Should we be worried

About state-sponsored attacks against hospitals?

Security and the Board Need to Speak the Same Language

How security leaders speak to thier C-Suite and Board can make all the difference

The Rising Threat of Offensive AI

Can we trust what we see, hear and are told?

Who'd want to be a CISO?

Challenging job, but increasingly well paid

Medical Tourism - Growing in Popularity

Safe, fun, and much, MUCH more cost-effecitive

The Changing Face of the Security Leader

The role is changing, but what does the future hold?

Cyber Risk Insurance Won't Save Your Reputation

Be careful what you purchase and for what reason

Hospitals Targeted by Cyber Attack During Covid Crisis

Cyber-criminals and pariah nation-states are taking advantage of the disruption caused by the pandemic to run amok. 

Few things elicit the question of ethics than a lawyer chasing an ambulance leaving a road traffic accident or a hacker targeting a hospital during a global crisis, but the latter is precisely what has been happening since February.
The public and government officials alike, are outraged that cyber criminals would target health systems during a time of global pandemic crisis.

Increase in Cyber Attacks Against Healthcare

As our brave doctors and nurses fight each day to save lives those infected with the coronavirus, hackers and pariah nation-states fight each day to break into our health systems and research centers working on a vaccine or a cure. Ironically, both the virus and many of those engaged in the theft of research into a vaccine appear to come from the same country.

Photo: H.Shaw
Between the months of February and May of this year, there have been 132 reported breaches of healthcare covered entities, according to the HHS. This is an almost 50% increase in reported breaches during the same time last year. Perpetrators appear to be taking advantage of a distracted often remote workforce easily susceptible to phishing and other scams, or gaining access to hospital networks through insecure medical devices and other healthcare IoT systems. "These systems are notoriously difficult to secure and are an acknowledged cybersecurity risk," claimed Tim Ozekcin, CEO of biomedical security company, Cylera.

In a letter this week signed by international political and business leaders, the International Committee of the Red Cross called for governments to take “immediate and decisive action” to punish cyber attackers.

“There are more and more cyberattacks...on the healthcare sector and unless there are really strong measures taken, they will continue,” said Cordula Droege, chief legal officer at the ICRC. “What we’re seeing at the moment are still indications of how devastating it could be.”

Also this week, NATO, issued a statement condemning the "destabilising and malicious cyber activities directed against those whose work is critical to the response against the pandemic, including healthcare services, hospitals and research institutes. These deplorable activities and attacks endanger the lives of our citizens at a time when these critical sectors are needed most, and jeopardise our ability to overcome the pandemic as quickly as possible."

Invoking its founding principle of Collective Defense and its’s more recent Cyber Defence Pledge, NATO confirmed that it is ready to take action against the perpetrators of these cyber attacks.

"Reaffirming NATO's defensive mandate, we are determined to employ the full range of capabilities, including cyber, to deter, defend against and counter the full spectrum of cyber threats," NATO said.

The World Health Organization has reported a 500% increase in cyberattacks on its systems during the spread of the Coronavirus pandemic through April compared with the same period last year, and has been dealing with a major email security breach at the same time while trying to deal with the largest pandemic to hit the world on over a century.

So far this year, the U.S. Department of Health and Human Services has investigated 177 data-breach incidents at medical organizations, nearly double the 91 under investigation in the same period in 2019.

Photo: Lianhao Qu

Opportunistic Rise in Cyber-Crime

Cyber-crime appears on the rise everywhere while most of us are out of our comfort zone working from home or otherwise disrupted. According to the FBI, the number of reported cybercrimes has quadrupled for the period of December - April compared to the same period last year. The FBI’s Internet Crime Complaint Center, known as the IC3, has been swamped with 3 to 4 times the usual number of calls each day as COVID-19 spread across the United States.

According to Tonya Ugoretz, Deputy Assistant Director of the FBI Cyber Division, "there was this brief shining moment when we hoped that, you know, 'gosh cyber criminals are human beings too,' and maybe they would think that targeting or taking advantage of this pandemic for personal profit might be beyond the pale. Sadly, that has not been the case," she reported.

