What is social engineering?

Cybercriminals are constantly finding new ways to exploit individuals and organizations for their personal and financial gain. One of the most prevalent and effective methods they employ is social engineering. Social engineering refers to the manipulation of individuals to gain unauthorized access to sensitive information, commit fraud, or carry out other malicious activities. Social engineering uses psychological manipulation and exploits human error or weakness rather than technical or digital system vulnerabilities.

Understanding social engineering attacks

A peer-reviewed paper published in PMC on human cognition and social engineering cyberattacks defines the attack category as a psychological attempt to persuade an individual to act as intended by an attacker, exploiting weaknesses in human interactions and behavioral and cultural constructs. The paper traces the cognitive mechanisms involved, noting that short-term factors, including workload, stress, and reduced vigilance, predictably increase susceptibility to conditions that attackers deliberately engineer through timing, volume, and urgency.

What distinguishes social engineering from traditional hacking is the absence of any technical exploit. Attackers do not need to discover a zero-day vulnerability or break through a firewall when an employee can be persuaded to hand over credentials, transfer funds, or click a link that appears entirely legitimate. A 2022 research paper in Applied Sciences examining the psychology of social engineering describes the category as increasingly favored precisely because it is more convenient to compromise a human than to discover a vulnerability in a security system, and because attacks do not follow specific patterns that defenses can reliably anticipate.

Read also: What is phishing? | What is spear phishing? | What is BEC?

The impact of social engineering

The data on social engineering's reach is consistent across every major source. The Verizon 2025 Data Breach Investigations Report, which analyzed over 22,000 incidents and 12,195 confirmed breaches, found that the human element was involved in 60% of all breaches. Social engineering actions were directly involved in 24% of breaches, and the report noted a big overlap between social engineering and credential abuse, in which successful manipulation leads to credential theft, enabling further intrusion.

Palo Alto Networks' 2025 Unit 42 Global Incident Response Report: Social Engineering Edition reported that social engineering was the top initial access vector in its incident response caseload between May 2024 and May 2025, accounting for 36% of all incidents. More than one-third of those social engineering cases involved techniques beyond phishing, including search engine optimization poisoning, fake system prompts, and help desk manipulation. Social engineering attacks led to data exposure in 60% of the cases, Unit 42 investigated 16 percentage points higher than for incidents overall.

The financial consequences are substantial. According to the FBI's 2024 Internet Crime Complaint Center report, business email compromise was one of the most common social engineering outcomes, generating 21,442 complaints in 2024 with adjusted losses of over $2.7 billion, making it the second most financially damaging cybercrime category tracked by the IC3 after investment fraud. Across all cybercrime categories, total reported losses reached $16.6 billion, a 33% increase from 2023.

For healthcare organizations, the consequences extend beyond financial loss to patient safety and regulatory exposure. According to Paubox's 2026 Healthcare Email Security Report, 170 email-related healthcare breaches occurred in 2025, affecting more than 2.5 million individuals. Impersonation appeared repeatedly across the most damaging of those incidents, often acting as the trigger that turned an attacker's initial access into PHI disclosure. Nearly one in three 2025 healthcare email breaches involved a business associate, showing how social engineering exploits trust across vendor and partner relationships, as well as internal staff.

How social engineering works

Attackers rely on a small set of psychological triggers that research has consistently identified as effective regardless of an individual's technical sophistication. The PMC paper on social engineering and human cognition identifies authority, urgency, familiarity, scarcity, and social proof as the principal levers, noting that these triggers work by shortcutting deliberate reasoning and encouraging reflexive compliance. An email appearing to come from a senior executive requesting an urgent wire transfer exploits authority and urgency simultaneously. A message from a vendor referencing an ongoing project exploits familiarity and context.

Reconnaissance has become more thorough and more automated as a precursor to social engineering attacks. LinkedIn profiles, company websites, press releases, and social media activity all provide the material attackers need to craft messages that reference real relationships, real terminology, and real business processes. The more convincing the context, the less likely the recipient is to pause and verify.

Generative AI has materially changed what is possible at scale. Attackers can now produce highly personalized, grammatically polished lures in large volumes without the manual effort that previously made sophisticated social engineering campaigns expensive to run. KnowBe4's 2025 Phishing Threat Trends Report found that at least one polymorphic feature was present in 76.4% of phishing attacks, showing the use of AI-assisted generation to continuously vary message characteristics and avoid pattern-based detection.

