How to vet an MSSP for healthcare compliance

Between 2005 and 2019 alone, healthcare suffered over 3,930 data breaches exposing 249 million patient records, according to a peer-reviewed study published in Healthcare journal. These breaches represented 61.55% of all data breaches across industries, with hacking incidents accounting for 64.65% of exposed health records. As cyberattacks grow more sophisticated — a trend that is stressed in KPMG’s 2025 cybersecurity outlook for healthcare — and regulatory scrutiny intensifies, Managed Security Service Providers (MSSPs) have become a big part of protecting patient data and maintaining operational continuity, especially as ransomware and phishing attacks target healthcare systems, as noted in the FBI’s 2022 Internet Crime Report.

However, not all MSSPs possess the specialized capabilities needed to navigate healthcare’s complex compliance requirements. These are the overlapping and often evolving obligations that providers, payers, and vendors must meet across multiple regulatory frameworks, including HIPAA, the HITECH Act, state-specific privacy laws, and industry standards like NIST SP 800-53 and ISO 27001. According to a 2024 explainer published by the HITRUST Alliance, healthcare organizations face mounting pressure to harmonize these requirements while managing limited resources, fragmented IT environments, and high-risk data workflows. This complexity is why many turn to certifiable frameworks like the HITRUST CSF, which consolidates over 40 authoritative sources into a single, scalable control library.

Since 2008, the Department of Health and Human Services Office for Civil Rights (HHS OCR) has collected over $123 million in HIPAA settlements and civil monetary penalties, with individual penalties reaching up to $1.5 million for willful neglect violations, according to enforcement data summarized by Statista. Meanwhile, over 80 percent of U.S. hospitals and 85 percent of health insurers now accept or require HITRUST assessments during vendor onboarding, according to the HITRUST 2024 Trust Report. In this environment, vetting MSSPs for compliance readiness has shifted from a recommended practice to a fundamental requirement for protecting both patient data and organizational viability.

Read more: Why MSSPs must align with HITRUST

What makes an MSSP “healthcare-ready”

Healthcare-ready MSSPs demonstrate specialized capabilities that extend far beyond general cybersecurity services. At minimum, these providers must understand HIPAA’s three categories of safeguards: administrative safeguards that establish policies and designate privacy officers, physical safeguards that control access to protected data and equipment, and technical safeguards that protect electronic communications and prevent unauthorized system access, as defined in the HIPAA Security Rule and summarized by the U.S. Department of Health and Human Services.

Operationally, qualified MSSPs maintain dedicated Security Operations Centers (SOCs) that monitor healthcare networks 24/7, using advanced threat intelligence to identify attack patterns specifically targeting medical organizations. Continuous vigilance addresses a concern raised in IBM’s 2025 Cost of a Data Breach Report, which found that healthcare breaches take an average of 279 days to identify and contain, more than five weeks longer than the global average of 241 days. MSSPs with healthcare expertise can detect and respond to threats within minutes rather than allowing attacks to progress for months undetected.

Beyond monitoring, healthcare-ready MSSPs provide the infrastructure components that HIPAA compliance demands. These include comprehensive audit logging that tracks every access and modification of protected health information (PHI), automated encryption for data at rest and in transit, access controls that enforce the principle of least privilege, and breach notification protocols aligned with HIPAA’s 60-day reporting requirements. These capabilities must integrate seamlessly with electronic health records, secure communication platforms, and legacy systems without disrupting the clinical workflows that healthcare teams depend on for patient care.

Go deeper: How MSSPs help healthcare organizations avoid HIPAA fines

Evaluation criteria

When assessing MSSP candidates, healthcare organizations should evaluate providers across six dimensions that directly impact both compliance outcomes and operational effectiveness.

Certifications

HITRUST CSF certification stands as the gold standard for healthcare security providers. Unlike HIPAA's traditionally flexible approach, HITRUST provides prescriptive, measurable requirements verified through independent third-party assessment. A HITRUST-certified MSSP has demonstrated that its controls satisfy HIPAA requirements while harmonizing more than 40 authoritative standards including NIST SP 800-53, ISO 27001, COBIT, and GDPR.

SOC 2 Type II certification provides additional assurance, confirming that the MSSP maintains appropriate security controls for handling sensitive data over an extended operational period. ISO 27001 certification validates a comprehensive information security management system that encompasses policies, procedures, and technical controls. Together, these certifications demonstrate an MSSP's commitment to security excellence beyond basic HIPAA compliance.

Healthcare experience

Theoretical knowledge of HIPAA requirements proves insufficient without practical experience navigating healthcare's unique operational environment. Qualified MSSPs should provide specific examples of healthcare clients they protect, describe their approach to handling PHI across different clinical scenarios, and demonstrate familiarity with OCR enforcement patterns and common violation triggers.

Healthcare experience should extend to understanding Business Associate Agreements and the shared liability model they create. MSSPs must recognize that breaches occurring through their services can expose both themselves and their healthcare clients to regulatory penalties, creating alignment between provider security practices and client compliance obligations.

