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
Phishing-as-a-Service Evolves with Venom
“Whaling” has taken on a new meaning with a highly targeted phishing campaign active from November 2025 through March 2026, aimed exclusively at senior executives from more than 20 industries. The campaign, dubbed VENOM, is a phishing-as-a-service (PhaaS) platform that combines advanced evasion capabilities with immediate persistence of targeted executives. The initial phish impersonates an internal SharePoint document notification and uses embedded QR codes to convince victims to shift to unmanaged mobile devices to bypass corporate security controls. VENOM aims to establish persistence immediately by either registering a new MFA device or retaining long-lived refresh tokens, allowing threat actors to maintain access even after password resets or other base-level remediation efforts.
What’s Notable and Unique
This campaign is unique in its targeted nature of the PhaaS platform rather than broad, sweeping attempts. The threat actors behind VENOM create convincing phishing emails that impersonate SharePoint activity using the victim’s own domain, company name, and even fabricated email threads. These convincing social engineering tactics, combined with the specific targeting of executives, make this an effective capability for cybercriminals.
VENOM operates as a closed-access system, with full adversarial support, but has no public visibility on the dark web or from security researchers. The service likely operates on an invite-only basis, unlike most PhaaS platforms, which typically seek to have as many paying customers as possible. This, among other items such as the sophisticated evasion techniques, indicates a higher degree of sophistication than most other PhaaS offerings.
Either through MFA enrollment or Microsoft Device Code abuse, the threat actor forces the victim to aid them in establishing persistence early in the attack lifecycle. These tactics result in either valid tokens or an additional MFA login method controlled by the threat actor, meaning typical password resets alone are not effective against this technique. Administrators would be required to explicitly revoke sessions and token grants to mitigate the threat actors’ persistence.
Analyst Comments
Oftentimes, MFA is viewed as a one-stop shop to cybersecurity, but tactics such as this show how threat actors can bypass MFA, or worse, use it to establish persistence. Ultimately, this campaign highlights how modern attacks increasingly abuse legitimate authentication workflows rather than attempting to defeat them outright. Defenses that rely solely on MFA without other security posturing, such as continuous session monitoring, token revocation, and identity logging, can leave organizations vulnerable. As attackers shift toward token theft and device trust abuse, incident response and identity security strategies must evolve accordingly.
Sources
Meet VENOM: The PhaaS Platform That Neutralizes MFA
Article
Threat Actors Continue to Leverage BYOVD Technique
Multiple ransomware operations have recently been observed leveraging the Bring Your Own Vulnerable Driver (BYOVD) technique to disable endpoint security controls prior to ransomware deployment. Notably, the Qilin ransomware group commonly leverages a malicious msimg32.dll file loaded via DLL side-loading, along with vulnerable drivers including rwdrv.sys and hlpdrv.sys, to gain kernel-level access and disable security processes. Similarly, Warlock ransomware has been observed exploiting the vulnerable NSecKrnl.sys driver to bypass security controls. The use of BYOVD has also been observed across ransomware campaigns associated with Akira, INC, Medusa, and other threat actors.
What’s Notable and Unique
The Qilin ransomware group employs a sophisticated multi-stage infection chain, leveraging DLL side-loading (msimg32.dll) to execute malicious payloads directly in memory and evade traditional file-based detection. In DLL side-loading, a threat actor tricks a program into loading a malicious dynamic link library. The malware escalates privileges and uses signed but vulnerable drivers (rwdrv.sys and hlpdrv.sys) to bypass security controls, access system memory, and systematically disable endpoint defenses by terminating security processes and disabling monitoring callbacks at the kernel level.
Akira ransomware operators have also exploited the rwdrv.sys and hlpdrv.sys drivers. Additionally, Arete has observed threat actors leveraging multiple other drivers, including the vulnerable TrueSight.sys, to bypass security controls.
Meanwhile, Warlock ransomware operators disguised malicious activity by renaming rclone.exe to TrendSecurity.exe to appear legitimate. The file functioned as a loader, exploiting the vulnerable NSecKrnl.sys driver to disable security processes, while Group Policy Objects (GPOs) were leveraged to systematically disable security controls across the environment.
Analyst Comments
The BYOVD technique, employed by multiple known ransomware operators, reflects a broader shift toward pre-encryption defense evasion, including suppression of Windows telemetry, removal of monitoring callbacks, and abuse of legitimately signed but vulnerable drivers. This technique enables threat actors to evade detection, maintain persistence for extended periods, and maximize the operational impact of ransomware deployment across compromised environments. Organizations should implement strict driver control policies, such as Microsoft’s Vulnerable Driver Blocklist and application control mechanisms. Additionally, enforcing least privilege access, enabling multi-factor authentication (MFA), maintaining up-to-date patching, and continuously monitoring for anomalous driver and kernel-level activity can further reduce the risk of such attacks.
Sources
Qilin EDR killer infection chain
Web Shells, Tunnels, and Ransomware: Dissecting a Warlock Attack
Article
Ransomware Trends & Data Insights: March 2026
The threat landscape in March had a much more even distribution of threat groups than has been observed since the first half of 2025. Although Akira, Qilin, Play, and INC remained among the most active groups, Arete observed 21 unique ransomware and extortion groups in March, compared to only 15 in February. Akira and Qilin’s activity also declined from the previous month; in February, the two groups were responsible for almost half of all ransomware incidents, but in March they only comprised a little more than a quarter of all activity. Arete also observed activity from several emerging groups in the past month, including BravoX, NightSpire, Payouts King, and Securotrop.

Figure 1. Activity from the top 5 threat groups in March 2026
Analysts at Arete identified several trends behind the threat actors perpetrating cybercrime activities:
In March, threat actors actively exploited FortiGate Next-Generation Firewall appliances as initial access vectors to compromise enterprise networks. The activity involves the exploitation of recently disclosed security vulnerabilities, including CVE-2025-59718, CVE-2025-59719, and CVE-2026-24858, or weak credentials, allowing attackers to gain administrative access, extract configuration files, and obtain service account credentials. Arete also observed Fortinet device exploitation involving various threat groups, with the Qilin ransomware group notably leveraging Fortinet device exploits.
Phishing campaigns leveraging OAuth redirection and a resurgence of Microsoft Teams–based social engineering were also observed in March. In one campaign, attackers sent emails disguised as Microsoft Teams recordings or Microsoft 365 alerts, redirecting victims through legitimate OAuth endpoints to attacker-controlled pages hosting malicious ZIP payloads. A separate campaign has been ongoing since last year, in which attackers flood users’ inboxes with spam and impersonate IT support personnel to trick victims into initiating remote support sessions via tools like Quick Assist.
Arete recently released its 2025 Annual Crimeware Report. Leveraging data and intelligence collected during ransomware and extortion incident response engagements, this report highlights notable trends and shifts in the threat landscape throughout 2025, including Akira’s unusually high activity levels in the second half of 2025, evolving social engineering techniques, and trends in ransom demands and impacted industries.
Sources
Arete Internal
Report
Arete's 2025 Annual Crimeware Report
Harness Arete’s unique data and expertise on extortion and ransomware to inform your response to the evolving threat landscape.



