Athens Orthopedic Clinic Pays $1.5 Million to Settle HHS Charges of Systemic Noncompliance with HIPAA Rules

From HHS, a settlement notice involving one of thedarkoverlord’s victims. Athens Orthopedic Clinic is still facing a lawsuit from patients that made it all the way up to the Georgia Supreme Court on the issue of whether they had demonstrated enough harm to survive a motion to dismiss. Note: This blogger is the journalist referenced in HHS’s notice below and this site covered the Athens Orthopedic attack and incident response extensively in 2016 and thereafter (coverage linked from here). Athens Orthopedic Clinic PA (“Athens Orthopedic”) has agreed to pay $1,500,000 to the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) and to adopt a corrective action plan to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules. Athens Orthopedic is located in Georgia and provides orthopedic services to approximately 138,000 patients annually. On June 26, 2016, a journalist notified Athens Orthopedic that a database of their patient records may have been posted online for sale. On June 28, 2016, a hacker contacted Athens Orthopedic and demanded money in return for a complete copy of the database it stole. Athens Orthopedic subsequently determined that the hacker used a vendor’s credentials on June 14, 2016, to access their electronic medical record system and exfiltrate patient health data. The hacker continued to access protected health information (PHI) for over a month until July 16, 2016. On July 29, 2016, Athens Orthopedic filed a breach report informing OCR that 208,557 individuals were affected by this breach, and that the PHI disclosed included patients’ names, dates of birth, social security numbers, medical procedures, test results, and health insurance information. OCR’s investigation discovered longstanding, systemic noncompliance with the HIPAA Privacy and Security Rules by Athens Orthopedic including failures to conduct a risk analysis, implement risk management and audit controls, maintain HIPAA policies and procedures, secure business associate agreements with multiple business associates, and provide HIPAA Privacy Rule training to workforce members. “Hacking is the number one source of large health care data breaches. Health care providers that fail to follow the HIPAA Security Rule make their patients’ health data a tempting target for hackers,” said OCR Director Roger Severino. In addition to the monetary settlement, Athens Orthopedic has agreed to a robust corrective action plan that includes two years of monitoring. The resolution agreement and corrective action plan may be found at https://www.hhs.gov/sites/default/files/athens-orthopedic-ra-cap.pdf – PDF*. * People using assistive technology may not be able to fully access information in this file. For assistance, contact the HHS Office for Civil Rights at (800) 368-1019, TDD toll-free: (800) 537-7697, or by emailing [email protected] Of special note, and as I previously reported in covering this incident, it seemed that thedarkoverlord accessed AOC using credentials hacked from Quest Records. In the Corrective Action Plan, HHS noted that AOC had no business associate agreement in place with Quest, among others. In a statement to DataBreaches.net, Quest had claimed that they had notified their clients after discovering they had been hacked, but they did not answer my question as to when they notified AOC and whether it was before June 14 when the stolen credentials were used or not. Later today, one of the members or associates of thedarkoverlord is scheduled to plead guilty for his role in five TDO attacks, one of which appeared to be Athens Orthopedic.

Georgia Supreme Court resuscitates patient lawsuit against Athens Orthopedic Clinic

