Securing Patient Data at Cullman Regional Medical Center
26
Oct 2022
Discover how Cullman Regional Medical Center safeguards patient data with Darktrace AI. Learn how to keep sensitive data protected with the Darktrace experts!
Cullman Regional Medical Center strives to improve the health of our community by providing excellent medical resources. We have over 50 providers offering a wide range of specialized care across our offices in Cullman and Hartselle, Alabama.
To deliver the best services possible, we rely on technology. Staff members record medical histories in digital files. Guests interact with us through online portals. Medical IoT devices collect patient data. Yet the same digital adoptions that make healthcare more efficient also present vulnerabilities that threat actors can exploit to gain access to our digital systems.
Another major concern comes from insider threat, whether malicious or accidental. Data security depends on user compliance, which can be hard to enforce and monitor. Even unintentionally, medical professionals can introduce risk simply by bringing personal devices, such as smart phones or watches, into the network.
In late 2020, the FBI, CISA, and HHS issued a warning after the number of cyber-attacks targeting the healthcare sector reached record highs. The agencies cautioned that cybercriminals could exploit malware like TrickBot to harvest credentials, hijack resources to mine crypto-currencies, exfiltrate data, and deploy ransomware.
The attacks targeting the healthcare sector have gone up in frequency and complexity. While protecting our digital infrastructure and patient data has become increasingly difficult, it remains vitally important. That’s why we deployed Darktrace.
High stakes healthcare security
The consequences of cyber-attacks in medicine can be devastating. Lost or stolen medical records can damage a hospital’s reputation and cost millions of dollars. According to a Ponemon Institute study, the financial cost of a data breach in the healthcare sector can cost two to three times more than a breach in any other industry.
Beyond reputational or financial harm, cyber-attacks against hospitals and clinics can be lethal. They can force ambulances to be re-routed, surgeries to be postponed, and treatment options to be scaled back. In 2021, over 45 million patients were impacted by cyber-attacks on healthcare centers, and almost 25% of Health Delivery Organizations found that cyber-attacks increased patient mortality rates.
Darktrace protects our digital infrastructure to avoid these consequences. Its Self-Learning AI learns our organization— from the laptops and servers to the IoT devices to the users themselves— to recognize what constitutes our “pattern of life.” The AI then uses this information to identify the subtle behaviors that indicate a cyber-attack. Once an attack is detected, Autonomous Response reacts with surgical precision to neutralize it without disrupting our normal digital activity.
Darktrace is always on and can detect and respond to attacks within seconds, providing another layer of security for our hospital and clinics. Darktrace’s approach, based on understanding our organization to create bespoke security, allows the AI to spot threats that slip by traditional security tools, which rely on rules and signatures. In this way, Darktrace can detect insider threats, too.
Finally, not only does Darktrace protect us by stopping cyber-attacks, but it also serves as a deterrent to threat actors by making us a harder target.
Protection in action
Darktrace has successfully helped us monitor and protect our digital estate. We have used it to examine suspicious traffic and troubleshoot access related problems. Darktrace’s Cyber AI Analyst investigates attacks and translates its findings into understandable explanations displayed in a single screen.
Darktrace has proven its value to us on multiple occasions. The same day that one of our clinic managers installed a new file transfer protocol, Darktrace identified traffic going out over an unencrypted port. With its visibility and understanding of our cyber landscape, Darktrace detected this abnormal action and responded at machine-speed. It protected us from exposing personal patient data.
Another time, Darktrace noticed someone on our guest network running a network snooping tool, triggering us to remove their computer from the network. While it was only on our guest network, the threat actor could have been targeting the patients that were using it. Darktrace protected them, helping us live up to our goal of serving our guests with compassion and respect.
Keeping our organization healthy
We do not have a large enough IT staff to constantly monitor all traffic across our digital estate, so Darktrace supplements and augments our team. The AI continuously monitors our cyber landscape and responds to attacks without disrupting our normal digital activities. Moreover, it works at all times of the day, even when I am not online. By handling the maintenance of our security, Darktrace buys my team time to work on other projects.
