Mitigating and avoiding email threats in healthcare

Healthcare workers continuously rely on email for both day-to-day and critical operations. At the same time, email remains a primary target for cyberattackers. Recent reports show that an estimated 3.4 billion fraudulent emails are sent daily by cybercriminals. Without proper safeguards, such email threats can lead to the release of patients’ protected health information (PHI) after unauthorized access and/or accidental disclosure.

Email weaknesses can have serious consequences for healthcare providers, patients, and their PHI. Given that such threats exist today, healthcare organizations need to understand more about email cyberattacks and how to avoid the threat and/or the aftermath in case they do occur.

Learn about: What can email be used for in healthcare?

Cybersecurity threats to healthcare

The Health Insurance Portability and Accountability Act (HIPAA) sets the rules and regulations surrounding access to and disclosure of PHI. The HIPAA Privacy Rule establishes the national standards to protect PHI, while the Security Rule creates a framework for the defense of electronic PHI (ePHI). To enhance data confidentiality, healthcare organizations must prioritize HIPAA compliance by using strong security measures.

HIPAA compliance promotes strong security, especially as data breaches in the healthcare industry increase. According to reports, the total number of individuals affected by healthcare data breaches from 2005 to 2019 was 249.09 million. Of these, 157.4 million individuals were impacted in the last five years alone.

Common examples of breaches that result in exposed PHI include accidental disclosure, theft, lost, or stolen devices, hacking incidents, and phishing/ransomware attacks. The two most widespread types of healthcare breaches are hacking/IT incidents and unauthorized internal disclosures or insider threats. No matter the type, a data breach can have far-reaching consequences and can cause serious accountability and responsibility issues for an organization.

Email vulnerabilities in healthcare

Email is an essential communication tool in the healthcare workplace, with billions of emails sent and received daily worldwide. This widespread use makes email a primary target for cybercriminals seeking to exploit vulnerabilities and gain access to valuable information; email serves as the main attack vector for 75% of all cybersecurity threats.

According to the Information Security Media Group, more than 150 email-related breaches were reported to the U.S. Department of Health and Human Services (HHS) in 2025. Of those, nearly 2.2 million people were affected. Such vulnerabilities can have severe consequences for healthcare organizations, given the sensitivity of the information they handle and the importance of their work.

According to a Paubox healthcare report, 92% of healthcare IT leaders say they are confident in their ability to prevent email-based data breaches. Yet this confidence rarely translates to robust protection. Cyber hackers, unfortunately, understand this. Healthcare organizations must understand HIPAA’s regulations about email communication and implement proper security to mitigate risks and maintain patient confidence.

HIPAA regulations about email usage

HIPAA’s email-related rules balance the need for fast, efficient communication with necessary obligations that protect patient privacy. According to some HHS FAQs, “The Privacy Rule allows covered health care providers to communicate electronically, such as through e-mail, with their patients, provided they apply reasonable safeguards when doing so.”

In fact, HHS further states that “while the Privacy Rule does not prohibit the use of unencrypted e-mail for treatment-related communications between health care providers and patients, other safeguards should be applied to reasonably protect privacy, such as limiting the amount or type of information disclosed through the unencrypted e-mail. In addition, covered entities will want to ensure that any transmission of [ePHI] is in compliance with the HIPAA Security Rule.” In general, this means that any email containing PHI must be secured.

One of the best ways that HIPAA states to do this is with encryption during transmission (and during storage) to protect information in an email from unauthorized access. Encryption converts sensitive data into unreadable text that can only be decoded with the correct decryption key. Even if PHI is stolen, it won’t be visible to the hacker.

Known email security threats (2025 update)

1. Deepfake audio and video manipulation
2. QR code phishing and mobile device exploitation
3. Ransomware integration with email attack vectors
4. Business email compromise (BEC) and executive impersonation
5. Insider threats and data exfiltration
6. Supply chain email attacks and vendor impersonation
7. AI-enhanced phishing and social engineering
8. Configuration exploitation and cloud security gaps
9. Voice phishing integration and multichannel attacks
10. Advanced persistent email reconnaissance

Experts note that phishing and social engineering remain the most common email entry points, and healthcare organizations will continue to face security issues, especially as attackers continue to exploit human error.

More info: 10 email security threats changing cybersecurity defense in 2025

Email breach statistics

According to the World Economic Forum's Global Cybersecurity Outlook 2025, “72% of respondents report an increase in organizational cyber risks, with ransomware remaining a top concern.” For healthcare organizations, email security breaches can have devastating consequences beyond data loss. Real-world data shows the breadth of email threats.

For example, one of the largest email incidents involved Numotion (United Seating and Mobility) in 2024, when some of its employees’ email accounts were hacked. An investigation showed that PHI for more than 494,000 people was accessed. In another recent incident, a new phishing campaign targeted recipients of Microsoft Entra B2B by embedding fake invoice alerts inside legitimate Microsoft-generated messages.

