Top 20 Threat Scenarios & Playbooks for Medical(Healthcare) Security

A comprehensive list of 20 threat scenarios in healthcare security, including detailed descriptions, detection rules, and a playbook-style table to guide security teams in identifying and responding to these threats.

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20 Healthcare Security Threat Scenarios & Detection Playbook. Each threat is categorized into Cyber Attacks, Insider Threats, Physical Security, and Supply Chain Risks.

#	Threat Scenario	Description	Detection Rules & Indicators	Response Actions
1	Ransomware Attack on Hospital IT & OT Systems	Attackers deploy ransomware to encrypt medical data and devices.	Unusual file encryption activity Network traffic to known ransomware C2 servers Mass file modification attempts	Isolate infected systems Restore from backups Block C2 traffic
2	Unauthorized Remote Access to Medical Devices	Hackers exploit weak credentials or unpatched devices to control MRI, infusion pumps, or ventilators.	Multiple failed login attempts Remote access from non-whitelisted IPs Configuration changes on critical devices	Block unauthorized access Enforce MFA (Multi-Factor Authentication) Patch vulnerabilities
3	Tampering with IoMT Devices (Internet of Medical Things)	Attackers alter pacemakers, insulin pumps, or heart monitors remotely.	Unauthorized firmware updates Changes in device communication patterns Configuration modifications	Rollback device settings Isolate compromised devices Conduct forensic analysis
4	Phishing Attacks Targeting Healthcare Employees	Attackers trick doctors or staff into revealing credentials for EHR systems.	Emails containing malicious links Login attempts from unusual locations Sudden password resets	Quarantine phishing emails Train employees on phishing Enforce email security filters
5	Exploiting Legacy Systems in Hospitals	Many hospitals still use outdated Windows XP/7 with known vulnerabilities.	SMBv1 traffic detected Use of obsolete OS versions Unauthorized file access attempts	Upgrade or segment legacy systems Monitor unauthorized access Apply virtual patches
6	Data Theft of Patient Records (PHI Exfiltration)	Attackers steal Protected Health Information (PHI) from EHR databases and sell it on the dark web.	Massive file transfers from EHR Access during non-working hours Traffic to unknown external servers	Block external exfiltration Investigate user activity logs Restrict bulk downloads
7	Man-in-the-Middle (MitM) Attacks on Medical Communications	Attackers intercept and alter medical data (e.g., modifying MRI scans).	ARP poisoning detected SSL/TLS certificate mismatches Unusual traffic between devices	Encrypt all communications Detect spoofed traffic Implement strong VPN security
8	Malware in Medical Imaging Systems (DICOM Exploits)	Attackers embed malware inside DICOM image files to infect radiology networks.	DICOM files with embedded scripts Execution of unusual binaries on imaging systems	Scan DICOM files Restrict execution privileges Implement endpoint security
9	Insider Threat: Employee Stealing PHI Data	Disgruntled employee exports patient records via USB or email.	Large file exports from user workstations Unusual USB activity Access to restricted patient files	Investigate activity logs Restrict USB access Enforce role-based access control (RBAC)
10	DDoS Attack on Telemedicine & Hospital Networks	Attackers flood telemedicine services, preventing patient consultations.	Unusual spike in traffic from single IP Connection requests from botnets Increased latency on hospital networks	Rate-limit traffic Enable Web Application Firewall (WAF) Block attack sources
11	Credential Stuffing on Patient Portals	Attackers use leaked passwords to access hospital accounts.	Multiple login attempts from various locations Use of known breached credentials	Force password resets Enable MFA Block IPs with repeated login failures
12	Supply Chain Attack on Healthcare Software Vendors	Malicious updates from third-party vendors introduce backdoors.	Unexpected software updates File integrity changes in critical applications	Verify software sources Monitor application behavior Implement zero-trust security
13	USB-Based Malware on Medical Workstations	Malware spreads via USB plugged into EHR systems.	Execution of new binaries from USB USB mass storage device activity	Disable USB ports Enforce endpoint security policies
14	SQL Injection in Patient Management Systems	Attackers inject SQL commands to extract data.	Database queries with 'OR 1=1' or 'DROP TABLE' Large unexpected database exports	Implement input validation Monitor database queries
15	Unauthorized Physical Access to Data Centers	Intruders breach hospital server rooms to tamper with infrastructure.	Unapproved keycard access Motion detection in restricted areas	Lock down server rooms Install CCTV and alerts
16	Rogue Wireless Access Points in Hospitals	Attackers set up fake Wi-Fi to steal medical data.	Detection of unauthorized SSIDs New devices connecting to rogue networks	Scan for rogue APs Enforce Wi-Fi security protocols
17	API Exploits in Health Information Exchange (HIE)	Attackers exploit unsecured API endpoints to steal data.	Unauthorized API access attempts Unexpected data requests	Secure API authentication Monitor API request logs
18	Cyberattack on Smart Ambulances	Attackers intercept real-time telemetry from ambulances.	GPS location spoofing attempts Traffic redirections from ambulance-to-hospital links	Encrypt ambulance communication Implement endpoint security
19	Data Integrity Attacks on Medical Research	Attackers alter clinical trial results to manipulate research.	Unauthorized database edits Anomalies in clinical trial data	Implement data integrity monitoring Restrict database access
20	Malware Targeting Pharmacy Systems	Attackers disrupt hospital drug dispensing systems.	Unexpected software behavior in pharmacy networks Unauthorized system reboots	Monitor pharmacy system activity Implement application control

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Recap on Healthcare Cybersecurity

• Implement Zero Trust Architecture
• Implement medical/healthcare-specific device management monitoring solution
• Implement medical/healthcare-specific threat/vulnerability monitoring solution
• Strengthen endpoint detection & response (EDR)
• Conduct continuous employee training

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