Change Healthcare Breach Incident Score: Analysis & Impact (CHA1032510111225)

In this Rankiteo incident briefing, we review the Change Healthcare breach identified under incident ID CHA1032510111225.

The analysis begins with a detailed overview of Change Healthcare's information like the linkedin page: https://www.linkedin.com/company/change-healthcare, the number of followers: 146856, the industry type: IT Services and IT Consulting and the number of employees: 4876 employees

After the initial compromise, the video explains how Rankiteo's incident engine converts technical details into a normalized incident score. The incident score before the incident was 100 and after the incident was 100 with a difference of 0 which is could be a good indicator of the severity and impact of the incident.

In the next step of the video, we will analyze in more details the incident and the impact it had on Change Healthcare and their customers.

Change Healthcare recently reported "Active Directory Compromise and Ransomware Attack on Change Healthcare (2024)", a noteworthy cybersecurity incident.

In the 2024 Change Healthcare breach, attackers exploited a server lacking multifactor authentication (MFA), pivoted to Active Directory (AD), escalated privileges, and executed a highly costly ransomware attack.

The disruption is felt across the environment, affecting Active Directory, Domain Controllers and Hybrid Cloud Infrastructure (Azure AD), and exposing Health Records and Patient Data, plus an estimated financial loss of Millions (Ransom Paid + Operational Costs).

In response, teams activated the incident response plan, and began remediation that includes Ransom Payment (Millions), Patch Deployment for Domain Controllers (Post-Breach) and Potential Review of AD Security Posture.

The case underscores how Likely Ongoing (2024–2025), teams are taking away lessons such as Active Directory is the 'holy grail' for attackers; compromising it grants full network control, Hybrid environments (on-premises + cloud) introduce complex attack surfaces (e.g., Azure AD Connect, OAuth tokens, NTLM) and Legacy protocols (NTLM) and fragmented security tools create visibility gaps exploited by attackers, and recommending next steps like {'category': 'Credential Security', 'actions': ['Implement **Specops Password Policy** or similar to block >4B compromised passwords in real-time.', 'Enforce **12+ character passwords** with dynamic feedback during creation.', 'Enable **continuous scanning** for breached credentials (not just at reset).', 'Require **MFA for all privileged accounts** (admin, service, sync accounts).']}, {'category': 'Privileged Access Management (PAM)', 'actions': ['Segregate **admin accounts** from standard user accounts.', 'Adopt **just-in-time (JIT) access** for elevated privileges (auto-revoke after use).', 'Route admin tasks through **privileged access workstations (PAWs)**.', 'Audit and remove **stale accounts** (former employees, unused service accounts).']} and {'category': 'Active Directory Hardening', 'actions': ['Disable **legacy protocols** (NTLM, LM) or enforce **NTLM blocking**.', 'Deploy **conditional access policies** (evaluate device health, user location, behavior).', 'Monitor **AD changes** (group modifications, replication anomalies, off-hour admin actions).', 'Patch **domain controllers within 48 hours** of critical updates.']}.

Finally, we try to match the incident with the MITRE ATT&CK framework to see if there is any correlation between the incident and the MITRE ATT&CK framework.

The MITRE ATT&CK framework is a knowledge base of techniques and sub-techniques that are used to describe the tactics and procedures of cyber adversaries. It is a powerful tool for understanding the threat landscape and for developing effective defense strategies.

