How to prevent man-in-the-middle attacks in healthcare

Man-in-the-middle (MitM) attacks occur when a malicious actor intercepts the communication between a user and an application or between two devices, enabling them to eavesdrop, steal sensitive information, or even manipulate the transmitted data. In the healthcare context, these attacks can have consequences, from the theft of opioid prescriptions to the compromise of life-critical medical devices like pacemakers.

Understanding the mechanics of man-in-the-middle attacks

At the core of a MitM attack is the attacker's ability to infiltrate the communication channel between two parties, effectively inserting themselves as an intermediary. This is typically achieved through two steps: interception and decryption.

Interception

Threat actors employ various techniques to gain unauthorized access to communication channels. Unsecured Wi-Fi networks, DNS manipulation, and credential theft often serve as entry points. Exploiting these vulnerabilities allows attackers to insert themselves between the user and the intended application or device.

Decryption

Once inside the communication channel, attackers focus on decrypting intercepted data. Methods include brute-force attacks, exploiting outdated encryption protocols, or using advanced tools to crack encryption keys.

Read more: What is a man-in-the-middle (MITM) attack? 

The unique challenges faced by the healthcare industry

The healthcare industry is particularly susceptible to MitM attacks due to several factors:

The proliferation of IoT devices

The average hospital uses thousands of network-connected devices, with estimates suggesting around 17 devices per hospital bed. These IoT devices, which are integral to patient care and operational efficiency, often lack security measures, making them prime targets for MitM attacks.

Legacy infrastructure and outdated software

Many healthcare organizations continue to use legacy systems and outdated software, often running on unsupported operating systems without security patches. These weaknesses expose the infrastructure to exploitation by threat actors.

Shifting cybersecurity landscape

According to the recent Data Breach Investigations Report (DBIR), external threat actors are now responsible for the majority of cyber incidents in the healthcare industry, a shift from previous years. This proves the growing sophistication and persistence of attackers targeting the sector.

Read also: Execution methods of man in the middle attacks 

Expert insight

Jacob Wert is an accomplished IT professional, entrepreneur, and author, with over 24 years of experience in information security, cloud computing, and managed IT services. He currently serves as Founder & CEO of Trix Holdings, Inc., Private Matrix, and Infinite Office Solutions, Inc.

In discussing how to effectively thwart Man-in-the-Middle (MitM) attacks, Wert says, "To effectively thwart Man-in-the-Middle (MitM) attacks, you must grasp the vulnerabilities they exploit and the crafty strategies to counter them. Start by deploying ironclad encryption protocols like TLS (Transport Layer Security) to ensure that your data transmissions are not just secure, but utterly incomprehensible to any would-be eavesdroppers. Embrace the power of Public Key Infrastructure (PKI) to forge a bulletproof trust chain, making it impossible for rogue entities to pose as legitimate servers."

He also stresses the importance of managing digital certificates: "Keep those digital certificates fresh and meticulously managed to safeguard your communication channels. Lock down your Wi-Fi networks with WPA3 encryption and steer clear of public Wi-Fi for any sensitive dealings." Wert goes on to recommend using VPNs for creating secure data tunnels and to "amp up your defenses with Virtual Private Networks (VPNs), creating a secure tunnel for your data even over the shadiest of networks." Finally, he advocates for deploying Multi-Factor Authentication (MFA) and strong passwords, secured with password managers, to provide additional layers of protection.

Strategies to prevent man-in-the-middle attacks

Safeguarding healthcare networks against MitM attacks requires a multilayered approach that combines technological solutions, human behavior modifications, and strategic partnerships with security providers.

Leveraging security tools

Implementing a set of security tools is the foundation of MitM attack prevention. These include:

Firewalls and VPNs

Firewalls and virtual private networks (VPNs) can create a secure perimeter around the network, making it more difficult for attackers to gain unauthorized access.

SSL and security certificates

Secure sockets layer (SSL) and transport layer security (TLS) certificates help ensure the authenticity of websites and encrypt communication, making it harder for attackers to intercept and decrypt data.