The US FTC has reported that approximately $12 million has been lost due to Corona-virus-related scams since January. But it’s not just the US that has been targeted either. One man in Singapore tried to abscond with €6.64 million from a European pharmaceutical company after taking an order for surgical masks and hand sanitizer that he had no intention of delivering. Thanks to the quick actions of Interpol and Singapore authorities the money was returned and the man arrested.

“We’re very concerned now that we have these very sophisticated actors - nation-states, particularly China and Russia - targeting Covid-19 research, treatment protocols and vaccine development,” said John Riggi, Strategic Advisor for Cybersecurity and Risk at the American Hospital Association.

The message to watch out for potential theft of intellectual property has gone out right across the industry, especially by sophisticated nation-state actors according to officials at a number of leading academic medical centers. "Its like we're fighting two battles at the same time - the Covid-19 pandemic and defending against an escalation in cyber attacks against healthcare, " claimed Chad Wilson, CISO of Stanford Childrens' Hospital.

Hundreds of fake domains have been registered by criminals with names to entice the unsuspecting to click a link to a coronavirus news site, health and well-being site, to a charity site supporting everything from animal shelters for abandoned pets to food banks for the suddenly unemployed. At least one has even attempted to purport to be part of the Centers for Disease Control in Georgia otherwise known as the CDC. And there have been a whole range of scam sites setup to supply N95 masks, rubber gloves and other personal protective equipment (PPE) where users place an order never to see any goods – only fraudulent transactions on their credit cards. Many hospitals have also been defrauded in similar ways, receiving sub-par equipment from mainly Chinese manufacturers or none at all.

Intellectual property theft especially at hospitals and research institutes working on investigation of the virus or potential vaccines for COVID-19 has also been rife, especially from so-called international partners, some of whom may have been already compromised. Nation-state-actors are focused on gathering information about the response of US states to the ongoing pandemic and the progress of the research on vaccines with more than one nation-state appearing to be involved.

Photo: CDC

Healthcare & Medical Research Targeted

Most alarmingly though, is a spate of targeted ransomware attacks against hospitals. Last month a number of Czech hospitals and medical research centers were attacked, by as yet unknown perpetrators in what is thought to be a combined infiltration-theft and ransomware attack. The attack breached one of the major Czech COVID-19 testing laboratories at Brno University Hospital in the city of Brno in Moravia. According to Reuters,“The country’s NUKIB cybersecurity watchdog said the attacks, designed to damage or destroy victims’ computers by wiping the boot sector of hard drives.” The similarity with Russian FSB and GRU attacks against Ukrainian and other targets last year would tend to indicate nation-state involvement as would the boot sector wiping first attributed to the Russian GRU's 'Not Petya' attacks.


Colorado Medical Center Hit

But ransomware attacks against hospitals have hit closer to home. At least one US hospital has been hit in the past week by ransomware that encrypted its entire EMR system and its local backups. This was not a random broadcast attack but one carefully crafted against a known Pueblo, Colorado hospital with a un-patched perimeter. The hospital and many of its IT systems are still off-line at the time of writing this post and patient care is still being impacted by the attack. Its website came back up as we were about to go to press with the following message to the community.

This represents a daring escalation by cyber extortionists and risks a very real response by the United States. A mere two days before Parkview was hit, Mike Pompeo, US Secretary of State warned that there would be "zero tolerance" for such attacks.

"As the world battles the COVID-19 pandemic, malicious cyber activity that impairs the ability of hospitals and healthcare systems to deliver critical services could have deadly results," Pompeo said. "Anyone that engages in such an action should expect consequences," he added.

Drawing a Line in the Sand

Whether the pandemic cyber-attacks are just highly opportunistic criminals with no moral compass, or are a deliberate escalation of the hybrid warfare executed by a few pariah nation-states that have been pushing the boundaries of acceptability over the past few years, the perpetrators are treading on very dangerous ground.

