The Federal Bureau of Investigation (FBI), Cybersecurity and Infrastructure Security Agency (CISA), and Department of Health and Human Services (HHS) are releasing this joint CSA to provide information on the Daixin Team
All organizations should report incidents and anomalous activity to CISA’s 24/7 Operations Center at
[email protected] or (888) 282-0870 and/or to the FBI via your local FBI field office. When available, please include
the following information regarding the incident: date, time, and location of the incident; type of activity; number
of people affected; type of equipment used for the activity; the name of the submitting company or organization;
and a designated point of contact.
This document is marked TLP:WHITE. Disclosure is not limited. Sources may use TLP:WHITE when information
carries minimal or no foreseeable risk of misuse, in accordance with applicable rules and procedures for public
release. Subject to standard copyright rules, TLP:WHITE information may be distributed without restriction.
For more information on the Traffic Light Protocol, see cisa.gov/tlp/.
TLP: WHITE
Product ID: AA22-294A
October 21, 2022
Co-Authored by: TLP:WHITE
#StopRansomware: Daixin Team
SUMMARY
Note: This joint Cybersecurity Advisory (CSA) is part of an ongoing #StopRansomware effort to
publish advisories for network defenders that detail various ransomware variants and ransomware
threat actors. These #StopRansomware advisories include recently and historically observed tactics,
techniques, and procedures (TTPs) and indicators of compromise (IOCs) to help organizations
protect against ransomware. Visit stopransomware.gov to see all #StopRansomware advisories and
to learn more about other ransomware threats and no-cost resources.
The Federal Bureau of Investigation (FBI), Cybersecurity
and Infrastructure Security Agency (CISA), and Department
of Health and Human Services (HHS) are releasing this joint
CSA to provide information on the “Daixin Team,” a
cybercrime group that is actively targeting U.S. businesses,
predominantly in the Healthcare and Public Health (HPH)
Sector, with ransomware and data extortion operations.
This joint CSA provides TTPs and IOCs of Daixin actors
obtained from FBI threat response activities and third-party
reporting.
TECHNICAL DETAILS
Note: This advisory uses the MITRE ATT&CK® for Enterprise framework, version 11. See MITRE
ATT&CK for Enterprise for all referenced tactics and techniques.
Cybercrime actors routinely target HPH Sector organizations with ransomware:
• As of October 2022, per FBI Internet Crime Complaint Center (IC3) data, specifically victim
reports across all 16 critical infrastructure sectors, the HPH Sector accounts for 25 percent of
ransomware complaints.
Actions to take today to mitigate
cyber threats from ransomware:
• Install updates for operating
systems, software, and firmware as
soon as they are released.
• Require phishing-resistant MFA for
as many services as possible.
• Train users to recognize and report
phishing attempts.
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TLP: WHITE
• According to an IC3 annual report in 2021, 649 ransomware reports were made across 14
critical infrastructure sectors; the HPH Sector accounted for the most reports at 148.
The Daixin Team is a ransomware and data extortion group that has targeted the HPH Sector with
ransomware and data extortion operations since at least June 2022. Since then, Daixin Team
cybercrime actors have caused ransomware incidents at multiple HPH Sector organizations where
they have:
• Deployed ransomware to encrypt servers responsible for healthcare services—including
electronic health records services, diagnostics services, imaging services, and intranet
services, and/or
• Exfiltrated personal identifiable information (PII) and patient health information (PHI) and
threatened to release the information if a ransom is not paid.
Daixin actors gain initial access to victims through virtual private network (VPN) servers. In one
confirmed compromise, the actors likely exploited an unpatched vulnerability in the organization’s
VPN server [T1190]. In another confirmed compromise, the actors used previously compromised
credentials to access a legacy VPN server [T1078] that did not have multifactor authentication (MFA)
enabled. The actors are believed to have acquired the VPN credentials through the use of a phishing
email with a malicious attachment [T1598.002].
After obtaining access to the victim’s VPN server, Daixin actors move laterally via Secure Shell (SSH)
[T1563.001] and Remote Desktop Protocol (RDP) [T1563.002]. Daixin actors have sought to gain
privileged account access through credential dumping [T1003] and pass the hash [T1550.002]. The
actors have leveraged privileged accounts to gain access to VMware vCenter Server and reset
account passwords [T1098] for ESXi servers in the environment. The actors have then used SSH to
connect to accessible ESXi servers and deploy ransomware [T1486] on those servers.
According to third-party reporting, the Daixin Team’s ransomware is based on leaked Babuk Locker
source code. This third-party reporting as well as FBI analysis show that the ransomware targets
ESXi servers and encrypts files located in /vmfs/volumes/ with the following extensions: .vmdk,
.vmem, .vswp, .vmsd, .vmx, and .vmsn. A ransom note is also written to /vmfs/volumes/. See Figure
1 for targeted file system path and Figure 2 for targeted file extensions list. Figure 3 and Figure 4
include examples of ransom notes. Note that in the Figure 3 ransom note, Daixin actors misspell
“Daixin” as “Daxin.”
Figure 1: Daixin Team – Ransomware Targeted File Path
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TLP: WHITE
Figure 2: Daixin Team – Ransomware Targeted File Extensions
Figure 3: Example 1 of Daixin Team Ransomware Note
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TLP: WHITE
Figure 4: Example 2 of Daixin Team Ransomware Note
In addition to deploying ransomware, Daixin actors have exfiltrated data [TA0010] from victim
systems. In one confirmed compromise, the actors used Rclone—an open-source program to
manage files on cloud storage—to exfiltrate data to a dedicated virtual private server (VPS). In
another compromise, the actors used Ngrok—a reverse proxy tool for proxying an internal service out
onto an Ngrok domain—for data exfiltration [T1567].
MITRE ATT&CK TACTICS AND TECHNIQUES
See Table 1 for all referenced threat actor tactics and techniques included in this advisory.
Table 1: Daixin Actors’ ATT&CK Techniques for Enterprise
Reconnaissance
Technique Title ID Use
Phishing for Information:
Spearphishing Attachment
T1598.002 Daixin actors have acquired the VPN
credentials (later used for initial access) by
a phishing email with a malicious
attachment.
Initial Access
Technique Title ID Use
Exploit Public-Facing Application T1190 Daixin actors exploited an unpatched
vulnerability in a VPN server to gain initial
access to a network.
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Valid Accounts T1078 Daixin actors use previously compromised
credentials to access servers on the target
network.
Persistence
Technique Title ID Use
Account Manipulation T1098 Daixin actors have leveraged privileged
accounts to reset account passwords for
VMware ESXi servers in the compromised
environment.
Credential Access
Technique Title ID Use
OS Credential Dumping T1003 Daixin actors have sought to gain privileged
account access through credential
dumping.
Lateral Movement
Technique Title ID Use
Remote Service Session Hijacking:
SSH Hijacking T1563.001 Daixin actors use SSH and RDP to move
laterally across a network.
Remote Service Session Hijacking:
RDP Hijacking T1563.002 Daixin actors use RDP to move laterally
across a network.
Use Alternate Authentication
Material: Pass the Hash T1550.002 Daixin actors have sought to gain privileged
account access through pass the hash.
Exfiltration
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Technique Title ID Use
Exfiltration Over Web Service T1567 Daixin Team members have used Ngrok for
data exfiltration over web servers.
Impact
Technique Title ID Use
Data Encrypted for Impact T1486 Daixin actors have encrypted data on target
systems or on large numbers of systems in
a network to interrupt availability to system
and network resources.
INDICATORS OF COMPROMISE
See Table 2 for IOCs obtained from third-party reporting.
Table 2: Daixin Team IOCs – Rclone Associated SHA256 Hashes
File SHA256
rclone-v1.59.2-windows-amd64\git-log.txt 9E42E07073E03BDEA4CD978D9E7B44A957497
2818593306BE1F3DCFDEE722238
rclone-v1.59.2-windows-amd64\rclone.1 19ED36F063221E161D740651E6578D50E0D3CA
CEE89D27A6EBED4AB4272585BD
rclone-v1.59.2-windows-amd64\rclone.exe 54E3B5A2521A84741DC15810E6FED9D739EB80
83CB1FE097CB98B345AF24E939
rclone-v1.59.2-windowsamd64\README.html
EC16E2DE3A55772F5DFAC8BF8F5A365600FAD
40A244A574CBAB987515AA40CBF
rclone-v1.59.2-windows-amd64\README.txt 475D6E80CF4EF70926A65DF5551F59E35B71A0
E92F0FE4DD28559A9DEBA60C28
MITIGATIONS
FBI, CISA, and HHS urge HPH Sector organizations to implement the following to protect against
Daixin and related malicious activity:
• Install updates for operating systems, software, and firmware as soon as they are released.
