Article
US Government Alerts of Imminent Attacks Against the Healthcare Sector by Trickbot Group
Arete Analysis

Executive Summary
Last week, the Cybersecurity and Infrastructure Security Agency (CISA) in collaboration with the Federal Bureau of Investigation (FBI), and the Department of Health and Human Services (HHS) released the following alert: AA20-302A – Ransomware Activity Targeting the Healthcare and Public Health Sector.
The alert informs that there is credible intelligence of an increased and imminent cybercrime threat to U.S. hospitals and healthcare providers associated with the Trickbot and BazarLoader trojans that often leads to ransomware like the Ryuk and Conti ransomware. The alert also mentions the Trickbot Anchor tool set and Anchor DNS tool developed by this group.
News of these attacks against the Healthcare sector are of special concern due to the recent increase of COVID-19 cases in the US and evidence that shows ransomware attacks against the healthcare sector have been associated with persons losing their lives due to services being routed to nearby hospitals and laboratory results not being quickly delivered electronically to the providers.
Arete statistics and Intel from Arete’s Fusion Center and Open-source intelligence (OSINT) shows that this new wave of attacks since October 2020 have a slight change in TTPs and the BazarLoader malware has now been observed in systems compromised with Ryuk.
The Arete incident response (IR) practice has responded to more than ninety (90) Ryuk engagements since 2019 with more than six breach responses engagements just in the month of October 2020.
Based on Intelligence gathered from our DFIR cases, Arete’s Fusion Center had developed countermeasures deployed in the SentinelOne EDR platform to detect these threats and our Managed Detection and Response (MDR) team has been handling detections at our client’s sites.
This article is meant to share with the community Arete’s statistics and our assessment based on breach response engagements.
Statistical Data from Arete’s Metrics
The information listed below is based on Ryuk cases investigated by Arete IR since January 2019. Our IR and Data Analytics practices work together to track key data points for every ransomware engagement. Our IR practice tracks data points on the ransomware variant and collects statis-tics based on handled engagements:
Since 2019, Arete has responded to Ryuk cases in some of the following sectors:
Healthcare: 19 | Professional Service: 28 | Public services: 21 | Manufacturing: 11 | Technology/Engineing/ Telecom: 6 | Critical Infrastructure: 1
Average duration of business downtime: 9.47 days
Average original ransom demand in bitcoin: 125.39 BTC
Average final ransom demand in bitcoin: 72.58 BTC
Average ransom demand paid in US dollars: $621,064.05
Minimum ransom demand paid in US dollars: $10,000.00
Maximum ransom demand paid in US dollars: $5,177,510.78
Remote access is the most common method of intrusion found 39.34% of the times
During the Ryuk dwell time this year, Arete responded to ten (10) Conti ransomware engagements
Ryuk Ransomware Overview
Since August 2018, a Russian-based cybercrime group has been operating a ransomware known as Ryuk (a customized version of Hermes commodity ransomware).
The industry saw a sudden drop of Ryuk, starting around the time that COVID-19 had its major impact in March 2020. This is also around the same time that a very similar, Conti ransomware, began to kick-off, leading many to believe that Conti was merely a rebrand of Ryuk. The data suggests though that it is possible that Conti was a failed rebrand since Arete IR has not been engaged with Conti infected clients since Ryuk attacks started again in October 2020.
Ryuk typically compromises networks through Trickbot, or Emotet then delivering Trickbot. Trickbot has recently been in the news in the cyber industry due to Microsoft’s approval via a court order to engage in disruption efforts of this botnet. With this active disruption campaign, it is possible that the sudden return and up-tick of Ryuk infections is due to the Russian cybercrime group acting in retaliation utilizing their more mature ransomware product, Ryuk, as opposed to the potentially rebranded, Conti, which could still have been in a testing phase. This is based on the sudden stop of Conti and up-rise of Ryuk in line with the disruption efforts from Microsoft.
According to Microsoft, they initially disabled sixty-two (62) of the initially identified sixty-nine (69) Trickbot servers. Almost immediately, fifty-nine (59) new servers were attempted to be added to the Trickbot infrastructure. As of October 20, 2020, fifty-eight (58) of the new servers have also been disabled leaving a total number of eight (8) known active Trickbot servers.