Attacks against national critical infrastructure risk a very different kind of response from governments the world over. Just over a year ago, the Israeli Defense Forces dealt a very firm blow to nefarious cyber actors planning an attack on Israel with an air strike that wiped out HamasCyberHQ flattening the building and all inside.

HAMAS CyberHQ. Photo: Forbes

The US has also taken out a number of cybersecurity adversaries with drone launched hellfire missile attacks in Syria over the past few years. In fact, the US has reserved the right to retaliate against cyber-attacks with military force since 2011. The prospects therefore, for those cybercriminal elements that deliberately target US hospitals and medical research facilities obviously don't look too good.

Whether, and how, the US and other countries decide to respond to attacks against life-sustaining critical infrastructure like hospitals and healthcare research is a topic of hot debate. One issue is the problem of attribution. It's difficult to positively attribute an attack to an individual or a group, especially when more sophisticated attackers are good at covering their tracks or leaving breadcrumbs that point to others. Its also time-consuming, meaning that many years can go by before the culprit of an attack can be finally identified and dealt with.

Once identified, however, there are a wide range of options open to governments, extradition being only one of them. The international rule of law is opaque at best and needs to meet different standards and evidentiary bars in each country and its respective legal system. Even then, some people are considered beyond the law due to their connections. Some countries, notably Russia and other former communist block states, lack extradition treaties with the rest of the world. Going after perpetrators via legal means in the Peoples Republic of China or North Korea is also senseless as they usually operate at the behest of the state, unlike Russia which employs freelance proxies in order to claim plausible deniability. Therefore, governments sometimes need to employ other methods, as Bobby Chesney the co-founder of the Lawfare blog and a highly respected figure in US national security circles, explained during a recent podcast. (Chesney is the Charles I. Francis Professor in Law at The University of Texas School of Law, where he serves as the Associate Dean for Academic Affairs and teaches courses relating to U.S. national security and constitutional law.)

According to Chesney, there are many perfectly legal avenues for US government agencies to pursue in the apprehension of cybercriminals that attack critical US Infrastructure, especially at a time of declared national emergency. "There is an unpublished line in the sand that if crossed could mean significant consequences for those that do" he claims.

That includes a wide range of punitive measures including black ops, as Roman Seleznev the son of a close Putin ally who was widely regarded as being beyond the law in Russia found out in 2017. Renditioned to the USA, tried and convicted of cybercrimes in at least two different states, Seleznev has the next 27 years to look forward to as a guest of the US prison service.

Photo: NIST Cybersecurity Framework (CSF)

A Change of Focus

Recognizing that not all cyber attacks can be prevented, many CISOs are focusing more of their attention on the Detect, Response and Recover segments of the NIST CSF. Their focus is on limiting damage and restoring functionality as quickly as possible to minimize impact. "Every minute a critical hospital system is down could mean patient lives, so speedy restoration is critical," claimed Esmond Kane, CISO of Steward Health. "The fact that a breach occurred or a perpetrator was able to gain access to the network and HIT systems, is of secondary concern once systems are back up and running. We have to deal with that later" he adds.

Recovery from Attack

In order to turn the lights back on and restore systems following a cyberattack, a hospital must first eradicate all traces of the ransomware and other malware, then carefully restore data from off-site backup tapes or cloud storage. First, however, the malicious exploit and ransomware code must be identified, forensically preserved by law enforcement for later prosecution of perpetrators, and systems cleaned up and formatted. This can be very time consuming, taking many days and of course, will impact patient care and safety.

Perpetrators also know that thanks to better backup procedures following WannaCry, victims have comprehensive and disconnected backups of their data to avoid paying ransoms which would be illegal in many jurisdictions. Hence they are now executing combined infiltration-theft-extortion attacks, as was recently seen in the Czech Republic. Non-Public data is exfiltrated as part of the attack and when the ransomware clock runs out without a payment being made, a perpetrator will release some protected data to the public internet with a second extortion payment demand threatening to release more regulated PII and PHI data. This is similar to a recent REvil Attack against a Los Angeles celebrity law firm that claimed to have masses of dirty laundry on Donald Trump as well as contracts and other documents for celebrity clients.