Prioritize patching VPN servers, remote access software, virtual machine software, and known
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TLP: WHITE
exploited vulnerabilities. Consider leveraging a centralized patch management system to
automate and expedite the process.
• Require phishing-resistant MFA for as many services as possible—particularly for webmail,
VPNs, accounts that access critical systems, and privileged accounts that manage backups.
• If you use Remote Desktop Protocol (RDP), secure and monitor it.
o Limit access to resources over internal networks, especially by restricting RDP and
using virtual desktop infrastructure. After assessing risks, if RDP is deemed
operationally necessary, restrict the originating sources, and require multifactor
authentication (MFA) to mitigate credential theft and reuse. If RDP must be available
externally, use a virtual private network (VPN), virtual desktop infrastructure, or other
means to authenticate and secure the connection before allowing RDP to connect to
internal devices. Monitor remote access/RDP logs, enforce account lockouts after a
specified number of attempts to block brute force campaigns, log RDP login attempts,
and disable unused remote access/RDP ports.
o Ensure devices are properly configured and that security features are enabled. Disable
ports and protocols that are not being used for business purposes (e.g., RDP
Transmission Control Protocol Port 3389).
• Turn off SSH and other network device management interfaces such as Telnet, Winbox, and
HTTP for wide area networks (WANs) and secure with strong passwords and encryption when
enabled.
• Implement and enforce multi-layer network segmentation with the most critical
communications and data resting on the most secure and reliable layer.
• Limit access to data by deploying public key infrastructure and digital certificates to
authenticate connections with the network, Internet of Things (IoT) medical devices, and the
electronic health record system, as well as to ensure data packages are not manipulated while
in transit from man-in-the-middle attacks.
• Use standard user accounts on internal systems instead of administrative accounts, which
allow for overarching administrative system privileges and do not ensure least privilege.
• Secure PII/PHI at collection points and encrypt the data at rest and in transit by using
technologies such as Transport Layer Security (TPS). Only store personal patient data on
internal systems that are protected by firewalls, and ensure extensive backups are available if
data is ever compromised.
• Protect stored data by masking the permanent account number (PAN) when it is displayed
and rendering it unreadable when it is stored—through cryptography, for example.
• Secure the collection, storage, and processing practices for PII and PHI, per regulations such
as the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Implementing
HIPAA security measures can prevent the introduction of malware on the system.
• Use monitoring tools to observe whether IoT devices are behaving erratically due to a
compromise.
• Create and regularly review internal policies that regulate the collection, storage, access, and
monitoring of PII/PHI.
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In addition, the FBI, CISA, and HHS urge all organizations, including HPH Sector organizations, to
apply the following recommendations to prepare for, mitigate/prevent, and respond to ransomware
incidents.
Preparing for Ransomware
• Maintain offline (i.e., physically disconnected) backups of data, and regularly test backup and
restoration. These practices safeguard an organization’s continuity of operations or at least
minimize potential downtime from a ransomware incident and protect against data losses.
o Ensure all backup data is encrypted, immutable (i.e., cannot be altered or deleted),
and covers the entire organization’s data infrastructure.
• Create, maintain, and exercise a basic cyber incident response plan and associated
communications plan that includes response procedures for a ransomware incident.
o Organizations should also ensure their incident response and communications plans
include response and notification procedures for data breach incidents. Ensure the
notification procedures adhere to applicable state laws.
▪ Refer to applicable state data breach laws and consult legal counsel when
necessary.
▪ For breaches involving electronic health information, you may need to notify the
Federal Trade Commission (FTC) or the Department of Health and Human
Services, and—in some cases—the media. Refer to the FTC’s Health Breach
Notification Rule and U.S. Department of Health and Human Services’ Breach
Notification Rule for more information.
o See CISA-Multi-State Information Sharing and Analysis Center (MS-ISAC) Joint
Ransomware Guide and CISA Fact Sheet, Protecting Sensitive and Personal
Information from Ransomware-Caused Data Breaches, for information on creating a
ransomware response checklist and planning and responding to ransomware-caused
data breaches.
Mitigating and Preventing Ransomware
• Restrict Server Message Block (SMB) Protocol within the network to only access servers that
are necessary and remove or disable outdated versions of SMB (i.e., SMB version 1). Threat
actors use SMB to propagate malware across organizations.
• Review the security posture of third-party vendors and those interconnected with your
organization. Ensure all connections between third-party vendors and outside software or
hardware are monitored and reviewed for suspicious activity.
• Implement listing policies for applications and remote access that only allow systems to
execute known and permitted programs.
• Open document readers in protected viewing modes to help prevent active content from
running.
• Implement user training program and phishing exercises to raise awareness among users
about the risks of visiting suspicious websites, clicking on suspicious links, and opening
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suspicious attachments. Reinforce the appropriate user response to phishing and
spearphishing emails.
• Use strong passwords and avoid reusing passwords for multiple accounts. See CISA Tip
Choosing and Protecting Passwords and the National Institute of Standards and Technology’s
(NIST’s) Special Publication 800-63B: Digital Identity Guidelines for more information.
• Require administrator credentials to install software.
• Audit user accounts with administrative or elevated privileges and configure access controls
with least privilege in mind.
• Install and regularly update antivirus and antimalware software on all hosts.
• Only use secure networks and avoid using public Wi-Fi networks. Consider installing and
using a VPN.
• Consider adding an email banner to messages coming from outside your organizations.
• Disable hyperlinks in received emails.
Responding to Ransomware Incidents
If a ransomware incident occurs at your organization:
• Follow your organization’s Ransomware Response Checklist (see Preparing for Ransomware
section).
• Scan backups. If possible, scan backup data with an antivirus program to check that it is free
of malware. This should be performed using an isolated, trusted system to avoid exposing
backups to potential compromise.
• Follow the notification requirements as outlined in your cyber incident response plan.
• Report incidents to the FBI at a local FBI Field Office, CISA at cisa.gov/report, or the U.S.
Secret Service (USSS) at a USSS Field Office.
• Apply incident response best practices found in the joint Cybersecurity Advisory, Technical
Approaches to Uncovering and Remediating Malicious Activity, developed by CISA and the
cybersecurity authorities of Australia, Canada, New Zealand, and the United Kingdom.
Note: FBI, CISA, and HHS strongly discourage paying ransoms as doing so does not guarantee files
and records will be recovered. Furthermore, payment may also embolden adversaries to target
additional organizations, encourage other criminal actors to engage in the distribution of ransomware,
and/or fund illicit activities.
REFERENCES
• Stopransomware.gov is a whole-of-government approach that gives one central location for
ransomware resources and alerts.
• Resource to mitigate a ransomware attack: CISA-Multi-State Information Sharing and Analysis
Center (MS-ISAC) Joint Ransomware Guide.
• No-cost cyber hygiene services: Cyber Hygiene Services and Ransomware Readiness
Assessment.
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• Ongoing Threat Alerts and Sector alerts are produced by the Health Sector Cybersecurity
Coordination Center (HC3) and can be found at hhs.gov/HC3
• For additional best practices for Healthcare cybersecurity issues see the HHS 405(d) Aligning
Health Care Industry Security Approaches at 405d.hhs.gov
REPORTING
The FBI is seeking any information that can be shared, to include boundary logs showing
communication to and from foreign IP addresses, a sample ransom note, communications with Daixin
Group actors, Bitcoin wallet information, decryptor files, and/or a benign sample of an encrypted file.
Regardless of whether you or your organization have decided to pay the ransom, the FBI, CISA, and
HHS urge you to promptly report ransomware incidents to a local FBI Field Office, or CISA at
cisa.gov/report.
ACKNOWLEDGEMENTS
FBI, CISA, and HHS would like to thank CrowdStrike and the Health Information Sharing and Analysis
Center (Health-ISAC) for their contributions to this CSA.
DISCLAIMER
The information in this report is being provided “as is” for informational purposes only. FBI, CISA, and
HHS do not endorse any commercial product or service, including any subjects of analysis. Any
reference to specific commercial products, processes, or services by service mark, trademark,
manufacturer, or otherwise, does not constitute or imply endorsement, recommendation, or favoring
by FBI, CISA, or HHS.
