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This week marks yet another dark moment for healthcare with yet another Russian cyber-attack against a supplier of critical services for two major London hospital trusts where over 200 life-saving operations and hundreds of other appointments have had to be cancelled, while ambulances have been placed in divert.

Impacted are King’s College Hospital, Guy’s and St Thomas’ - including the Royal Brompton and the Evelina London Children’s Hospital – along with their associated primary care services. This includes GP services across Bexley, Greenwich, Lewisham, Bromley, Southwark and Lambeth boroughs. All have had to revert to paper for blood tests and transfusions thanks to a ransomware attack against Synnovis, a provider of pathology services.

“This is having a significant impact on the delivery of services at Guy’s and St Thomas’, King’s College Hospital NHS Foundation Trusts and primary care services in south east London and we apologise for the inconvenience this is causing to patients and their families,” said an NHS spokesperson in statement.

Synnovis is a pathology partnership between Guy’s and St Thomas’ NHS Foundation Trust and King’s College Hospitals NHS Trust, and SYNLAB, Europe’s largest provider of medical testing and diagnostics. On Monday it was hit with a cyber extortion attack thought to be the work of a Russian criminal group known as Qilin. As a result, an emergency was declared, the National Cyber Security Centre notified, and the Cyber Operations Team called in for assistance. All of Synnovis's IT systems are believed to be affected.

The incident follows a separate case at Synlab Italia, which in April involved a different Russian group known as Black Basta forcing the company's services offline. The group has been linked to the Conti ransomware group, an even more infamous Russian organized crime syndicate. Following this attack, it took the provider nearly a month to restore the majority of its systems. It appears Synlab Italia didn't pay whatever ransom was demanded of it as Black Basta claims it has Synlab's data available for download in its blog. Black Basta is also thought to have been responsible for the attack last month against US healthcare provider Ascension Health.

The attack this week against Synnovis however, appears to be the work of yet another Russian crime group known as Qilin. This ‘Ransomware for rent’ group has targeted IT firms, medical organisations, courts, the 'Big Issue', and appears to operate with Vladimir Putin’s blessing. 'Qilin', also known as 'Agenda', has hacked hundreds of victims over the two years it has been operating under its known identities. Qilin’s 112 known victims span 30 different countries, with Russia and the Commonwealth of Independent States – (ex-Soviet satellite countries) - being the notable exceptions. No need to wonder why!

The Guy’s and St Thomas’ and the King’s College Hospital NHS Foundation Trust attacks are not unique events. In fact it's the third such attack in the past 12 months against NHS trusts. In June of last year, a Russian cybercrime gang called BlackCat hacked the Barts Health NHS Trust. Then earlier this year yet another Russian gang, INC Ransom, attacked NHS Dumfries and Galloway stealing 3 TB of protected health data.

The Russians have certainly cornered the cyber-extortion market, a criminal industry worth $14 billion as of 2022 and one growing rapidly at 73% according to SANS. Indeed, the growth of this industry appears to be directly linked to the number of ransoms being paid by victims, which in the first half of 2023 were estimated to have been more than $590 million. Cyber-extortion is according to the NCA and FBI, a form of cyber-terrorism. So, in effect, those who pay extortion payments could be breaking the law by giving money to wanted terrorists, yet many still do so and few of those who are directly financing this trade have been arrested or prosecuted thus far.

$590 million is also a valuable source of income and hard currency for Russia given all the trade sanctions the country is under following its partial invasion and ongoing war with Ukraine. What’s also apparent, is that no one in a criminal oligarchy like the Russian State is going to make $20 million a pop in ransom payments without sharing at least some of that new-found wealth with others all the way to the Mafia Don at the top, i.e. one Vladimir Vladimirovich Putin, reportedly the richest man in the world today.

But the costs of a ransom attack are far greater than merely the ransom payment (if payment is made), or the costs of forensic investigation, incident response, fines, lawsuits, and punitive damages. The costs when healthcare is attacked is measured in lives. How many patients die as a result of not receiving timely intervention and treatment (mortality), how many will die earlier than expected or are made to suffer for longer periods of time (morbidity), and how many patients are placed at risk thanks to critical IT and IoT systems being down and whose safety maybe compromised as a result.

Attacks against healthcare are not only an attack by a foreign adversary against a critical national infrastructure industry of a nation state, but also an attack that threatens the lives and wellbeing of its citizens. Attackers therefore run the risk that the full power of the state they attack might be used against them, kinetically, when all legal avenues fail to bring them to justice, or to stop their attacks. Russia does not regard cyber-attacks against other countries as a crime, nor does it honour extradition treaties with the rest of the world. Even then, its criminal justice system is irrevocably compromised and corrupted by money, power, and influence.

It is unknown to what extent the Kremlin is behind cyber-attacks against foreign critical national infrastructure, but Russia certainly turns a blind eye to it at the very least, by offering safe harbour to those engaged in this criminal activity. What is for sure, is that the criminal activities of some Russians, is helping to weaken and degrade many of Russia’s foreign adversaries. At the very least, the use of criminal proxies rather than official state assets, provides the Kremlin with some level of plausible deniability, no matter just how implausible that is now becoming, or how insincere Putin’s claims of denial are today.

Until such times as Russia finally fails as a state, and a new Russia adopts a real legal-judicial system - one uncorrupted by others so that criminals can eventually be held to account, the NHS and other providers of healthcare services including third parties, will need to seriously improve cybersecurity and operational resiliency of key systems needed by patients. The UK will also need to critically evaluate any single points of failure in application or underlying infrastructure, just as the US needs to following the recent UHG Change Healthcare attack. Relying on a single vendor or single application for critical parts of medical workflow can no longer be supported. The ability to switch out failed components of a modular architecture is already crucially needed, yet few healthcare providers have reached that level of resiliency today.

Out of all industries, health-care providers were the most targeted by ransomware gangs last year, according to a report by Cisco's Talos threat intelligence division. Cisco attributed the targeting to health-care organizations generally having “underfunded budgets for cybersecurity and low downtime tolerance.”

Given the criticality of IT and IoT in today’s digital health system and continuously rising cyber threats by adversaries, we need to focus a lot more time, effort, and money to build our healthcare services to be able to withstand all but the most destructive of attacks.



















Mitigating Medical Device Vulnerabilities

How can health systems secure smart medical devices if manufacturers don't patch them regularly? Richard Staynings, chief security strategist at Cylera, discusses how organizations can mitigate that risk using their existing tools and technologies at HIMSS24 in Orlando, Florida.

 

Lockbit Take-Down


Many of us in the cybersecurity community woke this morning to very welcome news that the infamous Lockbit Ransomware as a Service (RaaS) crime syndicate was hit with a take-down action of much of its infrastructure. This was apparently led by the UK’s National Crime Agency (NCA), and the FBI, as part of an international law enforcement task force known as ‘Operation Cronos’.

Lockbit was one of the most prolific and destructive Russian Ransomware-as-a-Service (RaaS) groups, claiming over 2,000 victims worldwide and extorting over $120 million in ransom payments. It was, to put it mildly, ruthless, launching secondary and tertiary attacks against victims who refused to negotiate with the extortionists or to pay their extortion demands.

As part of its initial seeding of compromised networks with ransomware, it exfiltrated confidential information and threatened to publish this on its websites if payments were not made by the organization. When demanded ransoms were not received, the group contacted individuals whose information it had stolen, and demanded they pressure the victim organization to pay the ransom, or sometimes offered to exclude their information from a release if a payment was received.
    
Richard Staynings, Cylera
Richard Staynings, Cylera
“Many times, corporate and individual victims paid the gang only to see their information posted publicly anyway” claimed Richard Staynings, Chief Security Strategist with Cheltenham based cybersecurity firm Cylera. “There is after all, no trust in thieves,” he added.

The group was also known to publicly taunt victims on its web site with a countdown clock when the information would be published unless payment was made.

Operation Cronos appears to have finally brought this criminal RaaS business to a halt, or at the very least slowed it down and ruined its reputation. Whether it stops the affiliates who use the RaaS to execute their attacks remains to be seem as it's likely that many of the Lockbit tools are still out there and affiliates are likely to have copies of these. 

It’s also quite likely, that many of the un-indicted perpetrators involved in Lockbit, will simply pick up and move into new crime groups to continue to ply their crafts as part of other cybercrime services. This has happened in the past when law enforcement took down other crime syndicates. It is also possible that a new Lockbit rises from the ashes and starts over again, perhaps even under the same name with some of the same people.

Some of these crime syndicates are thought to be associated with the Russian Mafia and many in the past have worked closely with the Kremlin, FSB and GRU for espionage purposes, or to punish other nations, while Mother Russia can claim plausible deniability.

Many of the cybercriminals who engage in ransomware and other forms of cyber extortion, are of Russian origin and are able to attack victims from within Russia and other former Soviet states with near impunity. This is largely thanks to a lack of extradition treaties between these countries and the rest of the world, combined with a legal system that is easily corrupted by those with power, influence or money.