Ryuk Wave Crashing on US Healthcare
Of the more than ninety (90) total Ryuk ransomware engagements that Arete IR has led since May 2019, nineteen (19) of those engagements were for a client in the healthcare industry (23%). Out of the seven (7) engagements of Ryuk ransomware that Arete IR has led since it re-emerged in October 2020, the most recent case is the only client that is in the healthcare industry (14%). This evidence shows it is not typical for Ryuk attacks to be focused primarily on the healthcare industry. This could further backup the theory that the impending Ryuk wave of attacks on the healthcare
industry could be retaliation for Microsoft’s disruption campaign against the Trickbot infrastructure that Ryuk is known for utilizing for initial intrusion.

Recommendations
Install an Endpoint Detection and Response (EDR) solution with the capability to halt detected processes and isolate systems on the network, based on identified conditions
Block: Any known attacker C2s in the firewall; A high number of SMB connection attempts from one system to others in the network over a short period of time
Implement: A system enforced password policy to force users into changing passwords at least every 90 days; Multifactor authentication (MFA) on RDP and VPN access
If not needed, eliminate vulnerable RDP ports exposed to the internet
Perform: Dark web monitoring periodically to verify if data from the organization is available for sell in the black market; Penetration tests • Periodically patch systems and update tools
Monitor: Connections to the network from suspicious locations; Downloadsuploads of files to file sharing services over non-standard hours, not commonly used in the organization, etc; Uploads of files from Domain Controllers to the internet; Network scans from uncommon servers (e.g. RDP server)
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Article
Adversarial AI Evolves from Prompting to Autonomous Attack Workflows
Cybercriminals and state-linked threat actors are increasingly incorporating artificial intelligence (AI) into multiple stages of offensive operations. Rather than relying on AI only for content generation or research, threat actors are now consistently using it to support reconnaissance, vulnerability discovery, credential theft, malware development, social engineering, and activities following initial compromise. The growing use of automated and agent-based workflows is allowing adversaries to coordinate offensive malicious activities with less manual involvement, potentially increasing the speed, scale, and efficiency of future campaigns.
What’s Notable and Unique
In one observed campaign, threat actors used AI to plan, build, and conduct an automated credential-harvesting operation within just several hours, demonstrating how compromised infrastructure can be rapidly repurposed to support larger-scale malicious activity.
Arete has observed several threat groups using AI-assisted capabilities to facilitate the analysis of data obtained during exfiltration so far this year, including INC Ransom, FulcrumSec, and Settra.
Attackers are also attempting to reproduce proprietary AI capabilities. Large-scale automated prompting campaigns have been used to extract information about the behavior and capabilities of proprietary AI models. The use of numerous accounts and intermediary infrastructure can make these activities more difficult to identify and attribute.
Analyst Comments
AI is increasingly becoming an operational component in the threat landscape rather than simply a tool that improves attacker productivity. By connecting reconnaissance, development, credential operations, and other activities through automated workflows, threat actors can conduct campaigns more quickly and reduce reliance on continuous human input. This trend also impacts security requirements for organizations deploying AI technologies. AI models, development environments, cloud resources, identities, repositories, and automated workflows should increasingly be considered interconnected elements of the enterprise attack surface, and organizations should maintain visibility across these areas and ensure that security controls account for both conventional threats and AI-enabled attack techniques.
Sources
GTIG AI Threat Tracker: From Prompting to Autonomy – The Evolution of Adversarial AI
Article
Top 9 Security Controls for SMBs
In today’s complex cyber threat landscape, small and medium-sized businesses (SMBs) should implement a layered, multi-pronged approach to security. Here are some proven, effective controls to consider:
1. Implement MFA for All Users
Multi-factor authentication (MFA) is an effective and accessible way to protect sensitive data, comply with regulatory standards, and prevent unauthorized access to critical systems. By ensuring that users not only use a password but also a secure token, an organization can significantly reduce phishing attempts, credential stuffing attacks, and ransomware incidents. MFA should be enabled for email, VPN, and critical system access.
2. Update Patch Management Programs
A modern patching program should include policies and mechanisms to manage software updates in a timely manner. Patching efforts should address not just operating system updates, but also commonly utilized software within the environment. An active patching plan aims to reduce the mean time to patch and provide metrics on existing patch efforts. In the event of a high-severity vulnerability, a mature patching program should also be able to identify the risks and exposure for a given set of systems based on the average time to patch. This helps stakeholders make informed decisions when a new exploit is released.
3. Leverage a Properly Managed Endpoint Detection and Response (EDR) Tool
With real-time threat detection and advanced visibility, endpoint detection and response (EDR) solutions can enhance an organization’s ability to detect and investigate potential malicious activity, including ransomware, lateral movement, fileless attacks, and more. Effective management of EDR should include proper configuration, regular agent updates, and established procedures for responding to alerts.