[email protected] or (888) 282-0870 and/or to the FBI via your local FBI field office. When available, please include
the following information regarding the incident: date, time, and location of the incident; type of activity; number
of people affected; type of equipment used for the activity; the name of the submitting company or organization;
and a designated point of contact.
This document is marked TLP:WHITE. Disclosure is not limited. Sources may use TLP:WHITE when information
carries minimal or no foreseeable risk of misuse, in accordance with applicable rules and procedures for public
release. Subject to standard copyright rules, TLP:WHITE information may be distributed without restriction.
For more information on the Traffic Light Protocol, see cisa.gov/tlp/.
TLP: WHITE
Product ID: AA22-294A
October 21, 2022
Co-Authored by: TLP:WHITE
#StopRansomware: Daixin Team
SUMMARY
Note: This joint Cybersecurity Advisory (CSA) is part of an ongoing #StopRansomware effort to
publish advisories for network defenders that detail various ransomware variants and ransomware
threat actors. These #StopRansomware advisories include recently and historically observed tactics,
techniques, and procedures (TTPs) and indicators of compromise (IOCs) to help organizations
protect against ransomware. Visit stopransomware.gov to see all #StopRansomware advisories and
to learn more about other ransomware threats and no-cost resources.
The Federal Bureau of Investigation (FBI), Cybersecurity
and Infrastructure Security Agency (CISA), and Department
of Health and Human Services (HHS) are releasing this joint
CSA to provide information on the “Daixin Team,” a
cybercrime group that is actively targeting U.S. businesses,
predominantly in the Healthcare and Public Health (HPH)
Sector, with ransomware and data extortion operations.
This joint CSA provides TTPs and IOCs of Daixin actors
obtained from FBI threat response activities and third-party
reporting.
TECHNICAL DETAILS
Note: This advisory uses the MITRE ATT&CK® for Enterprise framework, version 11. See MITRE
ATT&CK for Enterprise for all referenced tactics and techniques.
Cybercrime actors routinely target HPH Sector organizations with ransomware:
• As of October 2022, per FBI Internet Crime Complaint Center (IC3) data, specifically victim
reports across all 16 critical infrastructure sectors, the HPH Sector accounts for 25 percent of
ransomware complaints.
Actions to take today to mitigate
cyber threats from ransomware:
• Install updates for operating
systems, software, and firmware as
soon as they are released.
• Require phishing-resistant MFA for
as many services as possible.
• Train users to recognize and report
phishing attempts.
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TLP: WHITE
• According to an IC3 annual report in 2021, 649 ransomware reports were made across 14
critical infrastructure sectors; the HPH Sector accounted for the most reports at 148.
The Daixin Team is a ransomware and data extortion group that has targeted the HPH Sector with
ransomware and data extortion operations since at least June 2022. Since then, Daixin Team
cybercrime actors have caused ransomware incidents at multiple HPH Sector organizations where
they have:
• Deployed ransomware to encrypt servers responsible for healthcare services—including
electronic health records services, diagnostics services, imaging services, and intranet
services, and/or
• Exfiltrated personal identifiable information (PII) and patient health information (PHI) and
threatened to release the information if a ransom is not paid.
Daixin actors gain initial access to victims through virtual private network (VPN) servers. In one
confirmed compromise, the actors likely exploited an unpatched vulnerability in the organization’s
VPN server [T1190]. In another confirmed compromise, the actors used previously compromised
credentials to access a legacy VPN server [T1078] that did not have multifactor authentication (MFA)
enabled. The actors are believed to have acquired the VPN credentials through the use of a phishing
email with a malicious attachment [T1598.002].
After obtaining access to the victim’s VPN server, Daixin actors move laterally via Secure Shell (SSH)
[T1563.001] and Remote Desktop Protocol (RDP) [T1563.002]. Daixin actors have sought to gain
privileged account access through credential dumping [T1003] and pass the hash [T1550.002]. The
actors have leveraged privileged accounts to gain access to VMware vCenter Server and reset
account passwords [T1098] for ESXi servers in the environment. The actors have then used SSH to
connect to accessible ESXi servers and deploy ransomware [T1486] on those servers.
