Breaking Compliance News Blog

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• The attackers recently used phishing emails to gain access to a victim’s computer using legitimate remote monitoring and management (RMM) software in financial schemes.
• The same tactics can be used for other purposes such as cybersecurity attacks or network backdoor access to conduct cyber espionage.
• Attackers use legitimate remote management software that cannot be detected by normal security measures that prevent unauthorized software installation.

• RMM software is commonly used by IT departments and managed service providers to provide remote technical support and troubleshooting.
• Every managed service provider and IT department use RMM software.

• In mid-June 2022, a federal civilian employee received a phishing email containing a phone number.
• The employee called the number, which led them to visit the malicious domain, myhelpcare[.]online. CISA found additional similar attacks on multiple federal civilian department networks.
• Attacks also used emails with a malicious link that downloaded the RMM software.
  
• The CISA alert mentioned that legitimate RMM software vendors AnyDesk and ScreenConnect were identified in these attacks. CISA indicated that any legitimate RMM software can be used in these types of attacks.

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The scheme

• 25 people were charged with wire fraud – administrators and employees of three Florida nursing schools as well as recruiters.
• The recruiters sought out individuals that were willing to pay $10,000 to $15,000 for fake nursing school documents that allowed them to take national nursing licensure examinations.
• A total of 7,600 fake nursing diplomas and transcripts (completion of required courses and clinicals) were provided to individuals from all over the US. The buyers wanted to take licensing exams to become registered nurses, licensed practical nurses, or licensed vocational nurse licenses.
• The three now closed nursing schools that issued the fake documents were Siena College, Sacred Heart International Institute, and Palm Beach School of Nursing.
• None of the individuals that bought the fake documents have been charged (yet).

Why is this Important?

• In a NY Times article, the special agent in charge for the Miami region of the Office of Inspector General said approximately 2,800 buyers passed the licensure exam.
• A large percentage of the 2,800 that passed are working.
• The NY Times article stated that providers that hired these nurses “included Veterans Affairs hospitals in Maryland and New York, a hospital in Georgia, a skilled nursing facility in Ohio, a rehabilitation center in New York and an assisted-living facility in New Jersey.”

What to do?

The OCR notes serious concerns with Banner Health’s pervasive noncompliance with the HIPAA Security Rule

Banner Health

• OCR’s investigation of Banner’s data breach in 2016 found evidence of long-term, pervasive noncompliance with the HIPAA Security Rule across Banner Health’s organization, a serious concern given the size of this covered entity.
• Banner Health is one of the largest non-profit health systems in the country, with over 50,000 employees and operating in six states.

Findings

• No analysis to determine risks and vulnerabilities to electronic protected health information (ePHI) across the organization
• Insufficient monitoring of its health information systems’ activity to protect against a cyber-attack
• Failure to implement an authentication process to safeguard its ePHI
• Failure to have security measures in place to protect ePHI from unauthorized access when transmitted electronically

The Attack

• Banner Health discovered unauthorized access to process payment card data at some Banner Health food and beverage locations during a two-week period in June and July 2016.
• The attackers targeted payment card data, including cardholder name, card number, expiration date, and internal verification code, as the data was being routed through affected payment processing systems.
• Banner Health learned that attackers accessed patient information, health plan member and beneficiary information, and physician and other healthcare provider information.
• The attack hit 27 locations and 3.7 million individuals.

Why is this Important?

• The OCR indicated that hacking is the largest threat to ePHI, with 74% of 2021 reported breaches involving hacking/IT incidents.
• This settlement and corrective action plan remind us that healthcare providers must take action to protect the privacy and security of PHI. It is just as important to document all measures taken to secure ePHI.
• The corrective action plan states that Banner must do the following to address the findings of the OCR’s investigation:
  • Conduct an accurate and thorough risk analysis to determine risks and vulnerabilities to electronic patient/system data across the organization.
  • Develop and implement a risk management plan to address identified risks and vulnerabilities to the confidentiality, integrity, and availability of ePHI.
  • Develop, implement, and distribute policies and procedures for a risk analysis and risk management plan, the regular review of activity within their information systems, an authentication process to provide safeguards to data and records, and security measures to protect electronic protected health information from unauthorized access when it is being transmitted electronically.

What you should do

(Hint: Turn Banner’s Corrective Action Plan into a checklist)

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What is Rackspace?

Rackspace Technologies is a tech company that provides cloud-based servers, data storage and data backup services.

What Happened?

On December 2, 2022, at 2:49 a.m. EST, Rackspace posted a message stating that customers that used their hosted exchange email servers did not have email access. The Hosted Exchange services include mailboxes (up to 100GB), Microsoft Outlook, Outlook Web Access, mobile device synchronization, anti-spam and anti-virus protection.

On 12/6, Rackspace indicated that they suffered a ransomware attack.

Rackspace has not yet indicated when email service will be restored to their clients. In the meantime, email accounts and domains are being migrated to Microsoft 365. This temporary solution only provides access to new emails. Clients currently have no access to existing emails.

Rackspace has not reported the number of impacted customers. It has been speculated that the number of small and medium sized customers may be in the thousands.

Why is this Important?

In the old days, Microsoft Outlook and Office programs were installed on your company’s server. Email Exchange Servers were also physically located within your company. All emails, email attachments, documents, and spreadsheets were also stored on the server or on your desktop. Today, companies like Rackspace and Microsoft provide these applications with data storage in the cloud.

The Rackspace incident provides a sobering example that cloud applications and cloud stored data are not as safe as you think. Rackspace customers lost the ability to receive and send emails. According to news reports, many customers have email after Rackspace moved them over to Microsoft 365. But there is an ongoing concern of archived email data loss once email service is restored. Think about the impact to your organization and your job tasks if you lost the ability to send and receive emails, plus access to all of your old emails, both sent and received. My guess is that you will come to the same conclusion as me – the impact would be significant if not catastrophic.

Impact?

Loss of email typically means lost revenue. What is your organization’s tolerance to downtime? In other words, how long can you go without email? These are questions that need to be posed to each department. The loss of access to the EHR is the #1 issue, but that can be handled by going old school with paper documentation. The impact on other departments must be reviewed in detail.

Let’s start with the business office. Is there enough cash if billing Medicare, Medicare Advantage, Medicaid and private pay stops or takes longer than normal? What about follow-up of unpaid claims? Referrals? Communication with referring hospitals is typically handled by email. How do you review payor eligibility? How will you recruit staff for open positions without receiving email notifications from recruiting websites? Background checks and review of exclusion lists? The list goes on and on.

All of us are heavily dependent on emails to do our daily tasks. The temporary loss of being able to send or receive emails for a week or two is tolerable, but the tipping point may well be the possible loss of old emails and attachments.

What to do?

I reached out to Scott Wolff, President and Director of IT Operations at LanServ, Inc., a managed service provider (MSP) in St. Louis, and asked him: What do companies need to do to limit their email downtime and prevent the loss of archived (old) emails and attachments? Here is a list of recommendations from Scott W: