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How Paubox's Inbound Email Security can enhance HIPAA compliance

Written by Tshedimoso Makhene | October 08, 2025

Email is a primary communication channel between clinicians, patients, and business associates in the healthcare sector. However, email is the vector for cyberattacks such as phishing, spoofing, and business email compromise (BEC). These threats put electronic protected health information (ePHI) at risk and thus present serious challenges to HIPAA compliance.

The introduction of Paubox’s Inbound Email Security offers healthcare organizations a powerful way to defend against these evolving threats. By leveraging generative AI, behavioral analytics, and adaptive filtering, Paubox automatically detects and blocks malicious emails before they reach users’ inboxes. This proactive approach reduces the risk of data breaches and supports HIPAA’s technical safeguard requirements, helping covered entities and business associates maintain compliance while ensuring secure, uninterrupted communication.

Go deeper: Paubox launches generative AI email security for healthcare

 

Email threats in healthcare

Healthcare remains a top target for cybercriminals. As Juta Gurinaviciute, CTO at NordLayer, states,As the CTO of NordLayer, a cybersecurity company, I have witnessed a trend of malicious actors increasingly setting their sights on healthcare organizations. There are various reasons, but they primarily stem from the valuable data these institutions possess and the critical nature of their operations.”

Furthermore, according to CISA, 8 out of 10 organizations had at least one individual who fell victim to a phishing attempt by CISA Assessment teams, and 1 out of 10 phishing emails sent by CISA Assessors had a user execute a malicious attachment or interact with a malicious link.Paubox also revealed insights into 107 email-related healthcare breaches reported so far in 2025. This compares with a total of 180 such incidents recorded last year. Notably, "52% of these healthcare breaches occurred on Microsoft 365," marking an increase from "43% in 2024." Because email communications often carry patient information, credential data, attachments, or links to protected portals, a single misstep can lead to a HIPAA breach.

Some prominent threats include:

  • Spear phishing / social engineering: emails crafted to appear from trusted individuals to coax recipients into clicking malicious links or sharing credentials
  • Domain spoofing and display name impersonation: attackers mimicking trusted domains or user names, including executives, to deceive recipients
  • Business email compromise (BEC): manipulation of staff to take actions like sending funds, disclosing sensitive data, or redirecting payments
  • Malware or ransomware via attachments or embedded links.

Because these threats often exploit human behavior and contextual cues, a robust inbound defense must go beyond static filters.

Related: 10 Email security threats changing cybersecurity defense in 2025

 

Why Paubox’s approach goes beyond traditional filtering

Generative AI detection

Traditional filters rely on static rules, signature databases, and heuristics. But modern attacks often use subtle social engineering, context shifts, and compromised accounts that evade static signatures.

Paubox’s generative AI engine analyzes tone, context, sender behavior, and deviations from historical norms to spot anomalies that static systems miss. It also evolves in real time, reducing manual rule tuning and ensuring the system adapts to novel attack patterns. 

 

Executive/high-value account protection

Exec impersonation is a common scheme: attackers spoof a CEO’s or a physician’s identity to trick staff.

Paubox’s ExecProtect+ actively prevents lookalike domains or impersonation of protected names in the organization. This defends against one of the riskiest threat vectors. 

 

Quarantine flexibility and control

Not every blocked message is malicious, and giving users limited control over quarantined messages helps balance security and usability. Admins can decide the level of user autonomy, schedule reports, or allow user release under oversight. 

 

Transparency and investigation tools

When a threat is blocked, Paubox provides the reasoning or evidence behind that decision, along with historical context. This transparency helps compliance teams investigate, justify actions, and refine policies. 

 

Built for healthcare compliance

Paubox is HITRUST certified, supports business associate agreements (BAAs), and explicitly states that patient data is never shared with third parties. 

This alleviates major hurdles for healthcare organizations that must vet vendors for compliance.

 

Strong deployment compatibility

Paubox has easy implementation with Google Workspace and Microsoft 365, meaning it can integrate with infrastructure that many healthcare organizations already use. This reduces friction and accelerates adoption.

