[ Wednesday, February 25, 2015 ]
Hippler (East Texas Hospital Data Thief) Gets 18 Months: Like Gibson years ago, a healthcare worker who stole PHI to use for fraud
gets 18 months in jail. Two interesting points: first, the US Attorney's office isn't saying what hospital he worked at, and in fact the case has been weirdly under the radar. Secondly, is there a better name for a HIPAA violator than Hippler?
Jeff [8:08 AM]
[ Wednesday, February 18, 2015 ]
Health Data Identity Theft: Interesting
article from NPR on the black market for stolen health data.
Jeff [10:55 PM]
[ Friday, February 13, 2015 ]
De-Identification Resources: Looking for de-identification tools?
Here's a good place to start, with some proprietary and open source options. Nice to see my hometown UT-Dallas in the mix here.
A big hat tip to Daniel Barth-Jones (@dbarthjones) for this link.
Jeff [2:24 PM]
One More Anthem Thought: What if the hackers were really looking for a needle, not the haystack? What if they weren't after tens of millions of medical identities to conduct identity theft or something else, but were really looking for specific information on a handful of specific individuals, and only accessed the huge amount of data to cover their tracks? If it really was a hack by Chinese nationals operating under the guise of the Chinese government, wouldn't that make more sense?
I'm not saying I believe it was the Chinese government, any more than I believe the Sony hack was the North Korean government. Or, if actually were, I'm not buying that the Norks were so torked about a Seth Rogan film they'd waste their resources hacking Sony. I'm betting if it was them, they were looking for something else, perhaps something they could use to extort someone.
I'm not paraniod. Really.
Jeff [12:27 PM]
More Anthem: Lessons for IT Leaders. Encryption decisions (really, any protective decisions) can have much greater consequences tomorrow than you realize today. And it is very important that you know the value of your information: not just the value to you, but the value to a hacker. You may think the information you hold is mundane, but what you think doesn't really matter. What matters is what the predator thinks.
Jeff [12:21 PM]
[ Thursday, February 12, 2015 ]
More on the Anthem Hack, and "What It Means": I've
posted several posts on the Anthem hack, and I'm not the only one. AHLA sent out an email to its HIT and payers, plans and managed care practice groups explaining the hack and the class-action lawsuits already filed. More news is out today, from experts who think 2015 will be "
the year of the healthcare hack." Maybe, maybe not, but the news does bring a few additional issues to mind:
First, as the AHLA email points out, the initial lawsuits and some of the initial reporting point to the lack of encryption as a big factor. Some have indicated that the Anthem hack may cause HHS to harden the encryption requirement of the Security Rule (as you know, encryption is not a required element, only an addressable one, and HIPAA covered entities are free to forego encryption if they reasonably determine it's not right for them). However, the hackers apparently got user credentials; even if the data had been encrypted, the hackers could have used the credentials to de-crypt the data. The fact that encryption would've been irrelevant probably won't stop those claiming encryption should become required, but it's worth considering.
Secondly, some of the reporting is highlighting the "monetization" issue, which I've always seen as the issue. The hackers probably don't want the data because they're going to use the data; they want it so they can sell it to someone else who will use it for identity theft. If that's the case, there is a multi-tier market, which could be good or bad: as the data changes hands, it's harder and harder to catch the initial culprit; on the other hand, if there are several steps between the point of theft and the point of use, there are several opportunities to put systems or safeguards in place to catch the actors and/or prevent the improper use. In other words, you might not be able to stop the thief, but if you can stop the purchaser from using the stolen data, the criminal enterprise falls apart. Something to consider.
Another issue I hadn't thought about previously: not only can the stolen medical identity be used to obtain needed healthcare services (an impostor uses the stolen identity to directly receive needed healthcare services), the stolen identity could also be used to obtain unnecessary services. I can think of two examples: a stolen identity could be used to obtain Oxycontin or other prescription drugs that could then be resold, or could be used to bill for services that are not actually provided. In both cases healthcare providers would be required to be part of the scam, either unwillingly (a convincing doctor-shopping patient gets painkiller prescriptions) or willingly (a doctor bills for services not provided), but that's not inconceivable. My previous thoughts focused on the receipt of actual, needed services, in which case the value proposition is harder to see (you need an ultimate purchaser of the stolen identity who currently needs healthcare services); however, that's not the case, since you could get prescription drugs to sell on the black market. I hadn't considered that.
Finally, I had recently heard that while social security or credit card numbers don't bring much more than a couple of dollars each on the black market anymore, a stolen medical identity might be worth $50. In today's news from Reuters, it seems that a stolen medical identity is now worth only $20. These aren't hard and fast numbers, but still, that's a pretty big devaluation. Maybe the supply of medical identities (and concommitantly, the amount of hacking) is growing so fast the price is dropping; maybe hacker buyers are determining that medical identities aren't all that valuable; or maybe there's really not that big a market of buyers out there after all. I have no idea, but it's worth considering.
Jeff [10:50 AM]
[ Wednesday, February 11, 2015 ]
Jeff [6:40 PM]
[ Tuesday, February 10, 2015 ]
More Anthem Fallout: Is Healthcare Particularly Vulnerable to Hacking? There are a lot of people saying that; most of them stand to profit if you believe them (including me, in fact). The Anthem breach gives an opportunity for a
bunch of
news articles on
just this point. Let's consider this for a moment.
Much hacking and phishing is aimed at access to quick-value money: credit card numbers that can be used right away (with the victim perhaps not knowing about the use until the bill comes, or perhaps not even noticing it when the bill comes), actual bank account or financial acount data so current funds can be withdrawn, phony checks written, etc. In this type of hacking, the reward comes quickly to the hacker, but might be small change and is usually not a long-term proposition.