The FBI has accused Russia of harboring cybercriminals for years, where as long as the perpetrators of cyber crime direct their craft against victims outside of Russia, then the Russian state will conveniently turn a blind eye. This makes it particularly difficult to bring criminals to justice so long as they don't leave the former soviet block of countries.

Of course some wanted criminals used to considering themselves above the law have traveled outside of the former Soviet states and have been arrested or renditioned back to the United States for trial and punishment. One of the more notable of these was Roman Seleznev, the son of a close Putin confident and a member of the Duma lower house of parliament, Valery Seleznev as reported some time ago by this site

Lockbit was the largest RaaS and worked by selling its criminal services, acting as a one-stop shop to customers known as affiliates. These affiliates then identified and attacked victims using the Lockbit framework of tools and services. Based upon volume, the affiliates then received between 60% and 80% of the ransom payments they were able to extort back from Lockbit. The Lockbit network consisted of hundreds of so called ‘bullet proof’ servers located all over the world. These have now been taken over by law enforcement as part of the Europol action. Copies of the Lockbit code, however, remain on PCs and servers in Russia and other countries where international law enforcement was unable to seize assets, since the crime of ransomware is not recognized in many of these countries.

It was perhaps inevitable that the NCA would lead this takedown effort following a January 2023 ransomware attack against part of the UK Royal Mail in which packages could not be mailed overseas for many weeks. The attack was identified as using Lockbit so the group must have been in the sights of the NCA ever since. The Royal Mail is a critical infrastructure industry (CII) of the UK so any attack against a CII would have garnered attention at the highest levels, just as Lockbit attacks against the NHS have done so in the past.

“While not all cyber crimes can be fully investigated, I am sure that Lockbit and its affiliates were prioritized by the NCA and the UK government following the Royal Mail attack,” said Staynings. “Lockbit ransomware attacks against NHS trusts was already sure to get the NCA’s attention, so the Royal Mail attack may have been the nail in the coffin for the group.”

“Gangs would be well advised to stay clear of national infrastructure industries if they want to avoid unnecessary attention. That goes not just for the UK, but for any law-abiding western power,” Staynings added.

While the Lockbit infrastructure was taken offline and decryption advice and keys posted on its servers, law enforcement reportedly obtained access quite some time ago. It's highly likely that they have been digging around and gaining intelligence on affiliates and those involved in building and maintaining the Lockbit service. It is also likely that they were mapping out the entire infrastructure so as to capture as much of it as possible in one go with a single legal seizure action.

This has resulted in the identification, indictment, and arrest of many of the gang’s generals. But it has also shed light on a much greater number of victims than has been reported, many of whom appear to have paid ransoms against the advice of law enforcement and national laws in their respective countries that forbid extortion payments to terrorists. Ransom and extortion are, after all, forms of terrorism.

“The cat is now out of the bag, and we could see legal actions against business leaders and their legal counsel, who made ransom payments against national laws and hid a cyberattack from shareholders, and the SEC, FCA, and others,” claimed Staynings.

Graeme Biggar, NCA
Graeme Biggar, NCA
The NCA’s Graeme Biggar, said it assessed that the group was responsible for 25% of ransomware attacks in the last year including 200 that were known of in the UK - though he added that, there may have been many more. Indeed, total losses and damages from Lockbit and its affiliates could be in the billions of dollars. Whether this surpassed losses from ‘NotPetya’, another Russian cyberattack attributed to the Russian military GRU, remains to be seen.

NotPetya is thought to have caused between $10 and $12 billion in damages to global organizations attacked, including Maersk, Mondelez, Merck, WPP, Reckitt Benckiser, Saint-Gobain and TNT Express. 

Maersk alone lost $250 million and suffered a further $300 million in damages. The 2017 cyberattack currently stands as the single most damaging and costly attack of all time. Its attack code was designed to attack Ukraine, but the malware unintentionally spread right the way across the world, impacting Russian businesses as well.

As part of the seizures, more than 200 cryptocurrency accounts believed to be linked to Lockbit have been frozen, so it seems likely that once the investigation is complete, at least a few victims may receive some of their ransom payments returned, as has been the case in other confiscations.

“It’s great to see the home team win a game finally, but there’s a long way to the finals” claimed Staynings. “The trouble is that with cybercrime it takes many months or years to properly attribute actions. That includes victims, criminal actors, and all those involved in a cyberattack.”

“Undoubtedly, law enforcement needs to do things properly in order for prosecutions to stick and to identify all those involved in a criminal act. This was one of the better days, that’s for sure!” he concluded.