What is the difference between a data breach and a ransomware attack?

While data breaches and ransomware attacks in healthcare organizations share some commonalities, they are distinguished by their mechanisms, objectives, and immediate impacts. The primary concern in a data breach is the exposure of PHI, which may include patient names, social security numbers, medical histories, and other identifying information. 

According to a comprehensive analysis of breaches reported to the U.S. Department of Health and Human Services (HHS) Office for Civil Rights titled ‘Ransomware Attacks and Data Breaches in US Health Care Systems,’ the number of PHI data breaches in healthcare surged from 216 in 2010 to 566 in 2024, with the number of patient records affected rising from 6 million to 170 million over the same period. 

A ransomware attack is a specific type of cyber incident wherein malicious actors deploy malware to encrypt an organization’s data, effectively locking users out of systems and files. The attackers then demand a ransom, typically in cryptocurrency, in exchange for the decryption key. Ransomware attacks are particularly disruptive in healthcare due to the sector's reliance on timely access to patient data for clinical care and administrative functions. 

What is a data breach? 

A data breach is a security incident in which sensitive, protected, or confidential data is accessed, disclosed, or used by unauthorized individuals, thereby compromising the privacy or security of that information. Breaches can be broadly categorized into internal and external incidents. Internal breaches occur when individuals within an organization, such as employees or contractors, misuse their access privileges, inadvertently share confidential data, or fail to follow proper data disposal procedures.

External breaches, on the other hand, are typically the result of hacking, phishing, malware, ransomware attacks, or other cyber intrusions by actors outside the organization. These external threats often exploit vulnerabilities in information systems, such as weak passwords, lack of multifactor authentication, or unpatched software, to gain unauthorized access to large volumes of sensitive data.

The healthcare sector is particularly vulnerable to data breaches, accounting for the highest number of reported incidents compared to other industries. According to a study published on insights from healthcare data breaches over a 15-year period, more than 60% of all reported data breaches occurred in healthcare, with a proportion happening in just the last five years. 

This susceptibility is attributed to the high value of medical records on illicit markets, the complexity of healthcare IT environments, and the need for timely data access in clinical settings. The majority of breaches in healthcare are not the result of sophisticated cyberattacks, but rather stem from human error, negligence, and insufficient security awareness among staff.

What is a ransomware attack? 

Ransomware is a type of malware designed to infiltrate computer systems or connected devices, encrypting files so that they become indecipherable and inaccessible to authorized users. Once the encryption is complete, the attacker typically displays a ransom note demanding payment in exchange for the decryption key necessary to regain access to the locked data.

The history of ransomware dates back nearly three decades, with one of the earliest known attacks being the “AIDS Trojan” in 1989, which demanded victims send money to a physical address to unlock their files. However, the sophistication and prevalence of ransomware have grown exponentially, especially in the healthcare sector, where the urgency of data availability for patient care makes organizations particularly vulnerable to such extortion tactics. 

Healthcare providers, including hospitals, clinics, health plans, and clearinghouses, have increasingly become targets due to their need for continuous access to PHI and often limited cybersecurity resources. According to the above mentioned study ‘Ransomware Attacks and Data Breaches in US Health Care Systems,’ “In February 2024, a ransomware attack on Change Healthcare compromised the protected health information (PHI) of 100 million individuals, disrupted care delivery nationwide, and incurred $2.4 billion in response costs.”

The study also notes that from 2010 to 2024, ransomware attacks on healthcare entities have surged dramatically. Data from the HHS OCR reveals that ransomware incidents rose from zero reported cases in 2010 to representing 31% of all healthcare data breaches by 2021, before slightly declining to 11% in 2024.