The Georgia Supreme Court has breathed new life into a lawsuit by patients of Athens Orthopedic Clinic (AOC) whose data were stolen by thedarkoverlord in 2016. In  a decision issued this week, the judges unanimously reversed the Court of Appeals’ dismissal of the lawsuit, vacated other parts of their ruling, and remanded the case. At issue before the court was how Georgia law would apply the cognizable injury required for standing in a negligence suit under state law.  The lower court had granted the clinic’s motion to dismiss based on the majority agreeing that any harm alleged by the plaintiffs was future harm and speculative.  The state supreme court agreed with the plaintiffs, however, finding hat they had alleged enough harm to survive a motion to dismiss. The Athens Orthopedic Clinic case was one of thedarkoverlord’s earliest known hacks and extortion attempts in June, 2016.  This site’s coverage of the case and its aftermath can be found linked from here.  When the clinic wouldn’t pay the extortion demand, the hackers  allegedly falsely claimed to have sold some of the data that they had listed on a dark web marketplace.  But eventually, the hackers also began publicly releasing actual segments of the patient database on Pastebin. The pastes were downloaded by unnamed others, increasing the risk that patient data was falling into criminals’ hands or was being acquired by those who could and would misuse it. At least one named plaintiff, Christine Collins, alleged that she suffered actual fraudulent activity on her credit card shortly following the attack. To add to the patients’ concerns, AOC announced that it did not have any insurance that would cover it for offering affected patients credit monitoring and/or identity theft restoration services. While the litigation continues to work its way through the courts, one member of thedarkoverlord is preparing to stand trial for his role in the attack on the clinic and four other attacks.  Although not identified by name, AOC appears to be Victim 5 in Nathan Wyatt’s indictment.  It also appears that AOC was the victim  who received the “rap-style” phone threats, allegedly made by Wyatt. AOC reported the incident to HHS in the summer of 2016, but there is still no closing summary on any investigation by OCR, which may mean that they still have an open investigation or case.  DataBreaches.net notes that OCR already closed its investigation into other TDO hacks during that same time period, including two of the Missouri victims involved in the Wyatt case: Prosthetic & Orthotics Care and Midwest Orthopedic Pain and Spine. The fact that the AOC case is not closed could mean that the Atlanta region of OCR is just more backlogged than Missouri, or it may be a sign that AOC is not out of the woods with OCR yet.  One of the questions OCR may have for AOC may relate to claims by the hackers that even after AOC knew that they had been hacked, they still didn’t change their login credentials to all their systems, even after weeks and two emails from the hackers letting them know that they still had access.  Not only might OCR have some questions as to whether that happened, but if it did happen, it might support the plaintiffs’ negligence claims.      

Are thedarkoverlord’s victims entitled to damages from Athens Orthopedic Clinic? Georgia Supreme Court to rule.

Bill Rankin reports: In the spring of 2016, a cyber thief calling himself the “Dark Overlord” hacked into the databases of a Clarke County medical clinic and emerged with the personal information of an estimated 200,000 patients. The Athens Orthopedic Clinic refused to pay the hacker’s ransom and advised current and former patients to set up anti-fraud protections. Now a lawsuit filed by three of those patients — demanding that the clinic pay damages — could set a precedent in Georgia, where reports of data breaches have been soaring. Read more on AJC.  The plaintiffs in the case are Christine Collins, Paulette Moreland, and Kathryn Strickland.  The case number for the docket is S19G0007.

