Cybersecurity and the Law - Health IT Conference for … Core: •Identify •Protect •Detect •Respond •Recover 33 NIST Cyber Security Framework Framework Implementation Tiers:

Cybersecurity and the Law

February 29, 2016 – 9:30-10:30am

Adam H. Greene, JD, MPH Partner, Davis Wright Tremaine LLP

Conflict of Interest

Adam H. Greene Has no real or apparent conflicts of interest to report.

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Agenda

• Learning Objectives

• The Potential Legal Costs of Poor

Cybersecurity

• What the Law Requires

• The Value of Best Practices

• The Role of NIST

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Learning Objectives

• Explain the possible legal ramifications of a cyber-attack

• Review recent developments in Cyber Security Law

• Provide ideas on how to prepare executive management and the board for the inevitable

• Discuss the pros and cons of applying the NIST Cyber Security Framework within healthcare

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The Potential Legal Costs of

Poor Cybersecurity

A Really Bad Day …

An outside security consultant’s review identified sophisticated malware residing on your information systems.

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More Bad News…

Forensic investigation identified that: • Outside entity obtained initial access through spear phishing.

• Once inside network, obtained administrative credentials.

• Has been in system for four months.

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What Did They Get?

We don’t know what was exfiltrated. Possibly: • Information on 500,000 patients. • Including medical information and Social Security numbers.

• Affecting residents in 22 states where we operate.

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So, How Bad Is This?

Potential HIPAA Violations: • Impermissible disclosure of 500,000 patients’

protected health information (2015-16) • Failure to conduct an accurate and thorough risk

analysis (2011-16). • Failure to implement a risk management plan

(2011-16). • Lack of information system activity review (2011-

16). • Failure to protect from malicious software (2011-

16).

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So, How Bad Is This?

Potential HIPAA Penalties (HHS): • $50,000 per violation per day or per affected

individual • Annual cap of $1.5 million for multiple violations of

the same requirement

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So, How Bad Is This?

Potential HIPAA Penalties (HHS): • Impermissible disclosure: 2 years * $1.5M = $3M • Risk analysis: 6 years * $1.5M = $9M • Risk management plan: $9M • Information system activity review: $9M • Failure to protect from malicious software: $9M • HHS Total = $35M

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But Wait, There’s More ….

Potential HIPAA Penalties (State Attorney General): • $100 per violation per day or per affected individual

• Annual cap of $25,000 million for multiple violations of the same requirement

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Potential State AG HIPAA Penalties

• Impermissible disclosure: 2 years * $25K = $50K • Risk analysis: 6 years * $25K = $150K • Risk management plan: $150K • Information system activity review: $150K • Failure to protect from malicious software: $150K • Per State Subtotal = $625K • Total for 22 states = $13.8M

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And then there’s the FTC …

• If breached entity is for-profit entity, FTC can claim lack of security was unfair or deceptive trade practice.

• Standard 20-year consent order (potentially requiring independent monitoring).

• In Henry Schein Practice Solutions, Inc., FTC required payment of $250,000 to a redress fund

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Welcome to California …

125,000 of the affected patients reside in California.

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Welcome to California …

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Welcome to California …

125,000 x ($1,000 + $3,000 + $1,000) = $625M

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And don’t forget about …

• Breach notification costs • Credit monitoring costs • Breach notification legal costs • Legal costs for handling multiple regulatory investigations

• Legal costs for class action defense

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What the Law Requires

HIPAA Provides a Minimal Baseline:

• Substantial flexibility and technology neutral • Provides discretion to not implement certain technology based on risk-based approach

• Does not clearly require due diligence of vendors

• Does not require active monitoring of vendors – only requires action upon learning of violation

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But Don’t Let HIPAA’s Flexibility Fool You…

• For “accurate and thorough” risk analysis, OCR expects you to document how you are addressing every reasonably-anticipated risk.

• While not directly liable for most business associates’ actions, HIPAA may lead to substantial reputational harm and breach notification costs based on BAs’ violations

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FTC Applies More Stringent Standards than HIPAA

• Section 5 authority is inapplicable to non-profits.

• No clear information security standards. • Expects “defense in depth” • In GMR Transcription, complaint alleged a lack of active monitoring of subcontractor business associate.

