Logan Reid
Ransomware attacks on hospitals in the USA have evolved from being considered white-collar crimes to becoming a threat to life. Hospitals have increasingly become the targets of cybercriminals, with the FBI warning of an escalating threat to the healthcare sector. In 2020, several US hospitals were hit by ransomware attacks, including St. Lawrence Health Systems in New York and the Sky Lakes Medical Center in Oregon. These attacks have continued, with at least 141 hospitals directly affected by ransomware in 2023. The impact of these attacks extends beyond the targeted hospitals, as nearby hospitals struggle to absorb displaced patients, leading to increased wait times and strain on resources. The consequences of these attacks include prolonged wait times for critical care, increased ambulance diversion, and a rise in medical complications and mortality rates.
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What You'll Learn
Hospitals are a target during the pandemic
During the COVID-19 pandemic, hospitals have been particularly vulnerable to ransomware attacks. Several federal agencies have warned healthcare employers of the heightened threat posed by cybercriminals aiming to take advantage of the pandemic to cause disruption.
Ransomware attacks on hospitals have become increasingly common, with hospitals being the most likely healthcare delivery organization type to experience operational disruptions during such attacks. These disruptions can include electronic system downtime, delays or cancellations of scheduled care, and ambulance diversion. The consequences of these attacks can be severe, potentially impacting patient care and compromising sensitive patient information.
In October 2020, federal agencies issued an alert warning of an "increased and imminent cybercrime threat" to US hospitals and healthcare providers. This advisory was prompted by a wave of phishing attacks targeting healthcare employees through deceptive emails that appeared to be from the Department of Health and Human Services. These attacks have been attributed to cybercriminals in Eastern Europe seeking financial gain.
Hospitals have become attractive targets for cybercriminals due to their critical role during the pandemic. With other potential targets closed during lockdowns, hospitals remained open 24/7, making them vulnerable to attacks. The impact of ransomware attacks on hospitals can be devastating, as it not only affects their operations but also puts lives at risk.
To mitigate the threat, healthcare employers may need to invest in additional cybersecurity measures and provide employee training to identify and prevent phishing attacks. The sophisticated nature of these attacks and the involvement of foreign adversaries underscore the need for aggressive pursuit and prosecution by the US government.
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The impact of ransomware on patient care
Ransomware attacks on hospitals have evolved from being considered white-collar crimes to threat-to-life crimes. They directly threaten a hospital's ability to provide patient care, thereby endangering patient safety. During the early days of the COVID-19 outbreak, phishing emails and other cyberattacks on hospitals increased as cybercriminals sought to exploit the situation. The pandemic provided an incentive for attackers to target healthcare organizations, as hospitals were too busy delivering care to negotiate down ransom amounts.
The 2017 WannaCry ransomware attack, developed and deployed by North Korea, infected 1,200 diagnostic devices and forced five UK hospital emergency departments to close and divert patients. This attack also caused the cancellation of over 19,000 appointments.
To combat these attacks, hospitals must continuously evolve their cybersecurity processes and policies and collaborate with peers in healthcare, leaders in other sectors, and law enforcement and government agencies. While law enforcement efforts are commendable, they have not been able to prevent the increasing number of attacks on hospitals and critical infrastructure.
The increasing sophistication and frequency of ransomware attacks on hospitals and healthcare providers have raised concerns among federal agencies and cybersecurity companies. These attacks are often carried out by cybercriminals seeking financial gain, with hospitals being targeted for their sensitive data and critical role in patient care.
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The financial motivation of cyber attackers
While there are several motivations for hackers, financial gain is the primary motivation for most cyber attackers. This is achieved through various coercive means, such as phishing or ransomware. In the case of ransomware, cybercriminals encrypt their victim's data and ask for a ransom in return for unlocking the information. The average cost of a ransomware attack in 2024 was $5.13 million, with costs growing by 574% from 2019. The rise in cyber insurance also increases the odds of hackers being paid a ransom.
Some cybercriminal groups use their hacking skills to target large organizations. They are usually motivated by a cause, such as highlighting human rights issues or alerting a large corporation to its system vulnerabilities. State-sponsored actors engage in cybercrime to further their nation's interests, stealing intellectual property, personally identifying information, and money.
Opportunistic attackers rely on probability to spread their malware as much as possible without a specific target in mind. Once the infection takes place, the attacker monetizes the infected computer through different techniques, such as ransomware. Small businesses are ideal victims for attackers, and the price of data sold on the dark web is increasing.
