HHS Office for Civil Rights Settles HIPAA Ransomware Cybersecurity Investigation for $90,000

Settlement with Bryan County Ambulance Authority marks OCR's 7th ransomware enforcement action and 1st enforcement action in OCR's Risk Analysis Initiative

WASHINGTON – Today, the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) announced a settlement with Bryan County Ambulance Authority (BCAA), a provider of emergency medical services in Oklahoma for a potential violation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule. The settlement resolves an investigation concerning a ransomware attack on BCAA's information systems. Ransomware and hacking are the primary cyberthreats in health care. Since 2018, there has been a 264% increase in large breaches reported to OCR involving ransomware attacks. The settlement also marks the first enforcement action in OCR's Risk Analysis Initiative. This enforcement initiative was created to focus select investigations on compliance with the HIPAA Security Rule Risk Analysis provision, a key Security Rule requirement, and the foundation for effective cybersecurity and the protection of electronic protected health information (ePHI).

"Failure to conduct a HIPAA Security Rule risk analysis leaves health care entities vulnerable to cyberattacks, such as ransomware. Knowing where your ePHI is held and the security measures in place to protect that information is essential for compliance with HIPAA," said OCR Director Melanie Fontes Rainer. "OCR created the Risk Analysis Initiative to increase the number of completed investigations and highlight the need for more attention and better compliance with this Security Rule requirement."

OCR enforces the HIPAA Privacy, Security, and Breach Notification Rules, which set forth the requirements that covered entities (health plans, health care clearinghouses, and most health care providers) and business associates must follow to protect the privacy and security of protected health information. The HIPAA Security Rule establishes national standards to protect individuals' ePHI that is created, received, used, or maintained by a covered entity or business associate. It also requires appropriate administrative, physical, and technical safeguards to ensure the confidentiality, integrity, and security of ePHI. The settlement resolves OCR's investigation concerning BCAA and this ransomware attack.

In May 2022, OCR received a breach report concerning a ransomware incident that encrypted files on BCAA's network. BCAA determined that the encrypted files affected the protected health information of 14,273 patients. OCR's investigation determined that BCAA had failed to conduct a compliant risk analysis to determine the potential risks and vulnerabilities to ePHI in BCAA's systems.

Under the terms of the resolution agreement, BCAA agreed to pay $90,000 and to implement a corrective action plan that will be monitored by OCR for three years. Under the corrective action plan, BCAA will take a number of steps to ensure compliance with the HIPAA Security Rule and protect the security of ePHI, including:

• Conducting an accurate and thorough risk analysis to determine the potential risks and vulnerabilities to the confidentiality, integrity, and availability of its ePHI;
• Implementing a risk management plan to address and mitigate security risks and vulnerabilities identified in their risk analysis;
• Developing, maintaining, and revising, as necessary, its written policies and procedures to comply with the HIPAA Rules; and
• Training its workforce on its HIPAA policies and procedures.

OCR recommends that health care providers, health plans, health care 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 regularly.
• 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/bcaa-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.

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