According to third-party reporting, the Daixin Team’s ransomware is based on leaked Babuk Locker
source code. This third-party reporting as well as FBI analysis show that the ransomware targets
ESXi servers and encrypts files located in /vmfs/volumes/ with the following extensions: .vmdk,
.vmem, .vswp, .vmsd, .vmx, and .vmsn. A ransom note is also written to /vmfs/volumes/. See Figure
1 for targeted file system path and Figure 2 for targeted file extensions list. Figure 3 and Figure 4
include examples of ransom notes. Note that in the Figure 3 ransom note, Daixin actors misspell
“Daixin” as “Daxin.”
Figure 1: Daixin Team – Ransomware Targeted File Path
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Figure 2: Daixin Team – Ransomware Targeted File Extensions
Figure 3: Example 1 of Daixin Team Ransomware Note
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Figure 4: Example 2 of Daixin Team Ransomware Note
In addition to deploying ransomware, Daixin actors have exfiltrated data [TA0010] from victim
systems. In one confirmed compromise, the actors used Rclone—an open-source program to
manage files on cloud storage—to exfiltrate data to a dedicated virtual private server (VPS). In
another compromise, the actors used Ngrok—a reverse proxy tool for proxying an internal service out
onto an Ngrok domain—for data exfiltration [T1567].
MITRE ATT&CK TACTICS AND TECHNIQUES
See Table 1 for all referenced threat actor tactics and techniques included in this advisory.
Table 1: Daixin Actors’ ATT&CK Techniques for Enterprise
Reconnaissance
Technique Title ID Use
Phishing for Information:
Spearphishing Attachment
T1598.002 Daixin actors have acquired the VPN
credentials (later used for initial access) by
a phishing email with a malicious
attachment.
Initial Access
Technique Title ID Use
Exploit Public-Facing Application T1190 Daixin actors exploited an unpatched
vulnerability in a VPN server to gain initial
access to a network.
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Valid Accounts T1078 Daixin actors use previously compromised
credentials to access servers on the target
network.
Persistence
Technique Title ID Use
Account Manipulation T1098 Daixin actors have leveraged privileged
accounts to reset account passwords for
VMware ESXi servers in the compromised
environment.
Credential Access
Technique Title ID Use
OS Credential Dumping T1003 Daixin actors have sought to gain privileged
account access through credential
dumping.
Lateral Movement
Technique Title ID Use
Remote Service Session Hijacking:
SSH Hijacking T1563.001 Daixin actors use SSH and RDP to move
laterally across a network.
Remote Service Session Hijacking:
RDP Hijacking T1563.002 Daixin actors use RDP to move laterally
across a network.
Use Alternate Authentication
Material: Pass the Hash T1550.002 Daixin actors have sought to gain privileged
account access through pass the hash.
Exfiltration
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Technique Title ID Use
Exfiltration Over Web Service T1567 Daixin Team members have used Ngrok for
data exfiltration over web servers.
Impact
Technique Title ID Use
Data Encrypted for Impact T1486 Daixin actors have encrypted data on target
systems or on large numbers of systems in
a network to interrupt availability to system
and network resources.
INDICATORS OF COMPROMISE
See Table 2 for IOCs obtained from third-party reporting.
Table 2: Daixin Team IOCs – Rclone Associated SHA256 Hashes
File SHA256
rclone-v1.59.2-windows-amd64\git-log.txt 9E42E07073E03BDEA4CD978D9E7B44A957497
2818593306BE1F3DCFDEE722238
rclone-v1.59.2-windows-amd64\rclone.1 19ED36F063221E161D740651E6578D50E0D3CA
CEE89D27A6EBED4AB4272585BD
rclone-v1.59.2-windows-amd64\rclone.exe 54E3B5A2521A84741DC15810E6FED9D739EB80
83CB1FE097CB98B345AF24E939
rclone-v1.59.2-windowsamd64\README.html
EC16E2DE3A55772F5DFAC8BF8F5A365600FAD
40A244A574CBAB987515AA40CBF
rclone-v1.59.2-windows-amd64\README.txt 475D6E80CF4EF70926A65DF5551F59E35B71A0
E92F0FE4DD28559A9DEBA60C28
MITIGATIONS
FBI, CISA, and HHS urge HPH Sector organizations to implement the following to protect against
Daixin and related malicious activity:
• Install updates for operating systems, software, and firmware as soon as they are released.