Cisco's ZeroTrust Micro Segmentation

Containment and Risk Mitigation

While adoption of a Zero-Trust security framework and the implementation of network segmentation will severely limit the lateral spread of malware across a hospital network, one of the greatest recovery problems is the identification of sleeper malware or extraneous communications by that malware to command and control known as C2 severs. That's where Cylera’s MedCommand software comes into its element by quickly identifying suspicious network traffic, and tracing that traffic back to infected code that can then be eradicated from the network so that restoration of Health IT systems can commence.

Its just one more use of the Cylera MedCommand system. MedCommand identifies healthcare IoT (HIoT) connected assets, while profiling and risk assessing them for security group tag allocation and for network micro-segmentation under Zero Trust. A recent new feature also allows those who are responsible for managing medical devices and other HIoT assets to observe device utilization for better allocation of patients to available devices - something that has become critical when medical devices are short on supply and stretched to capacity under a global pandemic.

Covid patient in hospital isolation room


Covid-19 kills off 'Suprise' or 'Balance Billing'

Surprise Billing is a major cause of bankruptcy each year

The despised practice by healthcare providers of ‘surprising billing’ where the gap between what your health insurance regards as a fair and equitable charge for services and what your medical provider actually charges for that service, has been essentially outlawed during the Coronavirus epidemic.

The Department of Health and Human Services which is providing emergency funding to providers during the crisis, has tied millions of dollars in payments to its terms. Those state: "For all care for a possible or actual case of COVID-19, the provider will not charge patients any more in out-of-pocket costs than they would have if the provider were in-network, or contracted with the patient's insurance company to provide care.”

The agreement is posted on the page.

"HHS broadly views every patient as a possible case of COVID-19," the guidance states. "The intent of the terms and conditions was to bar balance billing for actual or presumptive COVID-19," an HHS spokesperson said late Friday. "We are clarifying this in the terms and conditions."

Many states have for a long time outlawed the practice of balance billing but some states have failed to legislate this.

HHS might have done with fine print what Congress and the White House could not do — despite bipartisan support and public outrage at the practice.

Photo: Vladimir Solomyani

Surprise Billing

Surprise billing often occurs when a patient goes to an in-network hospital for a procedure, but an out of network physicians or anesthetist is involved in the operation attempts to bill the insurance a rate much higher than the agreed upon in-network rate for his or her services. Insurance declines anything over the agreed upon rate and the patient is left footing the bill. This places the patient who was unaware of and wasn’t asked to approve any out of network services, up the proverbial creek without a paddle.

Balance billing which can sometimes amount to hundreds of thousands of dollars, is financially devastating for patients and a major cause of bankruptcy in the United States. The practice is outlawed in many states but has yet to be outlawed nationally despite bi-partisan support in Congress, thanks in part to the immense corrupting power of the healthcare lobby.

According to patient advocacy groups, certain lobbying groups later revealed to be connected to physician staffing firms owned by profit-driven private equity companies, spent millions last summer to buy political ads that targeted members of Congress who were working on legislation to end surprise billing.

Whether the fault of balance billing lies with insurance companies paying too little to cover procedures, or with some healthcare providers charging more than what insurance calls ‘market rates’ for their services, has been the subject of intense debate for years. Law suits and several media expose’s have embarrassed greedy providers and stingy insurance companies into rectifying their wrongs, but most of the media’s ire has been directed at for-profit health systems that attempt to shift costs from a growing number of Medicare and Medicaid patients where reimbursements are fixed (take it or leave it) to those with insurance who are not protected by the government from predatory billing practices.

Given the trillions of dollars currently being spent by the government on healthcare through the current epidemic, and the need to invest heavily for future pandemics, federal public health spend is at an all-time high and probably will be for the future. Not since the Second World War has the federal government surpassed insurers and individuals in the funding of critical health services to the American people. Given the rising grey tide of retirees claiming Medicare, and popular support for a universal safety net of public health services among Millennials and others, COVID-19 may have brought about some fundamental changes in health coverage and national health policy.

