical care providers. Further, medical devices rely on secure IT networks to function properly and deliver continuous, critical care to patients with heart conditions, diabetes, and other ailments. In the event of a security breach, the malfunction of devices could have potentially life-threatening consequences.

So what can we do to create a more secure environment for protected health information and equip healthcare IT staff with the security skills they need to fulfill this task?

First, we must start with a level of awareness. Calling attention to the alarming number of data breaches in today’s healthcare industry certainly helps the cause. According to Redspin’s Breach Report 2013 – Protected Health Information (PHI), the number of PHI breaches were up 138 percent from 2012, with 199 incidents reported to the U.S. Department of Health and Human Services (HHS), impacting over 7 million patient records. HHS even has a “wall of shame” webpage for the world to see lists of U.S. healthcare organizations that have had a security breach of protected health information affecting more than 500 individuals.

Part of the problem with security awareness lies in current processes, which don’t take into account how to mitigate fraud or medical identity theft.  If a patient’s healthcare record is compromised by someone who stole the identity to receive care and consequently had false information entered into that patient’s electronic health record, there’s no process in place that allows medical providers to go in and fix the record because it’s considered a legal document. Right now, we’re still at the awareness level for security and what has to be done is to help hospitals and other healthcare organizations recognize when an instance of medical identity theft has occurred so they can improve processes to protect patients.

Medical records are more susceptible to identity theft because the online systems for medical records and the networks on which they operate are not as locked down and sophisticated as other industries. We must also realize that healthcare is one of the last industries to move data from paper to online systems. Many physicians still use paper records for their patients. And others are only beginning the process of transitioning patient records to digital systems.

When it comes to educating healthcare IT staff, they need the resources, experience, and continuous drive to ensure they possess the latest knowledge and skills required to secure protected health information.  Many stressed the lack of security even at the basic awareness level in their organizations.

Let’s face it, making security a priority for the healthcare industry won’t happen overnight. It will require a concerted effort that begins with security awareness, followed by education and training of healthcare IT staff, and finally adoption and acceptance from the healthcare industry to create a secure digital environment for protected health information.