Athens Orthopedic Clinic patient data still exposed on leak site

DataBreaches.net discovered today that two copies of a paste (data dump) with over 860 AOC patients’ information is still available online if you know where to look for it. I’m providing a redacted screenshot below so patients can get a sense of what these pastes/leaks look like, although I’ve blacked out most of the street addresses, the patients’ last names, their date of birth, Social Security number, and other information that was in these records. The first leak by the hackers was removed after AOC reported it to Pastebin; that leak had 500 patients’ information in the same format as the one below. Keep in mind that there were over 860 entries like the few you’re seeing below and there was more than one copy of this paste on Pastebin. According to Pastebin, there have been 52 views of this paste as of today. Here are the data fields labels that were in this database, although not all fields had data in them: “/Today”,”/TodayLong”,”/PrimaryHealthInsCo”,”/PrimaryHealthInsType”,”/SecondaryHealthInsCo”,”/ SecondaryHealthInsType”,”/Address1″,”/Address2″,”/Age”,”/AnAge”,”/AgeSingular”,”/DOB”,”/CellPhone”,”/ City”,”/Email”,”/Fax”,”FName”,”FNameCaps”,”LName”,”/MI”,”LNameCaps”,”/NamePrefix”,”/NameSuffix”,”/ Note”,”/personid”,”/Phone”,”/PhoneExtension”,”/WorkPhone”,”/WorkPhoneExtension”,”/Race”,”/ Sex”,”man/woman”,”male/female”,”male/femaleFirstCap”,”he/she”,”he/sheFirstCap”,”him/her”,”his/her”, “his/herFirstCap”,”boy/girl”,”son/daughter”,”grandson/granddaughter”,”/SharedID”,”/SSNO”,”/State”,”/JobTitle”,”/ Zip”,”/UDF1″,”/UDF2″,”/UDF3″,”/UDF4″,”/UDF5″,”/UDF6″,”/UDF7″,”/UDF8″,”/UDF9″,”/UDF10″,”/PriDrPersonID”,”/ PriUDF1″,”/PriUDF2″,”/PriUDF3″,”/PriUDF4″,”/PriUDF5″,”/PriUDF6″,”/PriUDF7″,”/PriUDF8″,”/PriUDF9″,”/ PriUDF10″,”/PriDrAlias”,”/PriDrFirst”,”/PriDrLast”,”/PriDrNamePrefix”,”/PriDrNameSuffix”,”/PriNote”,”/ PriDrAddr1″,”/PriDrAddr2″,”/PriDrPhoneExtension”,”/PriDrEmail”,”/PriDrCellPhone”,”/PriDrFax”,”/PriDrPhone”,”/ PriDrZip”,”/PriDrState”,”/PriDrCity”,”/PriNPI”,”/RefPersonID”,”/RefDrAddr1″,”/RefDrAddr2″,”/RefDrCity”,”/ RefDrFirst”,”/RefDrLast”,”/RefDrNamePrefix”,”/RefDrNameSuffix”,”/RefNote”,”/RefDrPhone”,”/RefDrPhoneExtension”,”/ RefDrEmail”,”/RefDrCellPhone”,”/RefDrFax”,”/RefDrState”,”/RefDrZip”,”/RefUDF1″,”/RefUDF2″,”/RefUDF3″,”/ RefUDF4″,”/RefUDF5″,”/RefUDF6″,”/RefUDF7″,”/RefUDF8″,”/RefUDF9″,”/RefUDF10″,”/RefNPI”,”/PRIMINSPOLICYID”,”/ PRIMINSGROUPID”,”/SECONDARYINSPOLICYID”,”/SECONDARYINSGROUPID” DataBreaches.net has reported the two pastes to Pastebin to ask them to remove them promptly, and will check back tomorrow to see if they have been removed. Update 1 of Aug. 18: On July 25, this site reported that AOC had begun notifying patients (two) days after this site had notified it that a paste with 500 patients’ information had appeared on Pastebin with a note from the hackers. At the time, AOC gave this site a statement that said, in part: At the same time as all this was going on, we found out about the Pastebin dumps just before your email (yet remain grateful to your letting us know, as well) and have been trying since early Saturday to get the first removed and then the second one since yesterday. Last night, I discovered that in addition to the two pastes dated August 3rd that I reported yesterday as still being online, there was yet another paste – this one dated July 26 (after AOC’s statement) also still available online. This paste was identified by the hackers as a second copy of another paste. It also contains 500 patients’ details. Note that these pastes would be very hard for AOC to find as they would not show up in a routine search. But how many entities did the hackers share the links to these pastes with? Each paste was viewed at least dozens of times. DataBreaches.net has now requested that Pastebin remove this newly found paste, but that paste may put the number of unique patients’ leaked records at about 2,000 or more.  I hope AOC has copies of all these pastes so that they know exactly which patients had their details leaked on Pastebin in addition to being put up for sale on TheRealDeal market. Update of Aug 22: the pastes are still online, and I have emailed Pastebin again to request removal or an explanation of why they haven’t removed these pastes.

Athens Orthopedic Clinic incident response leaves patients in the dark and out of pocket for protection