The cyber security of our organization is crucial for the safety of our patients and practitioners. Since deploying Darktrace, my team feels reassured that our security posture can handle any attacks that come our way. Darktrace is a valuable tool in our security stack.
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Inside the SOC
Darktrace cyber analysts are world-class experts in threat intelligence, threat hunting and incident response, and provide 24/7 SOC support to thousands of Darktrace customers around the globe. Inside the SOC is exclusively authored by these experts, providing analysis of cyber incidents and threat trends, based on real-world experience in the field.
Author
Sean Simpson
Executive Director of IT, Cullman Regional Medical Center (Guest Contributor)
Darktrace's Detection of State-Linked ShadowPad Malware
An integral part of cybersecurity is anomaly detection, which involves identifying unusual patterns or behaviors in network traffic that could indicate malicious activity, such as a cyber-based intrusion. However, attribution remains one of the ever present challenges in cybersecurity. Attribution involves the process of accurately identifying and tracing the source to a specific threat actor(s).
Given the complexity of digital networks and the sophistication of attackers who often use proxies or other methods to disguise their origin, pinpointing the exact source of a cyberattack is an arduous task. Threat actors can use proxy servers, botnets, sophisticated techniques, false flags, etc. Darktrace’s strategy is rooted in the belief that identifying behavioral anomalies is crucial for identifying both known and novel threat actor campaigns.
The ShadowPad cluster
Between July 2024 and November 2024, Darktrace observed a cluster of activity threads sharing notable similarities. The threads began with a malicious actor using compromised user credentials to log in to the target organization's Check Point Remote Access virtual private network (VPN) from an attacker-controlled, remote device named 'DESKTOP-O82ILGG'. In one case, the IP from which the initial login was carried out was observed to be the ExpressVPN IP address, 194.5.83[.]25. After logging in, the actor gained access to service account credentials, likely via exploitation of an information disclosure vulnerability affecting Check Point Security Gateway devices. Recent reporting suggests this could represent exploitation of CVE-2024-24919 [27,28]. The actor then used these compromised service account credentials to move laterally over RDP and SMB, with files related to the modular backdoor, ShadowPad, being delivered to the ‘C:\PerfLogs\’ directory of targeted internal systems. ShadowPad was seen communicating with its command-and-control (C2) infrastructure, 158.247.199[.]185 (dscriy.chtq[.]net), via both HTTPS traffic and DNS tunneling, with subdomains of the domain ‘cybaq.chtq[.]net’ being used in the compromised devices’ TXT DNS queries.
Figure 1: Darktrace’s Advanced Search data showing the VPN-connected device initiating RDP connections to a domain controller (DC). The device subsequently distributes likely ShadowPad-related payloads and makes DRSGetNCChanges requests to a second DC.
Figure 2: Event Log data showing a DC making DNS queries for subdomains of ‘cbaq.chtq[.]net’ to 158.247.199[.]185 after receiving SMB and RDP connections from the VPN-connected device, DESKTOP-O82ILGG.
Additional cases of ShadowPad were observed across Darktrace’s customer base in 2024. In some cases, common C2 infrastructure with the cluster discussed above was observed, with dscriy.chtq[.]net and cybaq.chtq[.]net both involved; however, no other common features were identified. These ShadowPad infections were observed between April and November 2024, with customers across multiple regions and sectors affected. Darktrace’s observations align with multiple other public reports that fit the timeframe of this campaign.
Darktrace has also observed other cases of ShadowPad without common infrastructure since September 2024, suggesting the use of this tool by additional threat actors.
The data theft thread
One of the Darktrace customers impacted by the ShadowPad cluster highlighted above was a European manufacturer. A distinct thread of activity occurred within this organization’s network several months after the ShadowPad intrusion, in October 2024.
