Peter A Clarke

The FBI, CISA, and Treasury urge HPH Sector organizations to:

• Limit access to data by deploying public key infrastructure and digital certificates to authenticate connections with the network, Internet of Things (IoT) medical devices, and the electronic health record system, as well as to ensure data packages are not manipulated while in transit from man-in-the-middle attacks. 
• Use standard user accounts on internal systems instead of?administrative?accounts, which allow for overarching administrative system privileges and do not ensure least privilege.? 
• Turn off network device management interfaces such as Telnet, SSH, Winbox, and HTTP for wide area networks (WANs) and secure with strong passwords and encryption when enabled. 
• Secure personal identifiable information (PII)/patient health information (PHI) at collection points and encrypt the data at rest and in transit by using technologies such as Transport Layer Security (TPS). Only store personal patient data on internal systems that are protected by firewalls, and ensure extensive backups are available if data is ever compromised. 
• Protect stored data by masking the permanent account number (PAN) when it is displayed and rendering it unreadable when it is stored—through cryptography, for example. 
• Secure the collection, storage, and processing practices for PII and PHI, per regulations such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Implementing HIPAA security measures can prevent the introduction of malware on the system. 
• Implement and enforce multi-layer network segmentation with the most critical communications and data resting on the most secure and reliable layer. 
• Use monitoring tools to observe whether IoT devices are behaving erratically due to a compromise. 
• Create and regularly review internal policies that regulate the collection, storage, access, and monitoring of PII/PHI.

In addition, the FBI, CISA, and Treasury urge all organizations, including HPH Sector organizations, to apply the following recommendations to prepare for, mitigate/prevent, and respond to ransomware incidents.

Preparing for Ransomware

• Maintain offline (i.e., physically disconnected) backups of data, and regularly test backup and restoration. These practices safeguard an organization’s continuity of operations or at least minimize potential downtime from a ransomware incident and protect against data losses.
  • Ensure all backup data is encrypted, immutable (i.e., cannot be altered or deleted), and covers the entire organization’s data infrastructure. 
• Create, maintain, and exercise a basic cyber incident response plan and associated communications plan that includes response procedures for a ransomware incident.
  • Organizations should also ensure their incident response and communications plans include response and notification procedures for data breach incidents. Ensure the notification procedures adhere to applicable state laws. 
    • Refer to the National Conference of State Legislatures: Security Breach Notification Laws for information on each state’s data breach laws. 
    • For breaches involving electronic health information, you may need to notify the Federal Trade Commission (FTC) or the Department of Health and Human Services, and, in some cases, the media. Refer to the FTC’s Health Breach Notification Rule and U.S. Department of Health and Human Services’ Breach Notification Rule for more information.
  • See CISA-Multi-State Information Sharing and Analysis Center (MS-ISAC) Joint Ransomware Guide and CISA Fact Sheet Protecting Sensitive and Personal Information from Ransomware-Caused Data Breaches for information on creating a ransomware response checklist and planning and responding to ransomware-caused data breaches.

Mitigating and Preventing Ransomware

• Install updates for operating systems, software, and firmware as soon as they are released. Timely patching is one of the most efficient and cost-effective steps an organization can take to minimize its exposure to cybersecurity threats. Regularly check for software updates and end-of-life notifications and prioritize patching known exploited vulnerabilities. Consider leveraging a centralized patch management system to automate and expedite the process.
• If you use Remote Desktop Protocol (RDP), or other potentially risky services, secure and monitor them closely.
  • Limit access to resources over internal networks, especially by restricting RDP and using virtual desktop infrastructure. After assessing risks, if RDP is deemed operationally necessary, restrict the originating sources, and require multifactor authentication (MFA) to mitigate credential theft and reuse. If RDP must be available externally, use a virtual private network (VPN), virtual desktop infrastructure, or other means to authenticate and secure the connection before allowing RDP to connect to internal devices. Monitor remote access/RDP logs, enforce account lockouts after a specified number of attempts to block brute force campaigns, log RDP login attempts, and disable unused remote access/RDP ports.
  • Ensure devices are properly configured and that security features are enabled. Disable ports and protocols that are not being used for a business purpose (e.g., RDP Transmission Control Protocol Port 3389). 
  • Restrict Server Message Block (SMB) Protocol within the network to only access servers that are necessary and remove or disable outdated versions of SMB (i.e., SMB version 1). Threat actors use SMB to propagate malware across organizations.
  • Review the security posture of third-party vendors and those interconnected with your organization. Ensure all connections between third-party vendors and outside software or hardware are monitored and reviewed for suspicious activity.
  • Implement listing policies for applications and remote access that only allow systems to execute known and permitted programs under an established.
  • Open document readers in protected viewing modes to help prevent active content from running.
• Implement user training program and phishing exercises to raise awareness among users about the risks of visiting suspicious websites, clicking on suspicious links, and opening suspicious attachments. Reinforce the appropriate user response to phishing and spearphishing emails. 
• Require MFA for as many services as possible—particularly for webmail, VPNs, accounts that access critical systems, and privileged accounts that manage backups. 
• Use strong passwords and avoid reusing passwords for multiple accounts. See CISA Tip Choosing and Protecting Passwords and National Institute of Standards and Technology (NIST) Special Publication 800-63B: Digital Identity Guidelines for more information.
• Require administrator credentials to install software.
• Audit user accounts with administrative or elevated privileges and configure access controls with least privilege in mind.
• Install and regularly update antivirus and antimalware software on all hosts.
• Only use secure networks and avoid using public Wi-Fi networks. Consider installing and using a VPN.
• Consider adding an email banner to messages coming from outside your organizations.
• Disable hyperlinks in received emails.

Responding to Ransomware Incidents

If a ransomware incident occurs at your organization:

• Follow your organization’s Ransomware Response Checklist (see Preparing for Ransomware section). 
• Scan backups. If possible, scan backup data with an antivirus program to check that it is free of malware. This should be performed using an isolated, trusted system to avoid exposing backups to potential compromise.
• Follow the notification requirements as outlined in your cyber incident response plan. 
• Report incidents to the FBI at a local FBI Field Office, CISA at us-cert.cisa.gov/report, or the U.S. Secret Service (USSS) at a USSS Field Office. 
• Apply incident response best practices found in the joint Cybersecurity Advisory, Technical Approaches to Uncovering and Remediating Malicious Activity, developed by CISA and the cybersecurity authorities of Australia, Canada, New Zealand, and the United Kingdom.