HHS Office for Civil Rights Settles Ransomware Cybersecurity Investigation under HIPAA Security Rule for $250,000

The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) announced a settlement with Cascade Eye and Skin Centers, P.C., a privately-owned health care provider in the state of Washington, concerning potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule, following a ransomware attack investigation by OCR. Ransomware and hacking are the primary cyber-threats in health care. Since 2018, there has been a 264% increase in large breaches reported to OCR involving ransomware attacks.

“Cybercriminals continue to target the heath care sector with ransomware attacks. Health care entities that do not thoroughly assess the risks to electronic protected health information and regularly review the activity within their electronic health record system leave themselves vulnerable to attack, and expose their patients to unnecessary risks of harm,” said OCR Director Melanie Fontes Rainer. “Ensuring the confidentiality of electronic protected health information is critical to protect health information privacy and integral to our national security in the health care sector. OCR urges all health care entities to take the essential precautions and stay vigilant to safeguard their systems from cyberattacks.”

OCR enforces the HIPAA Privacy, Security, and Breach Notification Rules, which sets forth the requirements that health plans, health care clearinghouses, and most health care providers, and their business associates must follow to protect the privacy and security of protected health information (PHI). The HIPAA Security Rule establishes national standards to protect individuals’ electronic personal health information that is created, received, used, or maintained by a covered entity. It also requires appropriate administrative, physical and technical safeguards to ensure the confidentiality, integrity, and security of electronic protected health information. The settlement resolves OCR’s investigation concerning Cascade Eye and Skin Centers’ compliance with the HIPAA Security Rule.

OCR initiated an investigation following the receipt of a complaint alleging that Cascade Eye and Skin Centers experienced a ransomware attack. OCR’s investigation determined that approximately 291,000 files that contained electronic PHI (ePHI) were affected. OCR found multiple potential violations of the HIPAA Security Rule, including failures by Cascade Eye and Skin Centers to conduct a compliant risk analysis to determine the potential risks and vulnerabilities to ePHI in its systems, and to have sufficient monitoring of its health information systems’ activity to protect against a cyber-attack.

Under the terms of the settlement, Cascade Eye and Skin Centers has paid $250,000 to OCR and will implement a corrective action plan that requires Cascade Eye and Skin Centers to take steps toward protecting and securing the security of protected health information. OCR will monitor the corrective action plan for two years. These actions include:

• Conduct an accurate and thorough risk analysis to determine the potential risks and vulnerabilities to the confidentiality, integrity, and availability of its ePHI;
• Implement a risk management plan to address and mitigate security risks and vulnerabilities identified in their risk analysis;
• Developing a written process to regularly review records of information system activity, such as audit logs, access reports, and security incident tracking reports;
• Developing policies and procedures for responding to an emergency or other occurrence that damages systems that contain ePHI;
• Developing written procedures to assign a unique name and/or number for identifying and tracking user identity in its systems that contain ePHI;
• Reviewing and revising, if necessary, written policies and procedures to comply with the HIPAA Privacy and Security Rules.

OCR recommends health care providers, health plans, clearinghouses, and business associates that are covered by HIPAA take the following steps to mitigate or prevent cyber-threats:

• Review all vendor and contractor relationships to ensure business associate agreements are in place as appropriate and address breach/security incident obligations.
• Integrate risk analysis and risk management into business processes; conducted regularly and when new technologies and business operations are planned.
• Ensure audit controls are in place to record and examine information system activity.
• Implement regular review of information system activity.
• Utilize multi-factor authentication to ensure only authorized users are accessing ePHI.
• Encrypt ePHI to guard against unauthorized access to ePHI.
• Incorporate lessons learned from incidents into the overall security management process.
• Provide training specific to organization and job responsibilities and on regular basis; reinforce workforce members’ critical role in protecting privacy and security.

The resolution agreement and corrective action plan may be found at: https://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/agreements/cascade-eye-skin-centers-ra-cap/index.html

The HHS Breach Portal: Notice to the Secretary of HHS Breach of Unsecured Protected Health Information may be found at: https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf

OCR is committed to enforcing the HIPAA Rules that protect the privacy and security of peoples’ health information. Guidance about the Privacy Rule, Security Rule, and Breach Notification Rules can also be found on OCR’s website.

If you believe that your or another person’s health information privacy or civil rights have been violated, you can file a complaint with OCR at https://www.hhs.gov/ocr/complaints/index.html.