Warner raises alarm following exposure of sensitive patient data

U.S. Sen. Mark Warner (D-VA) raised concern with the U.S. Department of Health and Human Services’ failure to act following a mass exposure of sensitive medical images and information by health organizations.

In a letter to the HHS Director of the Office for Civil Rights, Sen. Warner identified this exposure as damaging to individual and national security, as this kind of information can be used to target individuals and to spread malware across organizations.

“I am alarmed that this is happening and that your organization, with its responsibility to protect the sensitive personal medical information of the American people, has done nothing about it,” wrote Sen. Warner. “As your agency aggressively pushes to permit a wider range of parties (including those not covered by HIPAA) to have access to the sensitive health information of American patients without traditional privacy protections attaching to that information, HHS’s inattention to this particular incident becomes even more troubling.”

“These reports indicate egregious privacy violations and represent a serious national security issue — the files may be altered, extracted, or used to spread malware across an organization,” he continued. “In their current unencrypted state, CT, MRI and other diagnostic scans on the internet could be downloaded, injected with malicious code, and re-uploaded into the medical organization’s system and, if capable of propagating, potentially spread laterally across the organization. Earlier this year, researchers demonstrated that a design flaw in the DICOM protocol could easily allow an adversary to insert malicious code into an image file like a CT scan, without being detected.”

On Sept. 17, a report revealed that millions of Americans had their private medical images exposed online, due to unsecured picture archiving and communication servers (PACS) that utilize the Digital Imaging and Communications in medicine (DICOM) protocol. Along with the medical images, these PACS also exposed the names and social security numbers of those affected, leaving this information open to anyone with basic computer expertise, as these required no authentication to access or download.

This exposure was uncovered by German researchers, who contacted the German Federal Office for Information Security (BSI). BSI then alerted the United States Computer Emergency Readiness Team (US-CERT), who confirmed the exposure and reached out to HHS. However, if they received this information, HHS has failed to act on it, even failing to list TridentUSA Health Services – one of the main companies responsible for the exposure – on its breach portal website.

In his letter to Director Roger Severino, Sen. Warner also raised alarm with the fact that TridentUSA Health Services successfully completed an HHS Health Insurance Portability and Accountability Act (HIPAA) Security Rule compliance audit in March 2019, while patient images were actively accessible online.

Sen. Warner also posed the follow questions for HHS regarding the incident, and its current cybersecurity requirements and procedures:

1. Did HHS receive a notice from US-CERT regarding the open PACS ports available with diagnostic imaging available on the internet without any restrictions?
2. If so, what actions were taken to address the issue?
3. What evidence do you require organizations to produce during a HIPAA Security Rule audit? Are organizations asked to turn over their audit logs? How does OCR review the logs?
4. Does OCR have information security experts on staff or does it rely on external consultants as part of these audits?
5. What are the follow-up procedures if an organization’s log files reveal access to sensitive data from outside the United States, such as in this case?
6. Please describe your information security audit process.
7. Please describe your oversight of the DICOM protocol and PACS security. Do you require organizations to implement access controls? If so, what kind? Do you require full-disk encryption and authentication for PACS? Are the DICOM protocol implementations included in the audits?

Sen. Warner has been a champion for cybersecurity throughout his career, and has been an outspoken critic of poor cybersecurity practices that compromise Americans’ personal information. In September, Sen. Warner wrote to TridentUSA Health Services to inquire about the company’s data security practices, following reports that a company affiliate exposed medical data belonging to millions of Americans.

Earlier that month, Sen. Warner demanded answers from U.S. Customs and Border Protection (CBP) and South Korean company Suprema HQ, following separate incidents that affected both entities and exposed the personal, permanently identifiable data of many Americans. Sen. Warner has introduced legislation to empower state and local government to counter cyberattacks, and to increase cybersecurity among public companies.