Can the Health Care Industry Protect Itself from Cyberattacks?
By: Drew del Junco and Jesse M. Coleman
The health care industry is racing to adopt cutting-edge technology to provide patients with the best treatment possible at the lowest possible cost. But the rise in health care innovation has yielded unintended consequences: a sharp uptick in the number of cyberattacks that exploit the medical data of unsuspecting patients. While data breaches in the banking and retail space are well documented, breaches in the health care industry have not received the considerable media attention they deserve. Health care practitioners should be ever vigilant and proactive in protecting health data from unwanted intrusions.
Recent Health Data Breaches
Hackers and technology seemingly evolve in tandem. In 2017 alone:
U.S. Department of Health and Human Services (“HHS”) received 477 reports of health data breaches, which affected almost 5.6 million patient records. That’s an average of more than one breach per day throughout the year.
The single largest reported breach was the result of insider-wrongdoing in which a hospital employee inappropriately accessed the billing information of nearly 700,000 patients on an encrypted USB and CD.
An academic health center in Georgia was recently afflicted by two separate phishing attacks in which several employees inadvertently disclosed their login credentials to unscrupulous hackers, leaving the personally identifiable information (“PII”) and protected health information (“PHI”) of an estimated 417,000 people exposed. As a result, a wide range of PII and PHI was compromised, including names, addresses, dates of birth, diagnoses, medication and treatment information, and health insurance details.
A phishing attack at a California-based academic health center compromised the health data of approximately 15,000 patients after an employee responded to a phishing e-mail with login credentials, which the cybercriminal used to view patient data and send e-mails to other staff demanding large amounts of money. The breached data included names, addresses, and phone numbers, and in some cases Social Security numbers (“SSN”), medical record numbers, and diagnoses.
And in 2015, one of the largest health insurers in the U.S. suffered what was believed to be the biggest breach of a health care company to date: hackers stole information on 37 million patient records—including names, birthdays, street and e-mail addresses, SSN, employment information, and income data.
The Black Market for Stolen Medical Data is Thriving
Medical data is big business and is worth top dollar on the black market—up to $1000 per patient. The going rate for Social Security numbers on the black market is 10 cents and credit card numbers can fetch upwards of 25 cents. But electronic medical health records—which consist of demographic information and data about past medical history, including doctor’s visits and diagnoses—could be worth hundreds or even thousands of dollars. That’s because medical records are the most comprehensive records about the identity of a person that exist today. If stolen, medical records can be used to buy medical equipment or drugs—either of which can be resold—or to file fraudulent insurance claims. If that isn’t frightening enough, because medical records cannot be canceled, they lack the kinds of protection that credit cards and other financial information provide.
Whether used in a secure or open location, mobile devices like smartphones and tablets can offer hackers backdoor access to a medical group’s network. Although medical devices that connect to the Internet or Bluetooth have proven revolutionary for health care practitioners, because they may not have been network-ready originally, such devices may not be equipped with sufficient security protections to fend off hackers.
Moreover, a rise in the consolidation of health care services, via mergers and acquisitions, means more medical records are transferred and reviewed—sometimes on “legacy” systems that were never intended for digitization—offering plenty of opportunity for hackers to snatch them.
HIPAA Security and Breach Notification Rules
Promulgated in early 2003, the Health Insurance Portability and Accountability Act (“HIPAA”) Security Rule is designed to safeguard electronic protected health information (“ePHI”). Any entity covered by HIPAA is subject to the Security Rule, the purpose of which is to protect the availability, integrity, and confidentiality of ePHI. Any ePHI that a covered entity creates, receives, maintains, or transmits must be protected against reasonably anticipated threats, hazards, and impermissible uses or disclosures.
The HIPAA Breach Notification Rule mandates that covered entities notify patients when their ePHI has been compromised. If a breach of ePHI impacts more than 500 people, the Breach Notification Rule obliges the covered entity to promptly notify HHS and issue a notice to the media. If the breach affects less than 500 people, it must be reported to the web portal of HHS’s Office for Civil Rights (“OCR”), although any report need only be provided once a year. The following information should be included in a breach notification:
The nature of the ePHI involved, including the types of personal identifiers exposed;
If known, the unauthorized person who used the ePHI or to whom the disclosure was made;
Whether the ePHI was actually acquired or viewed (if known); and
The extent to which the risk of damage has been mitigated.
Breach notifications must be made without unreasonable delay (i.e., no more than 60 days after the breach is discovered). In addition, the covered entity is obligated to inform those affected of the steps taken to protect from potential harm, including a description of the efforts to investigate the breach as well as any actions taken to prevent further security incidents.
Mere compliance isn’t enough. HIPAA incentivizes health care providers to adopt secure networks by imposing large fines on providers who experience breaches of PHI as a result of a cyberattack. The cost and consequences of a breach are borne by the entity, rather than the cybercriminal. For example, as a result of a breach of ePHI affecting approximately 100,000 people, a private hospital system in Florida recently forked over approximately $5.5 million in fines to settle potential violations of HIPAA, and agreed to implement a robust corrective action plan. Besides being subject to potentially ruinous fines and penalties, the settlement process and implementation of a corrective action plan can itself be expensive, burdensome, and time-consuming.
Preventive Measures to Proactively Protect Health Data
While significant progress is being made, there is still much for health care organizations to do in order to ensure that the patient data entrusted to them is properly secured. What steps can the health care industry take to protect itself?
E-mail security measures should be leveraged to detect spam e-mails, phishing attempts, and other intrusions.
Access to ePHI should be limited only to authorized users, and procedures should be put in place governing the review, modification, and/or termination of users’ right of access.
Third-party vendors should install security patches on a more widespread basis for machines that record data such as CT scanners.
Old or unpatched operating systems should be upgraded so that medical facilities are less susceptible to cyberattacks.
Networks should be segmented—i.e., divided into subnetworks—to boost security.
Health care groups should implement “bring your own device” policies—such as allowed/banned apps and acceptable-use rules—for smartphones, tablets, and other mobile devices.
Employee training protocols should be increased to reduce the concern that employee negligence will contribute to a data breach, and staff should be sent frequent reminders to maintain cyber awareness.
Data should be backed-up regularly, encrypted, and safeguarded with multi-factor authentication.
Audit controls should be implemented and audit logs should be reviewed regularly.
Records of information system activity should be regularly reviewed, especially on applications that maintain ePHI.