A warning has been issued to the healthcare industry over an extensive campaign of targeted cyberattacks by the Orangeworm threat group. The Orangeworm threat group has been operating since 2015, but activity has been largely under the radar. It is only recently that the group’s activities have been identified and disclosed.
Attacks have been conducted on a range of industries, although the primary targets appear to be large healthcare organizations. 39% of confirmed attacks by the Orangeworm threat group have been on organizations in the healthcare industry, including large healthcare providers and pharmaceutical firms. IT service providers, manufacturers, and logistics firms have also been attacked, many of which have links to the healthcare industry.
Some of the IT service providers discovered to have been attacked have contracts with healthcare organizations, while logistics firms have been attacked that deliver medical equipment, as have manufacturers of medical devices. The aim appears to be to infect and investigate the infrastructure of the entire supply chain.
The Orangeworm threat group is using a custom backdoor, which is deployed once access to a network is gained. First the backdoor is deployed on one device, giving the Orangeworm threat group full control of that device. The backdoor is then aggressively spread laterally within a network via unprotected network shares to infect as many devices as possible with the Kwampirs backdoor. While some steps have been taken by the group to avoid detection, this lateral worm-like movement is noisy and easily detected. The threat group does not seem to be overly concerned about hiding its activity.
This attack method works best on legacy operating systems such as Windows XP. Windows XP is no longer supported, and even though the continued use of the operating system is risky and in breach of industry regulations, many healthcare organizations still have many devices operating on Windows XP, especially machines connected to imaging equipment such as MRI and X-Ray machines. It is these machines that have been discovered to have been infected with the Kwampirs backdoor.
Once access is gained, the group is spending a considerable amount of time exploring networks and collecting information. While the theft of patient health information is possible, this does not appear to be a financially motivated attack and systems are not sabotaged.
Symantec, which identified a signature which has allowed the identification of the backdoor and raised the alert about the Orangeworm threat group, believes this is a large-scale espionage campaign with the aim of learning as much as possible about the targets’ systems. What the ultimate goal of the threat group is, no one knows.
The method of spreading the backdoor does not have the hallmarks of nation-state sponsored attacks, which tend to use quieter methods of spreading malware to avoid detection. However, the attacks are anything but random. The companies that have been attacked appear to have been targeted and well researched before the attacks have taken place.
That suggests the Orangeworm threat group is a cybercriminal gang or small collective of hackers, but the group is clearly organized, committed to its goals, and is capable of developing quite sophisticated malware. However, even though the group is clearly capable, and has operated under the radar for three years, during that time no updates have been made to their backdoor. That suggests the group has been confident that they would not be detected, or that they simply didn’t see the need to make any updates when their campaign was working so well.
While espionage may be the ultimate aim, the Orangeworm threat group could easily turn to more malicious and damaging attacks. Once the backdoor has been installed on multiple devices, they would be under full control of the hackers. The group has the capability to deploy malware such as wipers and ransomware and cause considerable damage or financial harm.
The ease at which networks can be infiltrated and the backdoor spread should be of major concern for the healthcare industry. The attacks show just how vulnerable the industry is and how poorly protected many organizations are.
The continued use of outdated and unsupported operating systems, a lack of network segmentation to prevent lateral movement once access has been gained, the failure to protect network shares, and poor visibility of the entire network make these attacks far too easy. In fact, simply following security best practices will prevent such attacks.
The attacks by the Orangeworm threat group should serve as a wakeup call to the industry. The next wave of attacks could be far, far worse.