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Insights into Healthcare Industry Cyber Threats and the Supply Chain Supporting Criminal Activity

Throughout the pandemic, cybercriminals have taken advantage of new opportunities and have been attacking hospitals, clinics and other businesses and organizations on the front line in the fight against COVID-19.

Ransomware attacks on the healthcare industry soared in 2020, especially in the fall when a coordinated campaign claimed many healthcare victims. Ransomware remains a major threat to the healthcare sector and the high numbers of attacks have continued into 2021.

A recent report from the CTI League provides further information on these attacks and some of the other ways the healthcare industry was targeted in 2020. The report highlights the work conducted by the CTIL Dark team, which monitors the darknet and deep web for signs of data breaches and cybercriminal activity that has potential to impact the healthcare industry or general public health.

This is the first report to be released that highlights the discoveries and achievements of the CTIL Dark team, and delves into realm of healthcare ransomware attacks and the dark markets where access to healthcare networks are traded.

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In 2020, the CTIL Dark team’s research determined the main ransomware gangs targeting the healthcare sector to be Maze, Conti, Netwalker, REvil, and Ryuk. Between these five operations more than 100 ransomware attacks were conducted on the healthcare sector, two thirds of which were in North America and Europe. The attacks by these groups accounted for 75% of all attacks on the sector in 2020.

The increase in ransomware attacks in 2020 was attributed to the ease at which the industry could be attacked and the increased prominence of the industry during the pandemic, and no healthcare organization was immune. In fact while attacks on large healthcare organizations with the means to pay large ransom demands were favored, in the fall there was a significant increase in attacks on small- to medium-sized hospitals and clinics.

Ransomware attacks tend to dominate the news reports due to the major impact these attacks have on healthcare providers and their patients. Hospitals are forced to switch to pen and paper, appointments often have to be cancelled, and patient information is frequently leaked online and made available to a wide range of cybercriminals. What is less well understood is the supply chain that makes many of these attacks possible.

During the pandemic, demand for backdoor access to healthcare networks increased considerably, as did the number of criminals providing access. The supply chains established to provide credentials for healthcare networks to ransomware gangs and other threat actors saw the barrier to entry into cyberattacks on the sector significantly lowered.

2020 saw an increase in the number of Initial Access Brokers. These are the hackers who target and breach vulnerable networks and sell on access to the highest bidder, including ransomware gangs and their affiliates. The CTIL Dark team reports a doubling of the number of Initial Access Brokers between Q2, 2020 and Q4, 2020. Skilled hackers that can breach healthcare networks often sign up to ransomware-as-a-service operations as affiliates themselves. In 2020, several RaaS operations started recruitment drives targeting individuals who already had access to healthcare networks and could conduct large numbers of attacks.

A separate report recently published by Digital Shadows confirms the increase in activity by Initial Access Brokers and claims the average price for a set of RDP credentials that provide access to company networks is $9,765, with the price increasing based on the number of machines that can be accessed with the credentials.

The CTIL Dark team notes that ransomware attacks are becoming more extensive, targeted, and coordinated, with threat groups often partnering and sharing resources and information. In 2020, the ransomware activity investigated by the team most commonly involved attacks on perimeter vulnerabilities such as unpatched systems and weak passwords in remote connectivity solutions, rather than phishing attacks.

The CTIL Dark team also identified an increase in the number of databases containing PHI being sold on darknet forums for use in targeted attacks on patients, and employee databases for targeting healthcare employees to gain access to healthcare networks.

Phishing attacks increased in 2020, with opportunistic threat actors abandoning their regular campaigns and switching to COVID-19 themed campaigns that closely mirrored equipment shortages and knowledge gaps. Scams were conducted in response to the shortage in COVID-19 tests and PPE, followed by fake offers of antibody blood. When hydroxyquinoline was touted as a game changer for COVID-19 treatment, darknet vendors switched from offering cocaine to offering doses of the drug. Now, as the vaccine rollout gathers pace, scammers have switched to offering fake vaccines.

CTIL has predicted attacks targeting the healthcare sector will most likely increase in 2021 rather than decline, so it is essential for healthcare organizations to remain on high alert and leverage data from cybersecurity vendors, health-ISACs, law enforcement, and organizations such as CTIL league and implement policies, procedures, and protections to combat these threats.

Author: Steve Alder is the editor-in-chief of HIPAA Journal. Steve is responsible for editorial policy regarding the topics covered on HIPAA Journal. He is a specialist on healthcare industry legal and regulatory affairs, and has several 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.