Multi-factor authentication

Implementing multi-factor authentication (MFA) can effectively control access to systems and devices, reducing the risk of credential theft.

Endpoint security for IoT devices

Deploying endpoint security solutions on IoT devices can help protect them from MitM attacks and other cyber threats.

Wired connections for sensitive devices

Utilizing hardwired connections for sensitive medical devices can minimize the attack surface and reduce the risk of MitM intrusions.

Addressing human behavior

Technological solutions are helpful, but preventing MitM attacks also depends on the human factor. Security awareness training for healthcare staff should include:

Risks of public Wi-Fi

Educating employees on the dangers of using public and open Wi-Fi networks, and encouraging the use of secure, organization-provided connections.

Identifying fake websites

Training personnel to recognize and avoid phishing scams and fake websites that may be used in MitM attacks.

Importance of secure browsing

Emphasizing the need to use only secure, HTTPS-enabled websites for sensitive transactions and communications.

Enforcement of security policies

Implementing and strictly enforcing policies that restrict the use of public Wi-Fi and BYOD (bring your own device) practices, which can increase the risk of MitM attacks.

Partnering with a trusted security provider

Collaborating with a security provider that offers a holistic approach to protecting devices, networks, and data can be a game-changer in the fight against MitM attacks. A trusted partner can provide:

Threat intelligence leadership

Guidance on the latest MitM attack vectors and the most effective security measures to mitigate them, based on industry-leading threat intelligence.

Security solutions

A suite of security tools and services tailored to the unique needs of the healthcare industry ensures that all devices and networks are equipped with the necessary protection.

Compliance expertise

Assistance in understanding complex regulations, such as HIPAA, to ensure that security measures align with industry standards and legal requirements.

In the news

Researchers Talal Haj Bakry and Tommy Mysk showed how a Man-in-the-Middle (MiTM) attack could compromise Tesla accounts and control vehicles. They used a fake WiFi network called "Tesla Guest," which is familiar to Tesla owners. When a victim connects to this network, they are directed to a fake login page that steals their Tesla account information. With this information, attackers can bypass two-factor authentication and log into the Tesla app. They can then add a new 'Phone Key' to the car without any alerts to the owner. This new Phone Key allows them to unlock and drive the car. Despite reporting this vulnerability to Tesla, the company did not address the suggested security improvements. This method demonstrated with a Flipper Zero, can also be executed with other devices like an Android phone.

FAQs

What is a MitM attack and how does it relate to healthcare security?

A man-in-the-middle (MitM) attack involves an attacker intercepting and potentially altering communications between two parties without their knowledge. In healthcare, MitM attacks can compromise the confidentiality and integrity of electronic protected health information (ePHI) by intercepting and manipulating data exchanges between healthcare providers, patients, or systems, posing a risk to HIPAA compliance.

Why is a MitM attack a threat to HIPAA compliance?

A MitM attack is a threat to HIPAA compliance because it can lead to unauthorized access to ePHI, altering sensitive data, and violating patient confidentiality. Successful MitM attacks can result in data breaches, disrupt healthcare operations, and expose healthcare organizations to legal and financial penalties under HIPAA regulations.

What are the potential risks associated with Man-in-the-Middle (MitM) attacks under HIPAA?

• Data breaches: Attackers can intercept and access ePHI during transmission, leading to unauthorized disclosure of patient information.
• Data manipulation: Altered communications can result in incorrect information being recorded or shared, affecting patient care and treatment.
• Non-compliance penalties: Failure to protect ePHI from MitM attacks can result in fines and legal actions for HIPAA violations.
• Operational disruptions: Compromised data exchanges can disrupt healthcare services, affecting patient care and administrative functions.
• Reputational damage: Loss of patient trust and damage to the organization's reputation due to a breach or manipulation of sensitive information.

Learn more: HIPAA Compliant Email: The Definitive Guide