Some hacking is designed to allow for real identity theft: the hacker acquires a social security number and other information, impersonates the individual to obtain credit cards, car loans, even house loans, runs up big debts, and when the credit card company or bank tries to collect, the impostor is gone with the loot and the victim is left to try to prove that it wasn't him that got/used the credit card, loan, etc. The reward takes longer, but can be much bigger than snatching a credit card number.
With regard to both of these types of hacks, the victim, the bank or credit card company, and the vendor at which the stolen credit card is used are all incentivized to prevent the hack, since all of them stand to suffer substantial harm: the victim's credit might be ruined (or he might pay for something he didn't get), and the bank, the credit card company, or the later vendor might be left with the bill.
Health records sometimes contain credit card numbers, but often don't, making them not particularly useful for the first type of hack. On the other hand, health records usually contain social security numbers and other demographic data that can be useful for the second type of hack. Thus, medical records might be useful for traditional identity theft schemes.
The much bigger risk, and what medical records are particularly well suited for, is medical identity theft. This type of hack targets patients with good insurance, and allows someone to impersonate the insured and receive the insured's health benefits. The impostor gets free or reduced cost healthcare, but unlike most other hacks, the "victim" (the person whose data was stolen) doesn't necessarily suffer (or at least doesn't suffer immediately); in fact, the victim might benefit, since the impostor might actually pay a part of the victim's annual deductible. Additionally, the person whose data was stolen is not in a very good position to know it was stolen, unless he regularly checks his EOBs (frankly, even if he scrupulously checks his EOBs, they can be hard enough to understand that the medical identity theft might not even be noticed). Rather, the immediate victim is the insurer, who pays for care for someone who did not buy insurance. And if the insurer discovers the identity theft, the care provider becomes the victim, since the insurer may try to recover the funds paid to the provider for the imposter's care.
Unlike a stolen credit card number, which can be used to purchase almost anything (including cash cards), a stolen medical identity is not as easy to immediately monetize. However, the lower level of vigilance by the potential victim makes medical identity theft easier to pull off.
More importantly, however, the risks of medical identity theft far outweigh the risk of credit card theft or regular identity theft. An impostor who receives care while posing as the insured will leave behind a medical record that might be relied upon by some future healthcare provider. Perhaps the impostor is not allergic to penicillin, but the insured is; the impostor receives care at a hospital and the medical record says the patient may have penicillin. When the real insured shows up, tragedy might occur. Thus, while regular identity theft might cause financial ruin to its victims, medical identity theft can kill.
Does the Anthem hack indicate that an epidemic of medical identity theft is on its way? Most criminals are looking for quick cash, and medical identity theft doesn't offer as quick a reward as access to a bank account or credit card number. However, given that there is profit to be made in medical identity theft, and the risks are much greater, healthcare providers, insurers, and patients should all be on high alert for signs of it, and be prepared to quickly respond.
Jeff [11:12 AM]
Anthem Breach: Secondary Impacts on Employers. One thing to think about when you hear of big insurers being subject to a data breach: in many cases, while the company usually does have a great deal of insured beneficiaries (either through direct insurance purchases or fully-insured employers), almost all have a great many more beneficiaries covered as TPAs or otherwise. For example, most Americans with private insurance are insured by employers who have self-funded insurance plans. Those self-finded insurance plans then go and hire Anthem, United Healthcare, Blue Cross Blue Shield, Cigna, Aetna, or some other entity to administer those plans, and those third-party administrators (or TPAs) are usually insurance companies themselves; that makes sense, since they must know how to administer the employer's self-funded plan if they can administer their own insurance products.
So, when an insurer like Anthem suffers a breach, many of the impacted individuals will be direct Anthem subscribers, but more will likely be beneficiaries of some employer who hired Anthem as a TPA of its self-insured plan.
Thus, in addition to pondering Anthem's fate, and what Anthem ought to do, it makes sense to also ponder what those self-insured plans and plan sponsors ought to do. Interestingly, here's an employment law boutique
with a blog post on just that. Something for employer clients of Anthem to consider, for sure, and useful thoughts for all employers with either fully-insured or self-insured/TPA plans. Additionally, it's worth it for employers to start thinking about what they would do if such a breach occurred with their own TPA.
Update: Here's
another (shorter) blog post with an additional good point: check your BAAs to see who is responsible for notifications. Of course, if you are (i) a HIPAA covered entity or (ii) a HIPAA business associate with any possible breach notification obligations, you should already have breach notification communication tools (set channels of communication, form letters, vendors chosen if not actually lined up, etc.) in place, ready to pick up and use.
Jeff [10:06 AM]
[ Thursday, February 05, 2015 ]
HIPAA for Paralegals Webinar: if you're a paralegal interested in how HIPAA works, why providers hesitate to give you medical records you've requested for litigation purposes, or how to get those covered entities to give you those records, you might want to
check out this webinar I'm putting on next week. You can get a 50% discount if you use
priority code 15999 and discount code O7839374.
Anthem Breach: By now you've heard of
the latest huge data breach. Just a reminder, PHI has value as a breach target on multiple fronts: direct theft of account numbers (particularly credit card numbers that can be used immediately), regular identity theft value (stealing SSNs to get credit cards or loans in the victim's name), medical identity theft (to pose as the victim and use up their insurance benefits), sensitivity/"hostage" value (to obtain information on particular individuals for extortive uses or to extort the covered entity), etc. It appears that Anthem's credit card info was protected (probably in accordance with PCI standards), but the other PHI also has value.
Jeff [11:12 AM]
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