• In Henry Schein Practice Solutions, complaint faulted business associate for encryption that did not satisfy NIST standards.

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Successes and Failures of Class Actions

Limited Plaintiff Successes Absent Clear Damages • AvMed $3 million settlement (1.2 million affected customers, claim of unjust enrichment based on premiums allegedly not going towards adequate information security) (2014)

• Stanford $4 million settlement (20,000 patients, settlement mostly paid by Stanford’s vendors) (2014)

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Successes and Failures of Class Actions

Limited Plaintiff Successes Absent Clear Damages (cont’d) • Boston Medical Center, Superior Court held that plaintiffs had standing to sue based on data exposure (2016)

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Successes and Failures of Class Actions

Most Cases Dismissed on Lack of Standing • Clapper v. Amnesty International, U.S. Supreme Court held that individuals potentially subject to surveillance did not have standing based on allegations of possible future injury. (2013)

• Numerous cases have dismissed data breach class actions on lack of standing or lack of damages

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Dodging the CA CMIA Bullet

California Confidentiality of Medical Information Act provides $1,000 per person for negligent disclosure of medical information in absence of actual damages. • In Sutter Health, court held that evidence must show that medical information was actually viewed.

• In Eisenhower Med. Ctr., court held that patient demographic information was not “medical information.”

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To Be Determined

• Successful action under CMIA? Will court award millions in absence of any actual damages?

• Spokeo v. Robins, U.S. Supreme Court addresses whether consumer class can sue for monetary damages w/o identifiable financial or personal injuries.

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The Value of Best Practices

A Robust Cyber Security Program:

• Legal risks follow real risks – and health care hacking is on the rise.

• Tougher regulators are increasing legal risks from data breaches.

• Doing the bare minimum will lead to: – High breach notification incidents and costs – High litigation costs defending claims of

negligence – Fights with regulators over what is required

• Cyber insurance carriers may require more and more

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Convincing the C-Suite/Board • Inform:

– Evidence of increasing threats to health care data

– Increasing level of enforcement among more regulators

• Quantify: – How much breach will cost vs. risk reduction

through InfoSec investment – Focus on return on investment

• Progress Reports – What is current profile? – What is target profile? – How are we progressing towards target?

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The Role of NIST

The Role of NIST

• NIST standards are not required for private entities, unless incorporated through contract, but …

• A good set of tools for improving information cyber security;

• A good proxy for industry best practices; and

• Agencies such as the FTC are increasingly expecting NIST-level safeguards.

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NIST Cyber Security Framework

Framework Core: • Identify • Protect • Detect • Respond • Recover

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NIST Cyber Security Framework

Framework Implementation Tiers: • Partial (Tier 1) • Risk Informed (Tier 2) • Repeatable (Tier 3) • Adoptive (Tier 4)

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NIST Cyber Security Framework

Framework Profile: • Current Profile • Target Profile • Comparison of Profiles

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NIST Cyber Security Framework

1. Prioritize and Scope 2. Orient 3. Create a Current Profile 4. Conduct a Risk Assessment 5. Create a Target Profile 6. Determine, Analyze, and Prioritize Gaps 7. Implement Action Plan

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NIST, http://www.nist.gov/cyberframework/upload/cybersecurity-framework-021214.pdf

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Stay Tuned

• Section 405 of Cybersecurity Act of 2015 – HHS to work with NIST to create

information for health care industry stakeholders of all sizes for improving preparedness for, and response to, cybersecurity threats affecting health care industry

– Statute states that any new standards will be consistent with HIPAA but will be optional

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Resources • NIST Framework for Improving Critical

Infrastructure Cybersecurity, http://www.nist.gov/cyberframework/upload/cybersecurity-framework-021214.pdf

• NIST Guide for Conducting Risk Assessments, http://csrc.nist.gov/publications/nistpubs/800-30-rev1/sp800_30_r1.pdf

• Cybersecurity Information Sharing Act (part of Pub. L. 114-113), https://www.congress.gov/114/bills/hr2029/BILLS-114hr2029enr.pdf

• HIPAA Security Rule Crosswalk to NIST Cybersecurity Framework, http://www.hhs.gov/hipaa/for-professionals/security/nist-security-hipaa-crosswalk

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Questions

Adam H. Greene, JD, MPH

[email protected] 202.973.4213

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