Ransomware-as-a-Service (RaaS) gangs are joining forces to expand their operations and launch campaigns. Extortionware, a form of ransomware, requires less technical expertise and has fueled the growth of less-skilled attackers. Attackers combine encryption with data exfiltration (double extortion) or amplify the extortion's impact through DDoS attacks, media leaks, or contacting customers (triple extortion).
Some hackers are motivated by the pursuit of recognition. For example, a hacker named "Aleks", interviewed by the Talos Intelligence Group, claimed he taught himself cybersecurity skills to find new vulnerabilities and gain recognition. He initially conducted legitimate cyber testing and warned companies of their vulnerabilities but turned to launching his own attacks when he felt his work was not adequately recognized.
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The role of the US government in addressing attacks
The US government has taken several steps to address the rising threat of ransomware attacks, including those on hospitals. Federal agencies like the FBI, Homeland Security, and the Secret Service play a crucial role in preventing and responding to such attacks. They provide assistance to state, local, tribal, and territorial governments, as well as non-federal entities, through various means.
The FBI, for instance, collects evidence, conducts criminal investigations, and attributes attacks. The Department of Homeland Security has also recognised ransomware as a serious and growing threat, impacting federal, state, and local government operations. Additionally, the Multi-State Information Sharing and Analysis Center offers technical assistance, such as forensic analysis and recommended mitigations. Other agencies like the Federal Emergency Management Agency, National Guard Bureau, and the Department of the Treasury play more indirect roles, providing assistance through cybersecurity grants, guidance, and pursuing sanctions to disrupt ransomware activity.
To enhance collaboration and improve the delivery of ransomware assistance, the US government launched StopRansomware.gov, a one-stop hub for ransomware resources. This website integrates federal ransomware resources, offering guidance, alerts, and information on how to report attacks. It is a joint effort by the Department of Justice, Department of Homeland Security, Cybersecurity and Infrastructure Security Agency (CISA), the Secret Service, FBI, and other agencies.
The US government also investigates ransomware attacks on hospitals, with federal agencies warning of a rising wave of coordinated attacks designed for financial gain. These agencies include the Department of Health and Human Services, which plays a role in mitigating the impact of ransomware on the healthcare sector.
Furthermore, the government has urged organisations to prioritise cybersecurity and utilise available resources to protect themselves from ransomware attacks. This includes encouraging cautious device usage, keeping software and applications up to date, and regularly backing up data. The FBI discourages paying ransoms, as it does not guarantee data recovery and may encourage further illegal activity.
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The increase in ransomware attacks since 2016
Ransomware attacks have been a persistent threat since the first known attack in 1989, which involved a Trojan Horse virus sent to AIDS researchers. However, the nature of these attacks has changed significantly over time, with cybercriminals becoming increasingly sophisticated, skilled, and organised.
Since 2016, there has been a notable increase in the frequency and impact of ransomware attacks. The healthcare industry, including hospitals, has been a significant target. Between 2016 and 2021, ransomware attacks on healthcare delivery organisations doubled, with 560 healthcare facilities affected by ransomware attacks in 2020 alone. The likelihood of these organisations restoring encrypted or stolen data decreased during this period, and the probability of attacks affecting multiple facilities simultaneously increased. The average cost of a data breach in the healthcare industry was $10.93 million, the highest across all industries.
U.S. hospitals have been specifically targeted by coordinated ransomware attacks, with federal agencies issuing warnings of an "increased and imminent cybercrime threat". These attacks have been designed to infect systems for financial gain, with cybercriminals seeking to exploit the valuable data held by healthcare organisations. The impact of these attacks extends beyond financial harm, as they can disrupt care delivery, including electronic system downtime, delays or cancellations of scheduled care, and ambulance diversion.
Ransomware attacks have also targeted other critical sectors since 2016, including financial services, education, and government organisations. The rate of attacks in the financial services sector increased from 55% in 2022 to 64% in 2023, with over 204,000 people experiencing malicious login attempts to access their banking information in 2021. The education sector has been targeted extensively, with 79% of surveyed higher education institutions worldwide reporting ransomware attacks, resulting in significant business and revenue losses. Government organisations have also faced a growing number of attacks, with 246 ransomware attacks on U.S. government agencies between 2020 and 2023, costing an estimated $52.88 billion.
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Frequently asked questions
Yes, US hospitals have been affected by ransomware attacks.
The first ransomware attack is believed to have occurred in 1989 and was targeted at AIDS researchers.
Ransomware attacks are typically carried out for financial gain.
The consequences of ransomware attacks on hospitals include disruptions to healthcare operations, increased wait times, and diversion of ambulance traffic. These attacks may also lead to an increase in medical complications and mortality rates.
To mitigate the impact of ransomware attacks, healthcare organizations should forge partnerships and share resources to ensure patient care is not interrupted.