The thread involved the internal distribution of highly masqueraded executable files via Sever Message Block (SMB) and WMI (Windows Management Instrumentation), the targeted collection of sensitive information from an internal server, and the exfiltration of collected information to a web of likely compromised sites. This observed thread of activity, therefore, consisted of three phrases: lateral movement, collection, and exfiltration.
The lateral movement phase began when an internal user device used an administrative credential to distribute files named ‘ProgramData\Oracle\java.log’ and 'ProgramData\Oracle\duxwfnfo' to the c$ share on another internal system.
Figure 3: Darktrace model alert highlighting an SMB write of a file named ‘ProgramData\Oracle\java.log’ to the c$ share on another device.
Over the next few days, Darktrace detected several other internal systems using administrative credentials to upload files with the following names to the c$ share on internal systems:
ProgramData\Adobe\ARM\webservices.dll
ProgramData\Adobe\ARM\wksprt.exe
ProgramData\Oracle\Java\wksprt.exe
ProgramData\Oracle\Java\webservices.dll
ProgramData\Microsoft\DRM\wksprt.exe
ProgramData\Microsoft\DRM\webservices.dll
ProgramData\Abletech\Client\webservices.dll
ProgramData\Abletech\Client\client.exe
ProgramData\Adobe\ARM\rzrmxrwfvp
ProgramData\3Dconnexion\3DxWare\3DxWare.exe
ProgramData\3Dconnexion\3DxWare\webservices.dll
ProgramData\IDMComp\UltraCompare\updater.exe
ProgramData\IDMComp\UltraCompare\webservices.dll
ProgramData\IDMComp\UltraCompare\imtrqjsaqmm
Figure 4: Cyber AI Analyst highlighting an SMB write of a file named ‘ProgramData\Adobe\ARM\webservices.dll’ to the c$ share on an internal system.
The threat actor appears to have abused the Microsoft RPC (MS-RPC) service, WMI, to execute distributed payloads, as evidenced by the ExecMethod requests to the IWbemServices RPC interface which immediately followed devices’ SMB uploads.
Figure 5: Cyber AI Analyst data highlighting a thread of activity starting with an SMB data upload followed by ExecMethod requests.
Several of the devices involved in these lateral movement activities, both on the source and destination side, were subsequently seen using administrative credentials to download tens of GBs of sensitive data over SMB from a specially selected server. The data gathering stage of the threat sequence indicates that the threat actor had a comprehensive understanding of the organization’s system architecture and had precise objectives for the information they sought to extract.
Immediately after collecting data from the targeted server, devices went on to exfiltrate stolen data to multiple sites. Several other likely compromised sites appear to have been used as general C2 infrastructure for this intrusion activity. The sites used by the threat actor for C2 and data exfiltration purport to be sites for companies offering a variety of service, ranging from consultancy to web design.
Figure 6: Screenshotof one of the likely compromised sites used in the intrusion.
At least 16 sites were identified as being likely data exfiltration or C2 sites used by this threat actor in their operation against this organization. The fact that the actor had such a wide web of compromised sites at their disposal suggests that they were well-resourced and highly prepared.
Figure 7: Darktrace model alert highlighting an internal device slowly exfiltrating data to the external endpoint, yasuconsulting[.]com.
Figure 8: Darktrace model alert highlighting an internal device downloading nearly 1 GB of data from an internal system just before uploading a similar volume of data to another suspicious endpoint, www.tunemmuhendislik[.]com
Cyber AI Analyst spotlight
Figure 9: Cyber AI Analyst identifying and piecing together the various steps of a ShadowPad intrusion.
Figure 10: Cyber AI Analyst Incident identifying and piecing together the various steps of the data theft activity.
As shown in the above figures, Cyber AI Analyst’s ability to thread together the different steps of these attack chains are worth highlighting.
In the ShadowPad attack chains, Cyber AI Analyst was able to identify SMB writes from the VPN subnet to the DC, and the C2 connections from the DC. It was also able to weave together this activity into a single thread representing the attacker’s progression.
Similarly, in the data exfiltration attack chain, Cyber AI Analyst identified and connected multiple types of lateral movement over SMB and WMI and external C2 communication to various external endpoints, linking them in a single, connected incident.