Prioritize patching VPN servers, remote access software, virtual machine software, and known
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exploited vulnerabilities. Consider leveraging a centralized patch management system to
automate and expedite the process.
• Require phishing-resistant MFA for as many services as possible—particularly for webmail,
VPNs, accounts that access critical systems, and privileged accounts that manage backups.
• If you use Remote Desktop Protocol (RDP), secure and monitor it.
o Limit access to resources over internal networks, especially by restricting RDP and
using virtual desktop infrastructure. After assessing risks, if RDP is deemed
operationally necessary, restrict the originating sources, and require multifactor
authentication (MFA) to mitigate credential theft and reuse. If RDP must be available
externally, use a virtual private network (VPN), virtual desktop infrastructure, or other
means to authenticate and secure the connection before allowing RDP to connect to
internal devices. Monitor remote access/RDP logs, enforce account lockouts after a
specified number of attempts to block brute force campaigns, log RDP login attempts,
and disable unused remote access/RDP ports.
o Ensure devices are properly configured and that security features are enabled. Disable
ports and protocols that are not being used for business purposes (e.g., RDP
Transmission Control Protocol Port 3389).
• Turn off SSH and other network device management interfaces such as Telnet, Winbox, and
HTTP for wide area networks (WANs) and secure with strong passwords and encryption when
enabled.
• Implement and enforce multi-layer network segmentation with the most critical
communications and data resting on the most secure and reliable layer.
• Limit access to data by deploying public key infrastructure and digital certificates to
authenticate connections with the network, Internet of Things (IoT) medical devices, and the
electronic health record system, as well as to ensure data packages are not manipulated while
in transit from man-in-the-middle attacks.
• Use standard user accounts on internal systems instead of administrative accounts, which
allow for overarching administrative system privileges and do not ensure least privilege.
• Secure PII/PHI at collection points and encrypt the data at rest and in transit by using
technologies such as Transport Layer Security (TPS). Only store personal patient data on
internal systems that are protected by firewalls, and ensure extensive backups are available if
data is ever compromised.
• Protect stored data by masking the permanent account number (PAN) when it is displayed
and rendering it unreadable when it is stored—through cryptography, for example.
• Secure the collection, storage, and processing practices for PII and PHI, per regulations such
as the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Implementing
HIPAA security measures can prevent the introduction of malware on the system.
• Use monitoring tools to observe whether IoT devices are behaving erratically due to a
compromise.
• Create and regularly review internal policies that regulate the collection, storage, access, and
monitoring of PII/PHI.
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In addition, the FBI, CISA, and HHS urge all organizations, including HPH Sector organizations, to
apply the following recommendations to prepare for, mitigate/prevent, and respond to ransomware
incidents.
Preparing for Ransomware
• Maintain offline (i.e., physically disconnected) backups of data, and regularly test backup and
restoration. These practices safeguard an organization’s continuity of operations or at least
minimize potential downtime from a ransomware incident and protect against data losses.
o Ensure all backup data is encrypted, immutable (i.e., cannot be altered or deleted),
and covers the entire organization’s data infrastructure.
• Create, maintain, and exercise a basic cyber incident response plan and associated
communications plan that includes response procedures for a ransomware incident.
o Organizations should also ensure their incident response and communications plans
include response and notification procedures for data breach incidents. Ensure the
notification procedures adhere to applicable state laws.
▪ Refer to applicable state data breach laws and consult legal counsel when
necessary.
▪ For breaches involving electronic health information, you may need to notify the
Federal Trade Commission (FTC) or the Department of Health and Human
Services, and—in some cases—the media. Refer to the FTC’s Health Breach
Notification Rule and U.S. Department of Health and Human Services’ Breach
Notification Rule for more information.
o See CISA-Multi-State Information Sharing and Analysis Center (MS-ISAC) Joint
Ransomware Guide and CISA Fact Sheet, Protecting Sensitive and Personal
Information from Ransomware-Caused Data Breaches, for information on creating a
ransomware response checklist and planning and responding to ransomware-caused
data breaches.