Types of social engineering attacks

• Phishing remains the most prevalent form, sending fraudulent messages to large numbers of recipients with the goal of harvesting credentials, delivering malware, or redirecting payments. Unit 42's 2025 data found phishing accounted for 65% of social engineering-driven intrusions when isolating that category.
• Spear phishing applies the same approach with targeted research, personalizing messages for specific individuals or organizations. Executives, finance staff, and anyone with privileged system access are common targets because compromising their accounts provides higher-value access than a generic employee inbox.
• Business email compromise uses impersonation of executives, vendors, or internal departments to authorize fraudulent financial transactions or extract sensitive information. According to Paubox's Top 3 Healthcare Email Attacks in 2025 report, impersonation appeared across the most damaging healthcare email breaches in 2025, with attackers abusing trusted messaging infrastructure, including healthcare Direct secure messaging systems and Google-hosted services to make their messages appear legitimate by default.
• Vishing uses voice calls to impersonate IT support, financial institutions, or internal staff. Unit 42 found that 23% of social engineering incidents in its 2025 caseload involved callback or voice-based techniques, a trend it described as particularly concerning because traditional email security controls offer no protection against this channel.
• Pretexting involves constructing a fabricated scenario to establish credibility before making a request. An attacker posing as an auditor, a compliance officer, or a new employee asking for system access is using pretexting to lower the target's defenses before the actual manipulation occurs.
• Help desk manipulation has grown as a distinct social engineering vector. Unit 42 documented cases where attackers bypassed multi-factor authentication entirely by impersonating employees and manipulating IT support processes to escalate privileges, sometimes within minutes of gaining initial contact.

See more: What is vishing?

Recognizing social engineering attempts

Recognizing social engineering requires attention to context rather than content. Requests that invoke urgency or authority while bypassing normal approval processes, messages from familiar senders that ask for something outside their usual scope, and communications that arrive through slightly different channels or domains than expected are all worth pausing over.

Slight variations in email addresses or domains are a common indicator. Attackers frequently register domains that closely resemble legitimate ones, changing a single character or adding a subdomain that is easy to miss when reading quickly. According to Paubox's 2025 Healthcare Email Security Report, only 5% of known phishing attacks are reported by healthcare employees to their security teams, which means the overwhelming majority of social engineering delivery attempts via email go undetected at the human level.

Best practices for preventing social engineering

Effective defense against social engineering combines structural controls with verification discipline. Requests involving payments, credential changes, access escalation, or sensitive data transfers should always be confirmed through a second communication channel independent of the original message. Verification calls to known numbers, not numbers provided in the message itself, are a practical control that stops many social engineering attempts before they succeed.

Email authentication standards, SPF, DKIM, and DMARC in enforcement reduce the proportion of spoofed messages that reach recipients by verifying sender identity at the domain level. According to Paubox's 2026 Healthcare Email Security Report, 75% of breached organizations lacked DMARC enforcement, creating the authentication gaps that impersonation attacks depend on.

Pre-delivery blocking removes social engineering lures before employees encounter them. Paubox's Inbound Email Security detects spoofed sender identities and lookalike domains, blocking messages that abuse trusted names or impersonate executives and vendors before they reach healthcare inboxes. Paubox ExecProtect+ adds targeted protection for the high-value identities most frequently impersonated in BEC campaigns.

Limiting the blast radius of a successful social engineering attack also matters. The principle of least privilege, ensuring employees only have access to the systems their role requires, means a compromised account cannot automatically become a gateway to the entire environment. Multi-factor authentication, particularly phishing-resistant methods that do not rely on push notifications or one-time codes, reduces what an attacker can do even if they successfully harvest credentials.

Learn more: Paubox Inbound Email Security | Paubox ExecProtect+ | Paubox Top 3 Healthcare Email Attacks in 2025

In the news

In 2025, Palo Alto Networks' Unit 42 incident response teams documented a pattern of social engineering attacks targeting payroll and HR systems across multiple industries. In one case, attackers impersonated employees to manipulate help desks at payroll, IT, and HR shared services, using valid-looking credentials and convincing pretexts to redirect employee paychecks into attacker-controlled accounts. The compromise was discovered only when affected employees reported missing wages, at which point the investigation revealed fraudulent account changes dating back weeks. Unit 42 described the incident as illustrative of a broader trend where attackers bypass technical defenses entirely by targeting the humans who manage them, without deploying any malware or exploiting any software vulnerability.

FAQs

What is social engineering, and how does it relate to healthcare security?

Social engineering is a tactic used by cybercriminals to manipulate individuals into divulging confidential information or performing actions that compromise security. In healthcare, social engineering exploits trust and human psychology to gain unauthorized access to patient data, medical systems, or financial information.

Why is social engineering a significant threat to healthcare organizations?

Social engineering is a big threat because it targets the human element, which is often the weakest link in cybersecurity defenses. Through exploiting trust, deception, or fear, attackers can trick healthcare employees into disclosing sensitive information, clicking on malicious links, or transferring funds, leading to breaches of patient confidentiality, financial losses, and disruptions in healthcare services.

What measures can healthcare facilities take to prevent social engineering attacks?

Healthcare facilities can prevent social engineering attacks by implementing cybersecurity training for staff at all levels, raising awareness about common social engineering tactics such as phishing, pretexting, and baiting, encouraging skepticism and verification of requests for sensitive information or transactions, and establishing strict protocols for handling confidential data and financial transactions.

How does social engineering impact HIPAA compliance?

Social engineering impacts HIPAA compliance by increasing the risk of unauthorized access to protected health information (PHI). If attackers successfully manipulate staff through social engineering tactics, they can gain access to PHI, leading to potential data breaches and violations of HIPAA’s security and privacy rules.

See also: HIPAA Compliant Email: The Definitive Guide