Business Continuity and Securing a Remote Workforce during a Pandemic Crisis

How to survive the transition from two office locations to 25,000 and still remain secure.

The COVID-19 pandemic has critically changed the traditional concept of work for a major part of the workforce, possibly forever, as office staff work from home, and traveling salesmen work opportunities by video conference with customers. But what are the implications of this change for corporate cybersecurity and how can CIOs and CISOs adapt their technology infrastructure and cybersecurity controls to this new reality? These are just some of the questions that my panel was asked to address in a recent virtual cybersecurity conference on the challenges of working through an epidemic.

With ‘Stay at Home’ orders in effect across most of the world, this of course means that many customer-facing businesses are suffering. It’s certainly not a good time to be in the airline, hotel, or restaurant business as nearly everyone stays at home. Similarly, companies that have not completed their migration to the cloud and cloud-based services may be experiencing additional difficulties necessitating that remote staff VPN into the corporate network in order to access legacy client-server systems and applications.

And of course, the COVID-19 Pandemic since its humble beginnings in Wuhan China and subsequent spread around the globe, has reaped massive emotional and economic distress, as well as the deaths of thousands, and the making of millions more sick. Whether the recent relaxation of lockdowns in China and elsewhere is a permanent condition or results in a second wave of infections remains to be seen, but the global pandemic will have lasting effects on globalization and supply chains for critical medical and other supplies. It may also permanently change the way many of us work.

Photo: William Manuel Son

The King is dead. Long live the king!

Is there really a need for companies to continue to rent expensive downtown city offices? Is it really necessary for your employees to sit in their cars each day for two hours commuting to their cube through noxious traffic pollution, or be confined to a cramped subway or train car with potentially lots of disease-carrying passengers? It took Spanish Flu 18 months to work itself out, so Trumpian notions of a full return to what was ‘normal’ in a few weeks, is unlikely even by the greatest optimists. The bigger question is do we really want to return to the way things were just for the sake of it? I would suggest not.

Now that the cat is out of the bag, and bosses have seen that their staff work just as well from home, if not more productively than from their office cubes, the argument to keep things the way they are today, suddenly has a lot more weight.

Photo: Mike Von

What Questions Should You Ask?

How should you go about securing tens of thousands of staff now working from their patios, dining room tables, or home offices, connecting to your applications and infrastructure via an over-taxed VPN back to the nearest corporate office?

How can you ensure that your staff’s home wireless internet connection is not being snooped upon if they are not encapsulating and sending everything over the VPN? Do you insist that your staff's home network is running WPA2?

Do you even know if split tunneling is enabled in your VPN and what happens when that employee needs to print something to their home printer and has to disconnect from the VPN?

Have you put in place policies for remote access such that staff are expected to update firmware on their $50 cable modem or DSL router and are they even required to change the default password on these devices?

Do you provide your staff with Integrated Services Routers (ISRs) to connection back to corporate and for VOIP calling?

Do you provide staff with a laptop running a locked-down application stack with your security tools installed? Taking home the office workstation may not be an option and trying to purchase laptops in times of mass demand is becoming almost impossible.

Do you allow your staff to use their own (BYOD) computers to access your applications and data, and if so, what do you require in the way of AV, patching and acceptable use on these machines?

These and other questions were put to my team of security subject matter experts who joined me on virtual stage for a special CTG Intelligence conference on remote business working during Covid-19. Their answers and shared insights may help you to prepare for the new ‘normal’ for as long as it lasts.

The panel includes:
Richard Staynings, Chief Security Strategist at Cylera, out of Boulder, CO, USA
Page Jeffrey, Cyber Security Consultant at Trace3, out of Colorado Springs, CO, USA.
Luke McOmie, CxO Advisor Offensive Security at Coalfire out of Westminster, CO, USA.
Steve Harrington, Managing Director at Masergy out of London, UK.
Tanya Walters, Independent Cyber Operations Advisor out of Phoenix, AZ, USA.
Anthony Dezilva, Dir. CxO Services out of Scottsdale, AZ, USA.