Hospital Medical Devices Used As Weapons In Cyberattacks

Insulin pumps, heart monitors, x-ray communications systems and other medical devices already have been proven vulnerable to cyberattack by security researchers, but a new report confirms that hospital medical devices are being abused by cybercriminals and possibly cyberspies as a stepping-stone within healthcare networks to nab valuable healthcare identities and information.

A report by TrapX scheduled to publish next week reveals three cases where hospitals were hit by data breaches after their medical devices had been infected with malware backdoors to move laterally within the healthcare network. In all three cases, the hospitals were unaware that these devices--a blood gas analyzer, a picture archive and communications system (PACS) and an x-ray system--were infiltrated with malware. The devices were spotted when TrapX installed its sensor-based technology in the hospitals, which TrapX declined to identify by name.

Ransomware, as well as Zeus, Citadel, and even Conficker, malware were discovered on the devices. While none of these real-world hacks of the medical devices appeared to be used for sabotage per se, TrapX says the malware on them indeed could be used for remote control of the devices.  

"We did see multiple types of malware and ransomware resident on these [medical] devices," says Greg Enriquez, CEO of TrapX. The hospital's security teams were unable to see the malware themselves via their traditional security scans and tools because the systems are closed devices, he says.

"They're not open to security teams to scan or to use typical security products on," he says. "That's the challenge hospital professionals have in security: often these devices are behind secondary firewalls managed by the manufacturer of the device, and the security team doesn't have access."

Billy Rios, a security researcher who has studied various types of consumer and medical system vulnerabilities, says malware attacks on medical devices are "pretty common."

Some of these devices are based on Windows, for example, Rios says, so they are often susceptible to Windows exploits. "There have been previously reported cases where these devices have become infected by run-of-the-mill malware.  While this malware isn't custom-made for medical devices, it shows that the devices are vulnerable to exploitation," says Rios, who is founder of Laconicly LLC.

The attacks on the three hospitals were targeted in nature. In one case, three blood-gas analyzers were infected with malware within the hospital, which had in place a firewall, heuristics-based intrusion detection, endpoint security, and antivirus tools, as well as an experienced security team. The hospital had no clue of the infections until TrapX installed its sensors, and noticed several alerts about malicious activity in the hospital network. Each system had a backdoor that gave them access to the internal network, and hospital data records had been exfiltrated to somewhere in the European Community, TrapX says.

Zeus and Citadel Trojans were in place to grab passwords, and a worm was also found to spread and propagate the malware. "The devices had an early version of Windows," Enriquez says, which made them more vulnerable.

In the second case, a hospital's picture archive and communications system (PACS) used to share imaging records from MRI, CT, ultrasound, x-ray systems with physicians and others, was infected with malware.

As with the other hacked hospital, this one also had the proper security tools and staff in place, but had no clue that the PACS had been compromised. In this case, data was being siphoned out and sent to a location in Guiyang, China, via an SSL-encrypted port 443, suggesting a possible cyber espionage attack.

"We clearly saw it going to China," Enriquez says. "Where it goes from there, how it gets routed … that's unknown at this point."

The attack began with a user at the hospital visiting a malicious website that injected a Java exploit into the user's browser and provided remote access to the attackers, and ultimately, the injection of malware backdoor on the PACS, according to TrapX.

[Public safety may finally force Internet of Things manufacturers to start taking security seriously. Read Internet Of Things Security Reaches Tipping Point.]

In the third hospital, one of the x-ray systems was found harboring a backdoor for a "pivot" attack on the hospital network, the company said.

"I believe these medical providers were targeted. They are being targeted for a number of reasons: personal information is worth ten times more on the black market than a credit card number, and the personal information they have may have value to a nation-state," Enriquez says.

TrapX's "Anatomy of an Attack – Medical Device Hijack (MEDJACK)," will be released on June 15. The company says hospitals should include language in their contracts with medical equipment makers that covers malware infections. "They must include very specific language about the detection, remediation and refurbishment of the medical devices sold to the hospitals which are infected by the malware. They must have a documented test process to determine if they are infected, and a documented standard process to remediate and rebuild them when malware and cyber attackers are using the devices," says Mosh Ben Simon, co-founder and vice president of TrapX Security and general manager of TrapX Labs, in the report.