Rankiteo's analysis has identified several MITRE ATT&CK tactics and techniques associated with this incident, each with varying levels of confidence based on available evidence. Under the Initial Access tactic, the analysis identified Valid Accounts: Cloud Accounts (T1078.004) with moderate to high confidence (85%), with evidence including exploited a server lacking multifactor authentication (MFA), and hybrid Environment Abuse (Azure AD Connect, OAuth Tokens) and Valid Accounts: Domain Accounts (T1078.002) with high confidence (95%), with evidence including compromised Credentials (Phishing/Malware/Breach Databases), and weak/Reused Passwords (88% of breaches per Verizon DBIR). Under the Privilege Escalation tactic, the analysis identified Exploitation for Privilege Escalation (T1068) with high confidence (90%), with evidence including unpatched Domain Controllers (Privilege Escalation Flaw, April 2025), and escalated privileges, Steal or Forge Kerberos Tickets: Golden Ticket (T1558.001) with high confidence (95%), with evidence including techniques like Golden Ticket, DCSync, and Kerberoasting, and backdoors established such as Persistent AD Access via Golden Ticket, and Steal or Forge Kerberos Tickets: AS-REP Roasting (T1558.004) with moderate to high confidence (85%), supported by evidence indicating kerberoasting. Under the Defense Evasion tactic, the analysis identified Use Alternate Authentication Material: Pass the Hash (T1550.002) with moderate to high confidence (80%), with evidence including cached Administrative Credentials in Workstation Memory, and legacy Protocols (NTLM Enabled), Indicator Removal: File Deletion (T1070.004) with moderate to high confidence (70%), supported by evidence indicating evade detection by mimicking legitimate AD operations, and Impair Defenses: Disable or Modify Tools (T1562.001) with moderate to high confidence (75%), supported by evidence indicating lack of Visibility into Privileged Account Usage. Under the Credential Access tactic, the analysis identified OS Credential Dumping: DCSync (T1003.006) with high confidence (95%), with evidence including dCSync, and backdoors established such as Persistent AD Access via Golden Ticket/DCSync, OS Credential Dumping: LSASS Memory (T1003.001) with moderate to high confidence (85%), supported by evidence indicating cached Administrative Credentials in Workstation Memory, and Unsecured Credentials: Credentials In Files (T1552.001) with moderate to high confidence (80%), supported by evidence indicating service Accounts with Non-Expiring Passwords & Excessive Permissions. Under the Lateral Movement tactic, the analysis identified Remote Services: SMB/Windows Admin Shares (T1021.002) with high confidence (90%), with evidence including executed lateral movement, and legacy Protocols (NTLM Enabled), Remote Desktop Protocol (T1076) with moderate to high confidence (75%), supported by evidence indicating lateral movement, and Use Alternate Authentication Material: Pass the Ticket (T1550.003) with high confidence (90%), supported by evidence indicating golden Ticket. Under the Persistence tactic, the analysis identified Account Manipulation: Exchange Email Delegation (T1098.002) with moderate to high confidence (70%), supported by evidence indicating mimicking legitimate AD operations, Account Manipulation: Additional Cloud Credentials (T1098.001) with moderate to high confidence (80%), supported by evidence indicating hybrid Environment Abuse (Azure AD Connect, OAuth Tokens), and Create Account: Local Account (T1136.001) with moderate to high confidence (75%), supported by evidence indicating stale Accounts (Former Employees with Retained Access). Under the Exfiltration tactic, the analysis identified Exfiltration Over Alternative Protocol: Exfiltration Over Asymmetric Encrypted Channel (T1048.002) with moderate to high confidence (85%), with evidence including data exfiltration such as Confirmed (Health Records), and double Extortion ransomware model and Automated Exfiltration (T1020) with moderate to high confidence (75%), supported by evidence indicating exposed sensitive health records. Under the Impact tactic, the analysis identified Data Encrypted for Impact (T1486) with high confidence (100%), with evidence including deployed a ransomware attack that crippled operations, and data encryption such as Yes (Systems Locked) and Data Destruction (T1485) with moderate to high confidence (70%), supported by evidence indicating forced a complete halt to patient care services. Under the Command and Control tactic, the analysis identified Application Layer Protocol: Web Protocols (T1071.001) with moderate to high confidence (75%), supported by evidence indicating hybrid Environment Abuse (Azure AD Connect, OAuth Tokens) and Encrypted Channel: Symmetric Cryptography (T1573.001) with moderate to high confidence (80%), supported by evidence indicating mimicking legitimate AD operations. These correlations help security teams understand the attack chain and develop appropriate defensive measures based on the observed tactics and techniques.