Read also: Integrating Paubox Email Suite with popular email providers

 

Building a risk mitigation strategy around inbound email security

To fully realize the benefits and maximize HIPAA compliance support, an organization should integrate Paubox Inbound Email Security into a broader risk management plan. Below are recommended practices:

  • Conduct a thorough risk assessment: Identify where and how email is used to transmit or access ePHI. Evaluate the probability and impact of phishing, spoofing, and inbound email threats. Use these insights to prioritize protections and policies.
  • Define policies and governance: Organizations should create clear protocols for handling inbound messages by specifying which emails should be quarantined, delivered with caution, and blocked outright. They should also establish defined escalation paths for quarantined messages flagged as suspicious, such as review and verification by the security or IT team, to ensure timely action. Additionally, organizations must document these workflows, roles, and escalation procedures to maintain consistency, accountability, and compliance with HIPAA security requirements.
  • Configure Paubox with minimal friction: Take advantage of the deployment ease with Google Workspace and Microsoft 365 integrations to roll out quickly. Set baseline rules, tagging, and quarantine modes; start in monitoring-only mode before gradually tightening.
  • Integrate with incident response: Link Paubox’s alerts, logs, and dashboards to your broader incident response systems. When an inbound email is flagged as a potential threat, ensure it triggers your team’s response workflows (triage, investigation, containment, remediation, and documentation).
  • Provide ongoing training and awareness: Even with strong filtering, no solution is perfect. Reinforce employee awareness of phishing risks, suspicious email cues, and correctly handling quarantined signals. Promote a culture of reporting suspected messages.
  • Monitor, audit, and review: Regularly review logs, detection trends, false positives/negatives, and quarantine data. Use Paubox’s transparency and rationale tools to analyze patterns and refine rules or training. This supports mandatory audit control and security review requirements under HIPAA.
  • Document everything: Maintain documentation of risk assessments, configuration decisions, incident reviews, and policy evolution. This record helps demonstrate due diligence during compliance audits or investigations.

 

Example use cases and benefits

Here are a few scenarios illustrating how Paubox Inbound Email Security can make a difference in a healthcare setting:

Phishing attempt to the hospital staff

A malicious email appears to come from an executive asking a nurse to share a patient’s insurance verification via attachment. Paubox’s AI flags the tone/behavior as anomalous, quarantines the message, and allows the security team to investigate. The attachment is never exposed to the user.

 

Impersonation of a physician

An attacker spoofs a physician’s name via a lookalike domain (e.g.,drj0hnsmith.comvs.drjohnsmith.com”) to request prescription refills or patient data. ExecProtect+ blocks the domain or the name impersonation before it reaches staff, preventing disclosure of data or fraudulent requests.

 

Compromised vendor email

A third-party billing vendor’s email is compromised. The attacker sends an email with malicious links or requests for PHI. Paubox compares behavior to past patterns and flags it for human review or blocks it entirely.

 

Unexpected attachment in routine emails

A referral partner suddenly sends an executable file or macro-enabled document disguised as medical record attachments. Paubox’s encryption, quarantine rules, and scanning filter analyze the file before it can ever reach the endpoint.

In all these examples, the user never sees or interacts with the malicious payload, drastically reducing human error and exposure risk.

See also: HIPAA Compliant Email: The Definitive Guide (2025 Update)

 

FAQS

What is Paubox Inbound Email Security?

Paubox Inbound Email Security is a HIPAA compliant email security solution designed to protect healthcare organizations from phishing, spoofing, and other inbound email threats. It uses advanced threat detection and filtering technologies to identify malicious content before it reaches a user’s inbox.

 

How does Paubox Inbound Email Security support HIPAA compliance?

Paubox helps healthcare organizations meet HIPAA requirements by safeguarding electronic protected health information (ePHI) from unauthorized access or exposure. It ensures that emails containing ePHI are scanned, filtered, and quarantined as necessary to prevent data breaches.

 

Why is inbound email security important for healthcare organizations?

Email remains one of the most common attack vectors in healthcare. A single phishing email can compromise ePHI and trigger costly HIPAA violations. Inbound email security provides an essential layer of defense that reduces human error and mitigates compliance risks.