Even with security awareness, email threats continue to get through to healthcare organizations, leading to unsecured access and consequences beyond stolen data.

Read further: Email compromises continue to hit healthcare at alarming rate

Consequences of email vulnerabilities

The consequences of a successful email attack can be severe, leading to financial losses and further breaches. Moreover, patient privacy is compromised, and healthcare organizations may face legal repercussions, financial penalties, and damage to their reputation. Compromised medical records can even lead to identity theft, financial losses, and reputational harm for patients.

Organizations face hefty fines and penalties for HIPAA violations and reputational damage that can affect patient trust and long-term viability. Healthcare threats prove to be costly to resolve, with an average price tag of $676,517 in 2024 for negligence and $715,366 in 2025 for malicious intent.

Email attacks can lead to the encryption of critical files, rendering them inaccessible. Moreover, malware delivered through email can infect medical devices and systems, affecting their functionality and potentially risking patients’ lives. This can disrupt healthcare services, patient care, appointment scheduling, and communication among healthcare professionals.

Related: What are the consequences of not complying with HIPAA?

The aftermath: mitigating email vulnerabilities

The reality is that email breaches do continuously occur. When they do, healthcare organizations must know what to do to mitigate the situation. Healthcare providers need to continuously monitor their systems after a breach for anomalies and/or strange behavior. If an organization suspects that its system has been breached, it should identify and confirm the situation, then take steps to stop the leak of PHI.

They can continuously update and then implement more rigorous security measures to secure email, such as training employees, using advanced email filters, regularly updating their systems, and developing incident response plans. They should also conduct thorough security audits and compliance reviews to identify vulnerabilities further. After detection and investigation, organizations must follow the Breach Notification Rule and notify affected individuals, the government, and the media.

Swift and transparent communication helps lessen the fallout and indicates an organization’s commitment to rectifying a breach and ensuring it does not occur again. Proper mitigation can keep more patient data from being exposed and protect a healthcare organization from committing a HIPAA violation.

Avoiding email vulnerabilities in healthcare with HIPAA compliance

HIPAA compliance involves continuously updating security measures to protect sensitive health information and to avoid breaches. One of the first steps toward HIPAA compliance is conducting a risk assessment. This assessment helps identify vulnerabilities and develop strategies to address them. Other steps to avoid email threats include:

1. Establishing up-to-date email policies and procedures
2. Using business associate agreements (BAAs) when working with third parties
3. Obtaining patient consent when sending information through email
4. Using continuous employee awareness training, especially on email use
5. Ensuring proper technological safeguards, such as data encryption
6. Utilizing strong access controls like mandatory passwords
7. Creating data backup and disaster recovery plans in case of an incident
8. Regularly auditing and monitoring systems
9. Having an incident response plan ready in case it is needed

HIPAA compliance regulations aim to protect patient and employee health information. Adhering to HIPAA standards helps providers protect patient privacy, leading to strengthened relationships and better patient outcomes.

Benefits of sturdy email security

Investing in inbound and outbound email security delivers peace of mind by preventing costly email breaches. Inbound email security protects against threats entering an organization, while outbound security ensures sensitive data is not improperly sent out. Implementing strong, HIPAA compliant email security, like with Paubox, offers several benefits for healthcare organizations:

• Compliance with data protection laws (e.g., HIPAA)
• Protection of brand and reputation
• Enhanced productivity and patient care
• Prevents unauthorized access to PHI
• Protection of patients

Dig Deeper:

• HIPAA compliant email: The definitive guide (2025 update)
• 5 web threats that changed email security in 2025
• Email cyber threats 101: Types and tactics
• Common email security mistakes in healthcare and how to fix them
• Understanding email security threats in remote healthcare
  
  

FAQs

Are small healthcare practices at greater risk than larger organizations from these email threats?

Smaller organizations often lack dedicated security teams and advanced tools, making them easier targets.

How can organizations prepare for ransomware launched through email campaigns?

Regular backups, incident response plans, and phishing detection tools reduce the impact of ransomware.

What makes BEC harder to detect than regular phishing?

It exploits trust, timing, and real communication patterns instead of obvious fake messages.

What can organizations do beyond email filtering to reduce risk?

In addition to upgrading filtering systems, organizations should deploy real-time URL rewriting, train users to identify unusual behavior (like file password prompts), and restrict QR code scanning on unmanaged devices.

What makes email a risky communication tool for remote healthcare workers?

Email exposes sensitive patient data to interception or account compromise when devices or networks are insecure.

What makes Paubox particularly suitable for healthcare organizations?

Paubox is specifically designed for healthcare, offering HIPAA compliance, seamless integration with existing email systems, and security features that don't interfere with clinical workflows. It includes a signed BAA and maintains the highest level of email security while remaining user-friendly.