Mitigating and Preventing Ransomware
• Restrict Server Message Block (SMB) Protocol within the network to only access servers that
are necessary and remove or disable outdated versions of SMB (i.e., SMB version 1). Threat
actors use SMB to propagate malware across organizations.
• Review the security posture of third-party vendors and those interconnected with your
organization. Ensure all connections between third-party vendors and outside software or
hardware are monitored and reviewed for suspicious activity.
• Implement listing policies for applications and remote access that only allow systems to
execute known and permitted programs.
• Open document readers in protected viewing modes to help prevent active content from
running.
• Implement user training program and phishing exercises to raise awareness among users
about the risks of visiting suspicious websites, clicking on suspicious links, and opening
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suspicious attachments. Reinforce the appropriate user response to phishing and
spearphishing emails.
• Use strong passwords and avoid reusing passwords for multiple accounts. See CISA Tip
Choosing and Protecting Passwords and the National Institute of Standards and Technology’s
(NIST’s) Special Publication 800-63B: Digital Identity Guidelines for more information.
• Require administrator credentials to install software.
• Audit user accounts with administrative or elevated privileges and configure access controls
with least privilege in mind.
• Install and regularly update antivirus and antimalware software on all hosts.
• Only use secure networks and avoid using public Wi-Fi networks. Consider installing and
using a VPN.
• Consider adding an email banner to messages coming from outside your organizations.
• Disable hyperlinks in received emails.
Responding to Ransomware Incidents
If a ransomware incident occurs at your organization:
• Follow your organization’s Ransomware Response Checklist (see Preparing for Ransomware
section).
• Scan backups. If possible, scan backup data with an antivirus program to check that it is free
of malware. This should be performed using an isolated, trusted system to avoid exposing
backups to potential compromise.
• Follow the notification requirements as outlined in your cyber incident response plan.
• Report incidents to the FBI at a local FBI Field Office, CISA at cisa.gov/report, or the U.S.
Secret Service (USSS) at a USSS Field Office.
• Apply incident response best practices found in the joint Cybersecurity Advisory, Technical
Approaches to Uncovering and Remediating Malicious Activity, developed by CISA and the
cybersecurity authorities of Australia, Canada, New Zealand, and the United Kingdom.
Note: FBI, CISA, and HHS strongly discourage paying ransoms as doing so does not guarantee files
and records will be recovered. Furthermore, payment may also embolden adversaries to target
additional organizations, encourage other criminal actors to engage in the distribution of ransomware,
and/or fund illicit activities.
REFERENCES
• Stopransomware.gov is a whole-of-government approach that gives one central location for
ransomware resources and alerts.
• Resource to mitigate a ransomware attack: CISA-Multi-State Information Sharing and Analysis
Center (MS-ISAC) Joint Ransomware Guide.
• No-cost cyber hygiene services: Cyber Hygiene Services and Ransomware Readiness
Assessment.
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• Ongoing Threat Alerts and Sector alerts are produced by the Health Sector Cybersecurity
Coordination Center (HC3) and can be found at hhs.gov/HC3
• For additional best practices for Healthcare cybersecurity issues see the HHS 405(d) Aligning
Health Care Industry Security Approaches at 405d.hhs.gov
REPORTING
The FBI is seeking any information that can be shared, to include boundary logs showing
communication to and from foreign IP addresses, a sample ransom note, communications with Daixin
Group actors, Bitcoin wallet information, decryptor files, and/or a benign sample of an encrypted file.
Regardless of whether you or your organization have decided to pay the ransom, the FBI, CISA, and
HHS urge you to promptly report ransomware incidents to a local FBI Field Office, or CISA at
cisa.gov/report.
ACKNOWLEDGEMENTS
FBI, CISA, and HHS would like to thank CrowdStrike and the Health Information Sharing and Analysis
Center (Health-ISAC) for their contributions to this CSA.
DISCLAIMER
The information in this report is being provided “as is” for informational purposes only. FBI, CISA, and
HHS do not endorse any commercial product or service, including any subjects of analysis. Any
reference to specific commercial products, processes, or services by service mark, trademark,
manufacturer, or otherwise, does not constitute or imply endorsement, recommendation, or favoring
by FBI, CISA, or HHS.