These Cyber AI Analyst actions enabled a quicker understanding of the threat actor sequence of events and, in some cases, faster containment.
Attribution puzzle
Publicly shared research into ShadowPad indicates that it is predominantly used as a backdoor in People’s Republic of China (PRC)-sponsored espionage operations [5][6][7][8][9][10]. Most publicly reported intrusions involving ShadowPad are attributed to the China-based threat actor, APT41 [11][12]. Furthermore, Google Threat Intelligence Group (GTIG) recently shared their assessment that ShadowPad usage is restricted to clusters associated with APT41 [13]. Interestingly, however, there have also been public reports of ShadowPad usage in unattributed intrusions [5].
The data theft activity that later occurred in the same Darktrace customer network as one of these ShadowPad compromises appeared to be the targeted collection and exfiltration of sensitive data. Such an objective indicates the activity may have been part of a state-sponsored operation. The tactics, techniques, and procedures (TTPs), artifacts, and C2 infrastructure observed in the data theft thread appear to resemble activity seen in previous Democratic People’s Republic of Korea (DPRK)-linked intrusion activities [15] [16] [17] [18] [19].
The distribution of payloads to the following directory locations appears to be a relatively common behavior in DPRK-sponsored intrusions.
Observed examples:
C:\ProgramData\Oracle\Java\
C:\ProgramData\Adobe\ARM\
C:\ProgramData\Microsoft\DRM\
C:\ProgramData\Abletech\Client\
C:\ProgramData\IDMComp\UltraCompare\
C:\ProgramData\3Dconnexion\3DxWare\
Additionally, the likely compromised websites observed in the data theft thread, along with some of the target URI patterns seen in the C2 communications to these sites, resemble those seen in previously reported DPRK-linked intrusion activities.
No clear evidence was found to link the ShadowPad compromise to the subsequent data theft activity that was observed on the network of the manufacturing customer. It should be noted, however, that no clear signs of initial access were found for the data theft thread – this could suggest the ShadowPad intrusion itself represents the initial point of entry that ultimately led to data exfiltration.
Motivation-wise, it seems plausible for the data theft thread to have been part of a DPRK-sponsored operation. DPRK is known to pursue targets that could potentially fulfil its national security goals and had been publicly reported as being active in months prior to this intrusion [21]. Furthermore, the timing of the data theft aligns with the ratification of the mutual defense treaty between DPRK and Russia and the subsequent accused activities [20].
Darktrace assesses with medium confidence that a nation-state, likely DPRK, was responsible, based on our investigation, the threat actor applied resources, patience, obfuscation, and evasiveness combined with external reporting, collaboration with the cyber community, assessing the attacker’s motivation and world geopolitical timeline, and undisclosed intelligence.
Conclusion
When state-linked cyber activity occurs within an organization’s environment, previously unseen C2 infrastructure and advanced evasion techniques will likely be used. State-linked cyber actors, through their resources and patience, are able to bypass most detection methods, leaving anomaly-based methods as a last line of defense.
Two threads of activity were observed within Darktrace’s customer base over the last year: The first operation involved the abuse of Check Point VPN credentials to log in remotely to organizations’ networks, followed by the distribution of ShadowPad to an internal domain controller. The second operation involved highly targeted data exfiltration from the network of one of the customers impacted by the previously mentioned ShadowPad activity.
Despite definitive attribution remaining unresolved, both the ShadowPad and data exfiltration activities were detected by Darktrace’s Self-Learning AI, with Cyber AI Analyst playing a significant role in identifying and piecing together the various steps of the intrusion activities.
Credit to Sam Lister (R&D Detection Analyst), Emma Foulger (Principal Cyber Analyst), Nathaniel Jones (VP), and the Darktrace Threat Research team.
