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The HIPAA Journal is the leading provider of HIPAA training, news, regulatory updates, and independent compliance advice.

HPH Sector Warned About Email Bombing Attacks

Healthcare organizations have been warned about the threat of email bombing attacks, which are a type of denial-of-service (DoS) attack that targets email systems. As with other types of DoS attacks, the aim is to render systems unavailable. These attacks, also known as mail bomb or letter bomb attacks, usually involve a botnet – a network of malware-infected computers under the control of an attacker.

Once a target is selected, an email server is flooded with hundreds or thousands of email messages that overload the email system. These attacks are an inconvenience for the victim; however, these attacks can hide other malicious activities. For example, security warnings may be hidden within all the emails making it easier for those warnings to be missed. Those warning emails may be about account sign-in attempts, updates to account information such as changes to contact information, information about financial transactions, or online order confirmations. These attacks can also be used as a smokescreen to draw the attention of security teams while other systems are attacked. When email servers are targeted in email bombing attacks, network performance is often downgraded which can potentially lead to direct business downtime.

There are various types of email bombing attacks, one of the most common of which is registration bombs. These attacks use automated bots to crawl the web to find newsletter sign-up forms on legitimate websites. The targeted user is then signed up to hundreds or thousands of newsletters all at once, resulting in the user getting a steady flow of unwanted emails. An alternative form of this attack involves link listing, where email addresses are added to multiple subscription services that do not require verification. These attacks can result in emails being received for months or even years after the initial attack. In addition, victims’ email addresses are often added to various smalling, phishing, and malware lists.

Attachment attacks involve sending multiple emails with large attachments, which are designed to slow down mail delivery and overload server storage space, rendering email servers unresponsive. A zip bomb attack, aka a decompression bomb or zip of death attack, involves a large, compressed archive being sent to an email address, which consumes available server resources when decompressed, thus impacting server performance. Email bombing attacks may be conducted by a single actor or a group of actors, and threat actors offer these types of services on the dark web. One well-known seller of these services charges $15 for every 5,000 messages, with costs reducing based on the volume of messages required. E.g. $30 for 20,000 messages.

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In a recent HC3 Sector Alert, the HHS Health Sector Cybersecurity Coordination Center (HC3) provided an example of a damaging attack in 2016 where an unknown group of assailants subjected thousands of  .gov email inboxes to an email bombing attack that used subscription requests for legitimate companies. The attack rendered the email system unavailable for several days. “Organizations and individuals are encouraged to implement protections, security policies, and address user behavior in order to prevent future attacks,” said HC3. “Given the potential implications of such an attack on the HPH sector, especially concerning unresponsive email addresses, downgraded network performance, and potential downtime of servers, this type of attack remains relevant to all users.”

HC3 offered advice on how to defend against these attacks and mitigations for organizations that experience an email bombing attack. To defend against attacks, user behavior, and technical processes are suggested, such as covering these types of attacks in security awareness training and advising employees not to sign up for non-work-related services with their work email addresses. Online exposure can also be limited by using contact forms that do not expose email addresses. Employees should be told how they can recognize an attack in progress, and if one occurs, told never to engage as doing so can easily result in escalation. In the event of an attack, employees should immediately contact their IT or cybersecurity team.

Businesses can protect against these attacks using reCAPTCHA, which determines if a human is using the platform. reCAPTCHA prevents bots from hijacking sign-up processes that could facilitate email bombing attacks. In the event of an attack, email administrators should contact their email provider, who may be able to offer assistance in deleting the spam/junk emails from the email system.

Author: Steve Alder is the editor-in-chief of The HIPAA Journal. Steve is responsible for editorial policy regarding the topics covered in The HIPAA Journal. He is a specialist on healthcare industry legal and regulatory affairs, and has 10 years of experience writing about HIPAA and other related legal topics. Steve has developed a deep understanding of regulatory issues surrounding the use of information technology in the healthcare industry and has written hundreds of articles on HIPAA-related topics. Steve shapes the editorial policy of The HIPAA Journal, ensuring its comprehensive coverage of critical topics. Steve Alder is considered an authority in the healthcare industry on HIPAA. The HIPAA Journal has evolved into the leading independent authority on HIPAA under Steve’s editorial leadership. Steve manages a team of writers and is responsible for the factual and legal accuracy of all content published on The HIPAA Journal. Steve holds a Bachelor’s of Science degree from the University of Liverpool. You can connect with Steve via LinkedIn or email via stevealder(at)hipaajournal.com

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