The core differences

• A data breach involves unauthorized access, use, or disclosure of sensitive information often without the victim’s immediate knowledge.
• A ransomware attack involves malware that encrypts data or systems, denying access until a ransom is paid, causing immediate operational disruption.
• Data breaches primarily focus on stealing or exposing data, while ransomware attacks focus on extorting victims by blocking access to data.
• Ransomware attacks may also involve data exfiltration, which turns them into data breaches as well, but not all data breaches involve ransomware.
• Data breaches can result from hacking, insider threats, or accidental disclosures, whereas ransomware attacks typically start with phishing or malware delivery.
• The impact of data breaches is often the loss of confidentiality and potential misuse of data, while ransomware attacks cause both loss of data availability and potential data exposure.
• Data breaches may go undetected for long periods, but ransomware attacks cause immediate system lockdowns and operational interruptions.
• Healthcare organizations are more likely to experience ransomware attacks than other industries, with ransomware accounting for a large portion of healthcare breaches.
• The response to data breaches focuses on notification and mitigation of exposed data, while ransomware response involves system recovery, often from backups, and decisions about ransom payment.
• Ransomware attacks often result in higher percentages of sensitive data being affected compared to typical data breaches in healthcare.

The overlap and convergence in legislation

HIPAA establishes the foundational privacy and security rules for safeguarding PHI, requiring covered entities and their business associates to implement administrative, physical, and technical safeguards to prevent unauthorized access or disclosure of health data. 

The HIPAA Privacy Rule governs the permissible uses and disclosures of PHI, while the Security Rule focuses on protecting electronic PHI (ePHI) through risk assessments, access controls, encryption, and audit mechanisms. HIPAA’s Breach Notification Rule mandates timely notification to affected individuals, the HHS, and, in some cases, the media whenever a breach compromises the confidentiality. 

A Health Services Research study on remediation efforts following a data breach and the implications on hospital operations stated, “Corrective actions are intended to remedy the deficiencies in privacy and security of protected health information. However, enhanced security measures may introduce usability—which we define as the ease of use—problems.

New security procedures typically alter how clinicians access and use clinical information in health information systems and may disrupt the provision of care as providers require additional time to learn and use the new or modified systems.”

The convergence of legislation is particularly evident in how ransomware attacks are increasingly treated as data breaches under HIPAA and related laws. Traditionally, a data breach was defined as the unauthorized acquisition, access, or disclosure of PHI, often involving data theft or exposure. However, modern ransomware attacks frequently involve a dual-threat approach. 

Attackers encrypt data to deny access and exfiltrate PHI, threatening its public release if ransoms are not paid. This exfiltration component triggers breach notification requirements because it constitutes an impermissible disclosure of PHI.

How breaches and attacks are leveraged through email 

The ResearchGate study ‘A Review on Data Breaches in Healthcare Security

Systems’ looks at the reason healthcare organizations are so commonly attacked, “Another barrier discussed was one often seen in Healthcare Preparedness, limited funds, and limited time. There are different IT solutions for each cyberattack, and each solution might come with a different cost. Therefore, it becomes difficult for small-scale organizations to pay such a massive amount of money for security.”

Traditional email systems may not automatically encrypt messages containing PHI, exposing sensitive data to interception or unauthorized access during transmission. Legacy email systems often lack advanced threat detection capabilities, allowing sophisticated phishing and ransomware campaigns to evade detection. Attackers also use display name spoofing and domain impersonation to make malicious emails appear legitimate, increasing the likelihood of successful deception. These factors combined create a fertile ground for cyberattacks that can lead to widespread data breaches or ransomware infections, with devastating consequences for patient privacy and healthcare operations.

HIPAA compliant email platforms like Paubox provide a robust solution by integrating encryption, inbound threat protection, and compliance features seamlessly into existing email workflows. Paubox encrypts all outbound emails by default, ensuring that PHI is protected during transit without requiring users to take additional steps such as manually encrypting messages or using separate portals. This automatic encryption eliminates common user errors that can lead to accidental data exposure, reducing the risk of breaches caused by human mistakes.

FAQs

Can an employee accidentally cause a data breach?

Yes. Insider errors, like emailing PHI to the wrong recipient, losing devices, or mishandling data, are leading causes of breaches.

Can patients sue after a healthcare data breach?

It depends on the jurisdiction, but many patients file class-action lawsuits for negligence, emotional distress, or damages if their PHI is exposed or misused. 

What is a ransomware “double extortion” scheme?

Hackers encrypt data and steal it, threatening to leak it unless the ransom is paid, making the breach both a privacy violation and a ransom event.