Appendices
Darktrace / NETWORK model alerts
User / New Admin Credentials on Client
Anomalous Connection / Unusual Admin SMB Session
Compliance / SMB Drive Write
Device / Anomalous SMB Followed By Multiple Model Breaches
Survey findings: AI Cyber Threats are a Reality, the People are Acting Now
Artificial intelligence is changing the cybersecurity field as fast as any other, both on the offensive and defensive side. We surveyed over 1,500 cybersecurity professionals from around the world to uncover their attitudes, understanding, and priorities when it comes to AI cybersecurity in 2025. Our full report, unearthing some telling trends, is out now.
Nearly 74% of participants say AI-powered threats are a major challenge for their organization and 90% expect these threats to have a significant impact over the next one to two years, a slight increase from last year. These statistics highlight that AI is not just an emerging risk but a present and evolving one.
As attackers harness AI to automate and scale their operations, security teams must adapt just as quickly. Organizations that fail to prioritize AI-specific security measures risk falling behind, making proactive defense strategies more critical than ever.
Some of the most pressing AI-driven cyber threats include:
AI-powered social engineering: Attackers are leveraging AI to craft highly personalized and convincing phishing emails, making them harder to detect and more likely to bypass traditional defenses.
More advanced attacks at speed and scale: AI lowers the barrier for less skilled threat actors, allowing them to launch sophisticated attacks with minimal effort.
Attacks targeting AI systems: Cybercriminals are increasingly going after AI itself, compromising machine learning models, tampering with training data, and exploiting vulnerabilities in AI-driven applications and APIs.
Safe and secure use of AI
AI is having an effect on the cyber-threat landscape, but it also is starting to impact every aspect of a business – from marketing to HR to operations. The accessibility of AI tools for employees improves workflows, but also poses risks like data privacy violations, shadow AI, and violation of industry regulations.
How are security practitioners accommodating for this uptick in AI use across business?
Among survey participants 45% of security practitioners say they had already established a policy on the safe and secure use of AI and around 50% are in discussions to do so.
While almost all participants acknowledge that this is a topic that needs to be addressed, the gap between discussion and execution could underscore a need for greater insight, stronger leadership commitment, and adaptable security frameworks to keep pace with AI advancements in the workplace. The most popular actions taken are:
Implemented security controls to prevent unwanted exposure of corporate data when using AI technology (67%)
Implemented security controls to protect against other threats/risks associated with using AI technology (62%)
This year specifically, we see further action being taken with the implementation of security controls, training, and oversight.
For a more detailed breakdown that includes results based on industry and organizational size, download the full report here.
AI threats are rising, but security teams still face major challenges
78% of CISOs say AI-powered cyber-threats are already having a significant impact on their organization, a 5% increase from last year.
While cyber professionals feel more prepared for AI powered threats than they did 12 months ago, 45% still say their organization is not adequately prepared—down from 60% last year.
Despite this optimism, key challenges remain, including:
A shortage of personnel to manage tools and alerts
Gaps in knowledge and skills related to AI-driven countermeasures
Confidence in traditional security tools vs. new AI based tools
This year, 73% of survey participants expressed confidence in their security team’s proficiency in using AI within their tool stack, marking an increase from the previous year.
However, only 50% of participants have confidence in traditional cybersecurity tools to detect and block AI-powered threats. In contrast, 75% of participants are confident in AI-powered security solutions for detecting and blocking such threats and attacks.
As leading organizations continue to implement and optimize their use of AI, they are incorporating it into an increasing number of workflows. This growing familiarity with AI is likely to boost the confidence levels of practitioners even further.
The data indicates a clear trend towards greater reliance on AI-powered security solutions over traditional tools. As organizations become more adept at integrating AI into their operations, their confidence in these advanced technologies grows.
This shift underscores the importance of staying current with AI advancements and ensuring that security teams are well-trained in utilizing these tools effectively. The increasing confidence in AI-driven solutions reflects their potential to enhance cybersecurity measures and better protect against sophisticated threats.
The full report for Darktrace’s State of AI Cybersecurity is out now. Download the paper to dig deeper into these trends, and see how results differ by industry, region, organization size, and job title.