In 2015, Anthem Inc., experienced a colossal data breach. 78.8 million health plan records were stolen. This year, the health insurer settled a class action data breach for $115 million and OCR has now agreed a $16 million Anthem data breach settlement.

It Started with a Spear Phishing Email…

The Anthem data breach came as a huge shock back in February 2015, due to the sheer scale of the breach. Healthcare data breaches were common, but the Anthem data breach in a different league.

Prior to the announcement, the unenviable record was held by Science Applications International Corporation, a vendor used by healthcare organizations, that experienced a 4.9 million record breach in 2011. The Anthem data breach was on an entirely different scale.

The hacking group behind the Anthem data breach was clearly skilled. Mandiant, the cybersecurity firm that assisted with the investigation, suspected the attack was a nation-state sponsored cyberattack. The hackers managed to gain access to Anthem’s data warehouse and exfiltrated a huge volume of data undetected. The time of the initial attack to discovery was almost a year.

While the attack was sophisticated, a foothold in the network was not gained through an elaborate hack or zero-day exploit but through phishing emails.

At least one employee responded to a spear phishing email, sent to one of Anthem’s subsidiaries, which gave the attackers the entry point they needed to launch a further attack and gain access to Anthem’s health plan member database.

The Anthem Data Breach Settlement is the Largest Ever Penalty for a Healthcare Data Breach

The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) investigates healthcare data breaches that result in the exposure or theft of 500 or more records. An in-depth investigation of the Anthem breach was therefore a certainty given its scale. A penalty for non-compliance with Health Insurance Portability and Accountability Act (HIPAA) Rules was a very likely outcome as HIPAA requires healthcare organizations to safeguard health data. The scale of the breach also made it likely that it would result in the largest ever penalty for a healthcare data breach.

Before the Anthem data breach settlement, the largest penalty for a healthcare data breach was $5.55 million, which was agreed between OCR and Advocate Health Care Network in 2016. The Anthem data breach settlement was almost three times that amount, which reflected the seriousness of the breach, the number of people impacted, and the extent to which HIPAA Rules were alleged to have been violated.

OCR alleged that Anthem Inc., had violated five provisions of HIPAA Rules, and by doing so failed to prevent the breach and limit its severity. The Anthem data breach settlement was however agreed with no admission of liability.

The regulatory fine represents a small fraction of the total cost of the Anthem data breach. On top of the Anthem data breach settlement with OCR, Anthem faced multiple lawsuits in the wake of the data breach. The consolidated class action lawsuit was settled by Anthem in January 2018 for $115 million.

The class action settlement document indicated Anthem had already paid $2.5 to consultants in the wake of the breach, $31 million was spent mailing notification letters, $115 million went on improvements to security, and $112 million was paid to provide identity theft protection and credit monitoring services to affected plan members.

With the $115 million class action settlement and the $16 million OCR settlement, that brings the total cost of the Anthem data breach to $391.5 million.

At $391.5 million, that makes this the most expensive healthcare phishing attack by some distance and the cost clearly highlights just how important it is to adopt a defense-in-depth strategy to protect against phishing attacks.