On June 26, after learning that databases with patients’ protected health information had been put up for sale on the dark web, DataBreaches.net began investigating and trying to alert the victim entities so that they could take immediate steps to try to mitigate harm to patients. By that evening, I had sent an email to Athens Orthopedic Clinic (AOC) in Georgia, to say that it appeared that they had been hacked. I followed up the next day via e-mail and a phone call to make sure they received my notification. On June 29, they issued a statement confirming that they were investigating a potential breach that they had first been made aware of in the previous 48 hours. But their incident response after that point raises questions about any risk assessment and plan for breach response that they may have had in place, and how decisions they made may have negatively impacted the very patients to whom they were and are responsible. Did AOC’s Response to Ransom Demands Lead to Retribution by Hackers? Dealing with a ransom demand, as was the case here, is never an easy situation or decision. Paying a ransom does not guarantee that the extorters will not come back at a later time and demand more money. Nor does it guarantee that the criminals will not take the ransom and then sell the patient data on the dark web anyway. There is really no clear guidance for healthcare entities as to how to respond to this type of situation, as HHS’s recent guidance on how to respond to a ransomware demand doesn’t really apply when you know that the attacker actually has all of your patients’ information and is threatening to misuse it, leak it, or sell it. But ticking off the criminals by telling them that you’ll pay and then not paying, or stringing them along – even if it is at someone’s suggestion – may have backfired for AOC’s patients. Had AOC simply refused to pay the ransom from the outset or had they paid it, TheDarkOverlord (TDO) hackers likely would not have as responded as punitively as they did. According to emails DataBreaches.net has read, at various points, AOC indicated that it was willing to pay some ransom but needed to work out a payment system. Later, they indicated they were willing to do a wire transfer. At other points, they didn’t respond by deadlines TDO had given them, infuriating the hackers.  Read in sequence, the emails might appear to be stringing TDO along, stalling them, or jerking them around. And according to statements made to DataBreaches.net by TDO in encrypted chats, some of the public leaks of AOC’s patient information were in direct response to AOC failing to follow through on what it had told the hackers it would do. The TL;DR version is that TDO informed this site that they were determined to make an example of AOC to show the world that you don’t screw around with TDO. And they even warned AOC. As just one example, a snippet from one of their emails to AOC: If you continue to play these fucking games with us, a sort of hostage kill off is going to occur and leave thousands of patients records publicly listed and abused with your name signed to all of it as the source. So would patient data have been publicly leaked or would as much data have been leaked if AOC had made a decision, informed the attackers of that decision, and stuck to it?  AOC’s ever-changing responses and missed deadlines appears to have resulted in more patients  having their details leaked on Pastebin. Are Patients’ Data Still At Risk? Although AOC may have become a victim due to a vendor’s failure to secure their credentials, and while AOC trauma surgeon Chip Ogburn wrote a passionate and obviously heartfelt letter to patients assuring them that AOC is  committed to rectifying the data breach, there are also other questions raised by AOC’s incident response. That AOC didn’t know that they had been hacked and only learned of the hack weeks later when they were alerted to it by this site is not surprising to anyone familiar with breaches. But it still begs the question as to what software or technical safeguards AOC had in place to detect intrusions and the exfiltration of hundreds of thousands of patients’ records that included image files. Both HHS and the FTC may have questions about that. See also: Quest Records LLC Breach linked to TheDarkOverlord hacks; more entities investigate if they’ve been hacked   And once AOC confirmed that there had been an intrusion and patient data had been acquired, why didn’t they immediately change all passwords – even after the hackers contacted them and lectured them on their failure to change passwords?  AOC’s statement on their web site says, in part (emphasis added by me): If you were a patient of any Athens Orthopedic Clinic location or the patient of a doctor or provider who worked with any of our locations on or before June 14, 2016, we regret to tell you that that our electronic medical records system has been compromised and that your personal information is vulnerable. but DataBreaches.net has seen correspondence indicating that information of patients seen after June 14 was still accessible to the hackers. These emails indicate that TDO informed AOC in mid-July that they still had access to AOC’s internal network. They even mentioned specific systems that were still vulnerable. Here are some snippets from TDO emails to AOC during June and July: …. We are still in your system right now in fact. You have done little to mitigate against an advanced attacker. Pulling the internet plug won’t help when you have embedded devices that run over a cellular network. …. Now up to this point, you should have already changed all the passwords and usernames for all your systems, but they were not changed for all your systems. They should have been amended immediately from the time we sent the first email. We understand it may take a day or two…. However, within a few hours of the second email they should have definitely been changed seeing as how we specifically listed some systems by name. For record, they were not changed even at this time. It is now over two weeks later, and the passwords are […]