Fraud Management & Cybercrime , Healthcare , Industry Specific

UnitedHealth CEO: Paying Ransom Was 'Hardest Decision' Ever

CEO Tells Congress Attackers Gained Access Via a Citrix Portal; What Happened Next
UnitedHealth CEO: Paying Ransom Was 'Hardest Decision' Ever

Deciding to pay cybercriminals a ransom in the attack on Change Healthcare was one of the most difficult choices UnitedHealth Group CEO Andrew Witty ever faced, according to written testimony ahead of two congressional hearings this week on the disruptive Change Healthcare mega-hack.

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"As chief executive officer, the decision to pay a ransom was mine. This was one of the hardest decisions I've ever had to make. And I wouldn't wish it on anyone," he said in written testimony to the House Energy and Commerce Committee's Oversight and Investigations Subcommittee in advance of a hearing on Wednesday.

Witty's appearance before the subcommittee Wednesday afternoon will follow his testimony that morning, where he is the sole witness at a Senate Finance Committee hearing on the UHG cyberattack.

Lawmakers in both chambers are expected to grill Witty on the company's response to the attack and related issues, including whether UHG has grown too large and powerful through its many acquisitions. UHG bought Change Healthcare in 2022 for $13 billion, making the company responsible for 15 billion transactions annually, "touching" 1 in 3 patients in the U.S.

Witty's written House committee testimony does not indicate the amount of the ransom UHG paid, which BlackCat attackers behind the assault claimed was $22 million.

Among questions that lawmakers are likely to ask Witty is whether UnitedHealth Group ended up paying two ransoms - one to BlackCat, also known as Alphv, and another to the group RansomHub, which claimed to have custody of 4 terabytes of stolen Change Healthcare data (see: Change Health Attack: Details Emerge; Breach Will Top Record).

RansomHub two weeks ago began leaking some 22 files of UHG's stolen data after a BlackCat affiliate alleged he or she was scammed out of their cut of the $22 million attack bounty that initially UHG supposedly paid.

RansomHub removed the leaked data from its dark web site after a few days, fueling speculation that UHG had paid a second ransom to suppress the release of the stolen data.

Compromised Citrix Portal

Witty in his House committee testimony provided a few details of the attack method the hackers used.

While the forensics investigation is ongoing, so far UHG has determined that on Feb. 12 - nine days before attackers launched ransomware - criminals used compromised credentials to remotely access a Change Healthcare Citrix portal, an application used to enable remote access to desktops, Witty said.

"The portal did not have multifactor authentication. Once the threat actor gained access, they moved laterally within the systems in more sophisticated ways and exfiltrated data," he said.

Upon discovering the ransomware attack on Feb. 21, and not knowing at that time the entry point into Change Healthcare's network, the company immediately severed connectivity with Change's data centers to eliminate the potential for further infection, Witty said. "While shutting down many Change environments was extremely disruptive, it was the right thing to do," he said.

"We secured the perimeter of the attack and prevented malware from spreading beyond Change to the broader health system. It worked. There has never been any evidence of spread beyond Change - not to any external environment and not to Optum, UnitedHealthcare or UnitedHealth Group."

Within hours of the ransomware launch, UHG contacted the FBI and remains in regular communication with law enforcement, Witty said. "We shared critical information, including details about the intrusion, the method of attack, indicators of compromise and other information that would assist in their investigation."

By the afternoon of Feb. 21, UHG had summoned experts from Google, Microsoft, Cisco, Amazon and other companies to Change Healthcare’s Nashville central command operations center, where they joined security teams from Mandiant and Palo Alto Networks, Witty said.

Working the around the clock, the teams rebuilt Change Healthcare's technology infrastructure from the ground up.

"The team replaced thousands of laptops, rotated credentials, rebuilt Change Healthcare's data center network and core services, and added new server capacity. The team delivered a new technology environment in just weeks - an undertaking that would have taken many months under normal circumstances," Witty said.

Due to the nature of the attack and the complexity of data review, it is likely to take UHG several months of analysis before enough information will be available to identify and notify affected customers and individuals, in part because the files containing that data were compromised in the cyberattack," he said.

UHG and a team of external experts are continuing to monitor the internet and dark web to determine if data has been published, he said.

"We will, of course, comply with legal requirements and provide notice to affected individuals and have offered to our customers and clients to provide notice on their behalf where it is permitted," he said. UHG is working closely with the Department of Health and Human Services' Office of Civil Rights "to make sure our notice is effective, useful and complies with the law."

Witty said most of Change Healthcare's most critical IT systems - including pharmacy, provider payments and claims processing - which were taken offline during the response and recovery, are restored to near normal functionality.

The IT outage for more than a month disrupted legions of healthcare sector players, including pharmacies, doctor practices and hospitals. Some industry groups, including the American Medical Association, reported that many providers are still hampered and catching up with mounds of work that could not be processed during the height of the outage, which also seriously affected their financial stability.

As of April 26, UHG provided $6.5 billion in financial assistance to healthcare providers affected by the incident, Witty told lawmakers in his written testimony.

"As we have addressed the many challenges in responding to this attack, including dealing with the demand for ransom, I have been guided by the overriding priority to do everything possible to protect peoples' personal health information," he said.

"We will continue to share information that will enable law enforcement to pursue, capture and bring these criminals to justice."

Common Error?

Jasson Casey, CEO of security firm Beyond Identity, said the lack of multifactor authentication on Change Healthcare's Citrix portal as an entry into the company's network is unfortunately a common problem among other organizations.

"Many entities fail to implement this essential security measure due to perceived complexity, user inconvenience or inaccurate assumptions about the fundamental security of virtual desktop infrastructure," he said.

To avoid similar compromise scenarios, organizations should prioritize the implementation of phishing-resistant MFA across all critical systems, including Citrix portals, Casey said. "Phishable factors like push notifications, time-based one-time passwords, and passwords are no longer sufficient to protect against modern adversaries."


About the Author

Marianne Kolbasuk McGee

Marianne Kolbasuk McGee

Executive Editor, HealthcareInfoSecurity, ISMG

McGee is executive editor of Information Security Media Group's HealthcareInfoSecurity.com media site. She has about 30 years of IT journalism experience, with a focus on healthcare information technology issues for more than 15 years. Before joining ISMG in 2012, she was a reporter at InformationWeek magazine and news site and played a lead role in the launch of InformationWeek's healthcare IT media site.




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