4. Enhance EDR with Frontline Incident Intelligence
While EDR solutions are an important component of a security program, threat actors are continually adapting their techniques to evade detection, and as a result, standard detection methods may not always identify emerging threats or novel attack behaviors. To strengthen protection, organizations can supplement EDR tools with custom detection rules informed by incident response data. These rules can help identify indicators of compromise observed during cyber incidents, providing an additional layer of visibility beyond traditional detections.
Arete Bloktd℠ illustrates this approach by transforming threat intelligence and malware analysis into curated detection rules for EDR tools. Applying frontline intelligence to security tools can result in earlier detection, less investigative burden, and a more confident response.
5. Create and Continuously Test an Incident Response (IR) Plan
An incident response plan can help an organization effectively identify, respond to, and recover from a cybersecurity incident while minimizing disruption and downtime. An IR plan defines clear roles, escalation paths, communication strategies, and decision frameworks for both internal and external teams. To be effective, these plans should be regularly tested with post-incident reviews or tabletop exercises involving key stakeholders.
6. Maintain Encrypted and Tested Data Backups
In the case of a cyberattack, backups can help organizations maintain business continuity, support ransom negotiations with threat actors, and contribute to a timely and successful recovery. Encrypting backups makes it more difficult for threat actors to access or alter them, and regular testing ensures they remain accessible during a security incident.
7. Conduct Employee Security Awareness Training
Human error is a leading cause of cybersecurity incidents, and an organization’s employees are its first line of defense against cyber threats. Security awareness training reinforces the importance of data confidentiality, supports regulatory compliance, and helps employees recognize and understand red flags such as suspicious emails, malicious links, and social engineering attempts.
8. Assess and Address Existing Risk and Vulnerabilities
To maintain a proactive approach to risk management and improve resilience, organizations should regularly assess existing vulnerabilities through expert-led Vulnerability Assessments, Penetration Testing, and Threat Hunting Assessments. These exercises can help identify security gaps, support regulatory compliance, and prevent potential incidents. During remediation, prioritize high-impact vulnerabilities and make a plan for periodic assessments.
9. Apply Least-Privilege Access Controls
Employees should have access only to the systems, applications, and data necessary to perform their jobs. By removing unnecessary administrative privileges and regularly reviewing user permissions, organizations can reduce the risk of unauthorized access and limit the damage caused by compromised accounts or insider threats.
Organizations should regularly review their cybersecurity programs, stay informed about emerging threats, and evaluate whether their security controls are adapting to the evolving threat landscape.
Article
Ransomware Trends & Data Insights: August 2026
Although INC Ransom was the most active ransomware threat group observed in August 2026, overall activity remained relatively distributed across the threat landscape, with approximately 30 unique ransomware and extortion groups, including both established and newly emerged actors, observed during the month. Alongside INC Ransom, Storm, DragonForce, Qilin, and The Gentlemen were among the top five most active threat groups, underscoring the continued diversity and competitiveness of the ransomware ecosystem.

Figure 1. Activity from the top 5 threat groups in August 2026
Throughout the month, analysts at Arete identified several trends behind the threat actors perpetrating cybercrime activities:
August 2026 was a significant month for the emergence of new threat actors, with Arete identifying several previously untracked ransomware groups, including Storm, Dark Project, DireWolf, Morpheus, Orova, Spirals, Wallstreet Team, and Zawoo Team. This trend underscores the ongoing evolution of the threat landscape and the low barriers to entry for new cybercriminal operations.
Arete observed a continued use of AI-enabled capabilities across the ransomware ecosystem during August. Similar to Fulcrumsec and Setra, the newly emerged Zawoo Team appears to leverage AI-assisted analysis of stolen data, publishing highly structured and detailed victim assessments on its data leak site (DLS). Additionally, both the Aurora and Storm ransomware groups have been observed utilizing AI-driven or AI-assisted chat representatives during victim communications. These developments suggest that threat actors are increasingly incorporating AI to enhance data analysis, automate victim engagement, and improve the effectiveness and scalability of extortion operations.
In August, Arete also observed that despite sustained law enforcement disruption efforts, LockBit continues to demonstrate operational resilience, likely through the expansion of its affiliate ecosystem and the evolution of its tactics. Recent activity indicates an increased reliance on data theft and exfiltration-only operations, with observed victimology suggesting a notable focus on organizations within the financial sector.
Sources
Arete Internal
Report
Arete's H1 2026 Crimeware Report
Explore intelligence and operational data from the frontlines of ransomware and extortion response as we detail the most significant trends and developments in the cyber threat landscape in the first half (H1) of 2026.