Audit trail capabilities

HIPAA mandates detailed audit logs tracking every access, modification, and transmission of PHI. Qualified MSSPs provide automated logging systems that capture this information comprehensively while maintaining logs securely for required retention periods, usually 5 - 10 years, to align with HIPAA's documentation requirements.

Real-time monitoring capabilities identify suspicious activities immediately, generating the detailed documentation that compliance officers need for regulatory reporting. These audit trails also demonstrate due diligence that can reduce penalties when incidents occur. Since OCR has received more than 374,000 HIPAA complaints since the Privacy Rule's 2003 compliance date, with over 31,000 cases requiring corrective actions, intensive audit capabilities are required for both compliance and enforcement response.

Incident response

Documented incident response playbooks tailored to healthcare scenarios demonstrate an MSSP's preparedness for breach events. These playbooks should address breach assessment procedures that determine the scope of PHI exposure, containment strategies that minimize operational disruption to patient care, forensic investigation protocols that preserve evidence while maintaining system availability, regulatory notification workflows aligned with HIPAA's 60-day requirement, and communication templates for affected patients, business associates, and media when necessary.

MSSPs should specify their breach containment timelines and escalation protocols. IBM research confirms this urgency in the 2025 Cost of a Data Breach Report, showing that organizations with extensive use of AI and automation in their security operations reduce breach identification and containment time by 80 days compared to those without these capabilities, translating to cost savings of $1.9 million per incident.

Integration support

Healthcare organizations operate complex technology ecosystems that include electronic health record systems, practice management platforms, patient portals, medical imaging systems, and specialized clinical applications. Qualified MSSPs demonstrate compatibility with these systems while supporting secure communication platforms that healthcare teams rely on for daily operations.

Integration capabilities should extend to HIPAA compliant email solutions that protect PHI during transmission without creating workflow barriers. As noted in peer-reviewed research published in Cluster Computing, email compromise and phishing remain “amongst the most common malware techniques” leading to major data breaches in hospitals and health systems, making secure email integration a requirement rather than a convenience feature.

Compliance reporting

The ability to map security controls to multiple regulatory frameworks reduces administrative burden during audits and compliance reviews. Qualified MSSPs provide reporting that addresses HIPAA requirements while simultaneously satisfying state regulations like the NYDFS Cybersecurity Rule and federal mandates such as the FTC Safeguards Rule.

This multi-framework approach proves especially valuable for health systems operating across multiple states or for organizations subject to overlapping regulatory requirements. A single HITRUST validated assessment report can replace hundreds of custom questionnaires and site visits, freeing MSSP staff to focus on security operations rather than compliance documentation.

Paubox as a compliance-strengthening partner

Email communication presents persistent security challenges for healthcare organizations. Between January 2024 and January 2025, 180 healthcare organizations reported email-related breaches to the HHS Office for Civil Rights, according to the 2025 Paubox Healthcare Email Security Report. The report found that only 1.1% of breached organizations were classified as "low risk" for email security posture, while 31.1% were "high risk" and 67.8% were "medium risk," demonstrating that even organizations investing in security often maintain significant vulnerabilities.

Traditional encryption solutions compound these challenges by imposing workflow barriers that lead staff to bypass security controls entirely. Portals, encryption keys, and separate applications create friction that proves incompatible with the fast-paced clinical environment, where communication delays can affect patient care quality.

Paubox addresses these challenges through HITRUST CSF r2-certified email encryption that integrates seamlessly with existing Google Workspace and Microsoft 365 environments. The platform's automatic TLS-based encryption eliminates portals and plug-ins, allowing healthcare staff to send HIPAA compliant email without changing daily workflows or requiring additional training. For MSSPs evaluating compliance tools, Paubox partnership strengthens their overall security posture by satisfying Common Security Framework requirements for secure information exchange without the operational friction that characterizes traditional solutions.

The platform supports the compliance documentation that healthcare organizations and their MSSPs need for regulatory reporting. Monthly encryption logs provide detailed records of secure message transmission, message tracking capabilities create comprehensive audit trails for PHI communications, and the centralized management dashboard allows MSSPs to oversee multiple client environments from a single interface. Most deployments are complete within 48 hours, enabling MSSPs to offer secure email as a rapid service addition that immediately addresses one of healthcare's most common compliance vulnerabilities.

Learn more: Choosing between MSP and MSSP for HIPAA compliant email

FAQs

What does “least privilege” mean in access control? 

The principle of least privilege ensures that users only have access to the minimum data and systems necessary for their role. This reduces the risk of unauthorized access and limits the impact of compromised credentials.

What is an audit trail in HIPAA compliance? 

An audit trail is a detailed log of every access, modification, and transmission of PHI. HIPAA requires these logs to be retained for 5–10 years to support investigations, breach response, and regulatory audits.

What is the difference between MSP and MSSP?

A Managed Service Provider (MSP) offers general IT support, while a Managed Security Service Provider (MSSP) specializes in cybersecurity. MSSPs provide threat monitoring, incident response, and compliance-specific services tailored to healthcare environments.