This week, Hacking Healthcare begins with an update on Russian cyber retaliation against Germany for policy decisions that supported Ukraine. We break down just how swiftly cyber capabilities were weaponized against German government and critical infrastructure, and we make the case for building resiliency against some less sophisticated types of cyberattacks. Next, we stick to the international stage as we assess the recent news of a multinational takedown of the prolific Hive cybercriminal group. Beyond summarizing the law enforcement action, we analyze the overall effect these sorts of operations have on the ransomware ecosystem, and then we provide some best practices for mitigating ransomware risks.

As a reminder, this is the public version of the Hacking Healthcare blog. For additional in-depth analysis and opinion, become a member of H-ISAC and receive the TLP Amber version of this blog (available in the Member Portal.)


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TLP WHITE - 2.2.2023 -- Hacking Healthcare


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Welcome back to Hacking Healthcare.


German Support for Ukraine Leads to Cyberattacks on Critical Infrastructure 

In another example of how geo-politics influences malicious cyber activity, German critical infrastructure sectors came under cyberattack soon after the German government signaled its intent to further support Ukraine. The events reiterate how cyberattacks often fall in the grey area between accepted retaliatory actions by governments, such as trade sanctions, and unacceptable ones, such as military strikes. The swiftness of the attacks and who carried them out are notable.

On January 25th, the German government agreed to send Leopard 2 tanks to aide Ukraine in their fight against Russian aggression. The German government had been resistant to the idea, in part over concerns it might increase risk to German interests. However, international pressure appears to have succeeded in changing their policy.[i] Russian cyber retaliation was swift.

Within 24 hours of the announcement, reports indicated that hacking groups aligned with the Russian government had launched attacks against a wide range of German organizations.[ii] Victims included those in critical infrastructure sectors like transportation and finance, as well government agencies.[iii] Several pro-Russian “hacktivist” groups are said to be responsible, but their level of independence from the Russian state is an open question.[iv]

The German Federal Office for Information Security (BSI), which acts as Germany’s federal cybersecurity authority, has stated that the malicious actions were largely limited to distributed denial-of-service (DDoS) attacks.[v] These have had little serious effect, but several websites were put offline. Russia’s more serious cyber capabilities appear limited to use against Ukraine, where a new destructive wiper was seen just last week.[vi]

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FBI Seizes Infrastructure from one of Healthcare’s Largest Ransomware Attackers

The Hive ransomware group has earned a reputation for their prolific cyber operations that have victimized “more than 1,500 victims in over 80 countries around the world, including hospitals, school districts, financial firms, and critical infrastructure.”[xi] Those operations will be disrupted, at least for a little while, due to a joint law enforcement action involving the U.S. Justice Department (DOJ) and international partners from Germany and the Netherlands. According to the DOJ, the FBI was able to successfully seize two servers in Los Angeles, California that were behind Hive’s ransomware attacks.[xii]

According to Cyberscoop, “Hive has targeted more than 1,500 victims globally since June 2021, and caused major disruptions for health care providers and hospitals during the height of the pandemic”[xiii]. Common disruptions seen because of these attacks vary from electronic system shutdowns, and cancellations of scheduled care, to ambulance diversion.

The DOJ described Hive’s activities as being “responsible for extorting and attempting to extort hundreds of millions of dollars from victims in the United States and around the world,” which is why the success of the FBI operation is behind heralded as a major win in the ongoing battle against ransomware.[xiv] In total, the FBI  has distributed over  300 decryption keys to recent Hive victims, over  1,000 decryption keys for prior victims, and has prevented an estimated $130 million in ransomware payments.[xv]

Hive’s operations, while prolific, do not appear to be particularly unique. Hive reportedly operates ransomware-as-a-service (RaaS) to generate much of its revenue.[xvi] For those not ingrained in the cybercriminal world, RaaS is a business model between ransomware operators and affiliates, where affiliates pay to launch ransomware attacks that have already been developed by operators. Purchasing a readily available RaaS kit from Hive on the dark web allows affiliates that lack the skill or time to develop their own ransomware to be up and running quickly and affordably.

The DOJ, citing the Cybersecurity and Infrastructure Security Agency (CISA), further relayed that “Hive affiliates have gained initial access to victim networks through a number of methods, including: single factor logins via Remote Desktop Protocol (RDP), virtual private networks (VPNs), and other remote network connection protocol”.[xvii] Hive is reported to be convert to the double-extortion attack method. This tactic involves extracting sensitive data before encrypting the system, enabling them to ask for ransom to both decrypt the system and to not publish the stolen information. The Department of Justice noted that Hive focused on extracting the the most sensitive data in a victim’s system to increase the pressure to pay.[xviii]


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Tuesday, January 24th:

– No relevant hearings


Wednesday, January 25th:

– No relevant hearings


Thursday, January 26th:

– No relevant hearings


International Hearings/Meetings

– No relevant meetings

European Union

– No relevant meetings

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