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The OCR’s January 2018 newsletter details specific types of cyber extortion that healthcare organizations are currently encountering, including ransomware, denial of service attacks, distributed denial of service attacks and theft of protected health information (PHI). Each type of attack poses unique challenges that may affect an organization in different ways. However, all cyber extortion disrupts a healthcare organization’s day-to-day operations on some level and, in some cases, its ability to care for its patients. The OCR identified the four most frequent cyber extortion trends as follows:


<ol>
 	<li>Ransomware: Ransomware involves malware released into an organization’s computer systems, which typically renders the information on the computer system inaccessible through some form of encryption. While you may have heard of different variants of ransomware, all ransomware demands some sort of payment, often in a cryptocurrency such as bitcoin, for the organization to obtain a key that allows it to decrypt the information on its systems. While this may seem to be a promising solution, and is alluring to many healthcare organizations that find themselves facing a ransomware attack, an organization must remember that these are bad actors, sometimes even terrorist organizations, and there is no guarantee they will send the encryption key just because an organization paid the ransom demand. Often we see the bad actors refusing to provide the key at all, or providing a key that decrypts only some of the data, while demanding more money for additional keys. In some instances, the actor will threaten to release the information if the ransom is not paid, and will do so even after the ransom has been paid and the key provided.</li>
 	<li>Denial of Service/Distributed Denial of Service (DoS/DDoS): These types of cyber extortion attacks direct a very high amount of network traffic to targeted computer systems, overwhelming the systems and disrupting a healthcare organization, leading to loss in revenue and an inability to effectively and efficiently care for its patients by preventing legitimate traffic. While a DoS and a DDoS share similar traits, a DoS uses a web address to target a system, or spam to flood and overwhelm an email account. The goal in a DoS attack is to prevent legitimate users from accessing critical assets, such as payroll, electronic healthcare records or a particular website. A DDoS uses one system to attack another, such as an entire computer system instead of just one application, often resulting in a larger-scale attack. The attacker in both a DoS and a DDoS will seek some sort of payment in exchange for stopping the attack. As with ransomware, trusting the word of a bad actor is always risky, since payment does not guarantee the promised outcome.</li>
 	<li>Theft of PHI: This type of cyber extortion occurs when a bad actor steals sensitive information or PHI. The bad actor then holds the information for ransom, demanding payment from the healthcare organization under threat of releasing the information to the public. As with the other cyber extortion techniques previously discussed, there is never a guarantee that payment of the ransom will resolve the issue.</li>
</ol>
The threat of cyber extortion may seem overwhelming to many healthcare organizations, and understandably so. It is a constantly evolving area of concern, and something the media reports on more and more. It may seem impossible to prevent an attack from happening. But there are steps a healthcare organization can take to better protect itself, and its computer systems and PHI, from falling victim to a cyberattack. The OCR’s bulletin suggested the following, many of which are required by HIPAA:
<ul>
 	<li>Implementing an enterprise-wide risk analysis and management program, which focuses on cyber risks.</li>
 	<li>Implementing an inventory and vulnerability identification process to ensure accuracy of the risk analyses performed.</li>
 	<li>Training employees to identify malicious emails and technologies.</li>
 	<li>Implementing anti-malware solutions.</li>
 	<li>Diligently patching any system vulnerabilities.</li>
 	<li>Utilizing encryption.</li>
 	<li>Storing backups of all information in a secure location.</li>
 	<li>Hardening internal network defenses.</li>
 	<li>Having downtime procedures in place so you can operate during and recover from a cyberattack.</li>
 	<li>Strengthening audit review procedures to detect any intrusions or unauthorized access into your systems.</li>
</ul>
As cyber criminals continue to develop their techniques, healthcare organizations need to continually re-evaluate their cyber protections and be prepared to address a cyberattack. In addition to the above-referenced protections, we recommend healthcare organizations develop policies and procedures for incident response. Incident response procedures, including having a solid incident response team and plan, ensure the organization is able to quickly respond to a cyber incident, addressing all security, organizational and regulatory concerns in a timely manner. Running incident response drills, where the incident response team responds to a mock cyber incident, is also helpful in preparing a healthcare organization for responding to a cyber incident. Additionally, we recommend considering segmenting networks and creating backups of all systems, which should be stored separately, so if a healthcare organization’s systems are encrypted or affected during a cyberattack, the backups are not affected and can be used by the organization until the systems can be restored. Cyber threats are a scary reality that cannot be ignored and, given the continued move toward integration, which relies on electronic systems, are not going anywhere anytime soon. If healthcare organizations recognize the threat, take precautions and prepare for response to an incident, they can limit the disruption to their organizations and continue to provide services to their patients in the event a cyberattack does affect them.

Recent OCR Newsletter Highlights Growing Cyber Extortion Threat for Healthcare Organizations