The healthcare industry has long been targeted by cybercriminals looking to gain access to sensitive patient data, which is easy to sell on the black market to fraudsters such as identity thieves. In recent years hackers have turned to ransomware. They gain access to healthcare networks and encrypt data to prevent patient information being accessed and issue a ransom demand to the keys to decrypt files. Since the start of 2020, these two goals have been combined. Hackers have been gaining access to healthcare networks, then exfiltrate data prior to deploying ransomware. If the ransom is not paid, the data is leaked online or sold on. Patient data may even be sold even if the ransom is paid.

Both of these attack types can be achieved using phishing. Phishing allows threat actors to steal credentials and raid email accounts and use the credentials for more extensive attacks on the organization. Phishing emails can also trick healthcare employees into downloading malware that gives attackers persistent access to the network.

Protecting against phishing attacks is one of the most important ways to prevent data breaches and stop ransomware attacks, but there is no single measure that can be implemented that will provide total protection. Here we explain 5 steps that healthcare organizations should take to protect against healthcare phishing attacks. These include measures required by the HIPAA Security Rule so can help to ensure you achieve and maintain compliance.

5 Measures to Protect Against Healthcare Phishing Attacks

Each of the measures we have listed below is important and will work with the others to significantly improve your security posture; however, the first measure is the most important of all as it will stop the majority of phishing emails from being delivered to employee inboxes.

Spam Filtering

To achieve Security Rule compliance, HIPAA regulated entities must implement technical safeguards to ensure the confidentiality, integrity, and availability of electronic protected health information. A spam filter is one of the most important technical safeguards to protect against email-based attacks such as phishing. Spam filters will generally block in excess of 99% of spam and phishing emails and 100% of known malware.

Any inbound email must pass through the spam filter where it will be subjected to a variety of checks. These include antivirus scanning to block malware, checks against blacklists of known malicious IP and email addresses, and frameworks such as SPF, DKIM, and DMARC to identify and block email impersonation attacks. Advanced spam filters such as SpamTitan include additional malware protection through the use of a sandbox. Email attachments are executed in this safe environment and are checked for potentially malicious actions. This measure helps to identify previously unknown malware and ransomware variants.

SpamTitan also uses techniques such as Bayesian analysis to determine the probability of an email being spam or malicious. Greylisting is also used, which involves the initial rejection of a message with a request to resend. Spam servers do not tend to respond to these requests, so the lack of response or delay is a good indicator of spam.

SpamTitan also incorporates machine learning techniques, ensuring spam filtering improves over times. Thresholds can also be set for individual users, user groups, departments, and organization-wide, to give the greatest protection to accounts that are most likely to be targeted.

2-Factor or Multi-Factor Authentication

2-factor or multi-factor authentication is another technical safeguard to protect against phishing attacks. 2FA/MFA blocks the next stage of a phishing attack, where credentials for an account have already been obtained by an attacker, either through phishing, brute force attacks or other methods.

In addition to a password, a second factor must be provided before an individual is authenticated. This is often a token on a verified device. When an attempt is made to use a password to access the account from an unfamiliar device, location, or IP address, another factor must be provided before access is granted. This is typically a code sent to a mobile phone. 2-factor authentication will block more than 99.9% of automated attempts to gain access to an account according to Microsoft.

Security Awareness Training

Security awareness training is concerned with educating the workforce about threats such as phishing and teaching them how to recognize and avoid those threats. In security awareness training, employees are taught how to identify phishing emails and social engineering scams and are taught cybersecurity best practices to eradicate risky behaviors. Employees are targeted by phishers and not all phishing emails will be blocked by a spam filter. By training the workforce, and providing regular refresher training sessions, employees will get better at identifying and avoiding threats.

The HHS’ Office for Civil Rights explained in guidance for the healthcare industry that teaching employees how to recognize phishing is part of the requirements for HIPAA compliance. Financial penalties have been imposed for organizations that have not provided security awareness training to the workforce.

Conduct Phishing Email Simulations

Training for the workforce will raise awareness of threats, but it is important to test whether training has been assimilated and if it is being applied in real world situations. By setting up a phishing simulation program, security teams will be able to gauge how effective training has been. A failed phishing simulation can be turned into a training opportunity, and employees who regularly fail phishing email simulations can be provided with further training.

Phishing email simulation programs use real-world phishing examples on employees to see how good they are at identifying phishing emails. They can be used to gain an understanding of the types of phishing emails that are being opened and which links are being clicked. This information can be used to improve security awareness training programs.

Sign Up to Receive Threat Intelligence

Another important step to take to protect against phishing attacks is to stay up to date on the latest threats. The tactics, techniques, and procedures (TTP) of hackers and phishers is constantly evolving, and being aware of the latest TTPs will help healthcare organizations mitigate the threats.

Stay up to date by reading the threat alerts published by agencies such as CISA, the FBI, NSA, and HC3, and consider signing up an information sharing and analysis center to receive timely cyber threat intelligence updates. Knowing about new phishing campaigns targeting the sector will allow steps to be taken to block those threats, whether that is a cybersecurity newsletter for staff, implementing new spam filter rules, or other proactive steps to reduce risk.