Ransomware has become a leading threat for healthcare providers and ABA businesses alike. The numbers are staggering: 2024 saw a 264% spike in attacks targeting healthcare, and the Department of Health and Human Services (HHS) is now focusing more enforcement on these incidents than ever before. But what does ransomware actually look like on the ground in an ABA company, and what practical steps can you take to protect your business?
What Does a Ransomware Attack Look Like in ABA?
It usually starts with a simple mistake—an employee clicks a link in a phishing email, or opens an infected attachment....
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Sometimes, these messages look like they’re from your own admin team or a trusted payer. In a matter of seconds, malicious software can encrypt your company’s files, client notes, schedules, even payroll data. You’ll see a message demanding payment (usually in cryptocurrency) to “unlock” your data. If you don’t pay, you risk losing all access—or worse, the attackers may leak protected health information (PHI) online.
The damage isn’t just financial. A ransomware attack can halt all operations, disrupt therapy for dozens of families, cause weeks of lost revenue, trigger HIPAA breach notifications, and destroy the trust you’ve built with staff and clients.
Why This Matters for ABA Companies
The Office for Civil Rights (OCR) has been clear: ransomware is a HIPAA compliance issue. In 2024 alone, OCR settled five ransomware investigations, each resulting in steep penalties for missing risk assessments, poor staff training, or lack of Business Associate Agreements (BAAs). ABA providers—especially smaller ones—are at risk because most don’t have dedicated IT teams or formal policies in place.
Insider Threats and Simple Mistakes: The Real Story
Most ransomware and HIPAA breaches don’t start with a “hacker.” It’s usually a regular employee, rushing through a busy day, who clicks a link or shares a password without thinking. These “insider threats” don’t always mean malicious intent; often it’s just a lack of awareness or poor systems.
Prevention: What Every ABA Business Should Do
- Staff Training: Hold regular, practical HIPAA training that covers phishing, password security, and safe data handling. Real-world scenarios work better than generic slides.
- Risk Assessment: Complete a formal security risk assessment at least once a year. This isn’t just a box to check—use it to find gaps in your systems.
- Business Associate Agreements (BAAs): Make sure every vendor handling PHI—billing platforms, scheduling tools, email providers—has a signed BAA. Missing these is one of the most common and costly mistakes in OCR settlements.
- Data Backups: Keep frequent, encrypted backups of all key business data. Store at least one backup offline or in a secure cloud environment.
- Email Security: Set up external email tagging, so your staff always knows when an email is coming from outside your organization (see below for step-by-step guides).
External Email Tagging: A Simple, Effective Defense
Phishing emails are the most common way ransomware gets in. Criminals will often try to spoof your company’s own addresses, making emails look like they came from inside your organization. By enabling external email tagging, every message from outside your domain is flagged—making it much harder for staff to fall for these tricks.
How to set up external email warnings in your ABA practice:
- Microsoft 365: Watch this YouTube tutorial for step-by-step instructions: https://www.youtube.com/watch?v=f1VDVZ4GUfU
- Google Workspace (Gmail): Use Google’s official support page: https://support.google.com/a/answer/7380041?hl=en
Once you’ve enabled this feature, remind your team: If an “urgent” email comes from outside—even if it looks like it’s from a supervisor—verify by phone or internal chat before clicking links or sending any information.
How We Can Help: Practical HIPAA Support for ABA
You don’t have to figure this out alone. 3 Pie Squared now offers hands-on HIPAA consultation services, including help setting up your Microsoft 365 or Google Workspace accounts with best-in-class security. Our HIPAA Policy Manual includes risk assessments, BAA templates, staff training, and state privacy law compliance—all tailored for ABA business owners.
Book a call with our HIPAA expert and mention this article for a 10% discount on your first consultation: https://3piesquared.com/stephen-booking-page
Further Reading and Resources
- Full HIPAA Journal article on recent ransomware settlements: https://natlawreview.com/article/ocr-secures-two-hipaa-settlements-addressing-insider-threats-and-ransomware
- Official OCR Cybersecurity Guidance: https://www.hhs.gov/hipaa/for-professionals/security/guidance/index.html
- Our ABA-specific HIPAA Policy Manual: https://3piesquared.com/productDetails/hipaa_policy_manual
- Book a HIPAA consultation (10% discount): https://3piesquared.com/stephen-booking-page
Final Thoughts
Protecting your ABA practice from ransomware and insider threats doesn’t require an IT degree or a huge budget. It does require practical steps, staff training, and a willingness to adapt as threats evolve. The tools are out there—don’t wait until after a breach to take action.
Need help with your ABA business?
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