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
Critical MOVEit Automation Vulnerabilities Disclosed
A security advisory released by Progress Software details critical and high-severity vulnerabilities affecting their MOVEit Automation managed file transfer (MFT) solution. The vulnerabilities, tracked as CVE-2026-4670 and CVE-2026-5174, could allow a threat actor to bypass authentication and escalate privileges, leading to unauthorized access, administrative control, and data exposure. Cybercriminals have leveraged several MFT tools in previous campaigns, including the Accellion File Transfer Application (FTA), Fortra GoAnywhere MFT, and Cleo MFT. Flaws in MFT software are highly targeted by cybercriminals due to the volume and sensitivity of the data they control.
What’s Notable and Unique
MOVEit Transfer was heavily exploited by the Cl0p ransomware group in the summer of 2023. While the window of exploit activity lasted only a few weeks, victim extortion and data leaks continued throughout the remainder of the year, leading to more than 70 class-action lawsuits filed in the U.S.
There is no workaround or hotfix for these vulnerabilities. To fully patch the flaws, MOVEit administrators need to perform a "full install" of the latest version, which will require taking the system offline.
Security researchers have discovered ~1,400 MOVEit Automation instances exposed to the internet, with dozens belonging to U.S. local and state government agencies.
Analyst Comments
While the vulnerabilities patched in Progress Software's recent release differ from the SQL injection vulnerability exploited by the Cl0p ransomware group in 2023, exploitation of CVE-2026-4670 and CVE-2026-5174 could lead to equally impactful outcomes. Beyond the immediate impacts on affected organizations, trusted data-exchange platforms provide threat actors with an avenue to obtain sensitive information and infect partner and supplier environments. Furthermore, Arete has seen the time window between disclosure and weaponization of critical vulnerabilities continue to shrink, especially as threat actors increasingly adopt AI-enabled tooling. As such, organizations should not only implement the patches released by Progress Software, but also hunt for typical post-compromise behavior like enumeration of the underlying database, the creation of new user accounts or users operating with unexpected administrator privileges, and the presence of unauthorized remote monitoring and management (RMM) tools.
Sources
MOVEit Automation Critical Security Alert Bulletin – April 2026 – (CVE-2026-4670, CVE-2026-5174)
From Breach to Courtroom: Inside the MOVEit Exploitation and Mass Litigation
Progress warns of critical MOVEit Automation auth bypass flaw
Article
Ransomware Trends & Data Insights: April 2026
The threat landscape has remained relatively predictable thus far in 2026. In April, Qilin dethroned Akira as the most active threat group for the month. Akira, who had been the top ransomware threat each month since July 2025, was still only slightly behind Qilin and had roughly the same activity level as in March. INC Ransom and DragonForce also remained active threats in April, with those four ransomware groups accounting for half of all ransomware and extortion activity observed by Arete.

Figure 1. Activity from the top 3 threat groups in April 2026
Throughout the month, analysts at Arete identified several trends behind the threat actors perpetrating cybercrime activities:
Multiple ransomware operations continue to leverage the Bring Your Own Vulnerable Driver (BYOVD) technique to disable endpoint security controls prior to ransomware deployment. Qilin has recently been observed leveraging a malicious 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. Arete observed Akira using the same vulnerable drivers in multiple engagements dating back to Q3 2025.
DragonForce has leveraged several of the same tools in recent engagements, including the remote desktop application Remotely Agent and the PoisonX.sys vulnerable driver. Additionally, open-source reporting indicates that the group recently used a Python-based backdoor known as VIPERTUNNEL to maintain reliable operator access and evade detection. DragonForce was responsible for over 7% of Arete ransomware engagements in April, and Arete notes increased activity from the group this year compared to 2025.
A social engineering tactic has reemerged in recent months in which threat actors impersonate IT and helpdesk staff via Microsoft Teams to contact employees and attempt to convince them to install remote access tools like Quick Assist, giving the threat actors remote access to the victim’s environment. This tactic was initially observed in late 2024 and early 2025 and was linked to now-defunct groups like Black Basta and Cactus, but has more recently been observed in intrusions linked to the Akira and Payouts King ransomware groups.
Sources
Arete Internal
Article
Payouts King Utilizes QEMU Emulator to Bypass EDR
Researchers recently identified threat actor campaigns leveraging QEMU, a free open-source virtual machine (VM) emulator, to evade endpoint security solutions. Since QEMU acts as a VM within the target environment, endpoint detection tools cannot scan inside the emulator or detect any malicious files or payloads QEMU contains. Although threat actors have been utilizing QEMU maliciously since 2020, recent activity is attributed to the Payouts King ransomware group and a cluster of threat actors believed to be initial access brokers who have also been exploiting the CitrixBleed2 vulnerability CVE-2025-5777.
What’s Notable and Unique
Payouts King has been observed deploying QEMU since November and uses the VM to create a reverse SSH backdoor to evade detection and install various tools, including Rclone, Chisel, and BusyBox.
In a separate campaign, threat actors are exploiting CVE-2025-5777, a Citrix NetScaler vulnerability that allows attackers to bypass authentication. Once they’ve gained initial access, the threat actors use QEMU to deploy tools inside the VM, which are then used to steal credentials, identify Kerberos usernames, perform Active Directory reconnaissance, and set up FTP servers for staging or data exfiltration.
Analyst Comments
Threat actors continue to focus their efforts on defense evasion, often leveraging legitimate, easily accessible tools such as QEMU. The continued use of QEMU by multiple threat actors highlights the effectiveness of these tactics and the difficulty in detecting and defending against them. To counter this campaign, organizations should proactively monitor for unauthorized QEMU installations, abnormal scheduled tasks, and port forwarding rules.
Sources
QEMU abused to evade detection and enable ransomware delivery
Article
Microsoft Teams Continues to be Leveraged in Social Engineering Attacks
Microsoft warns that threat actors are increasingly abusing Microsoft Teams and relying on legitimate tools to gain access and conduct lateral movement within enterprise networks. The threat actors impersonate IT or helpdesk staff to contact employees via cross-tenant chats and trick them into granting remote access for data theft. Microsoft has observed multiple intrusions with a similar attack chain that utilized commercial remote management software, like Quick Assist and the Rclone utility, to transfer files to an external cloud storage service. This tactic, notably associated with Black Basta and Cactus ransomware operations in late 2024 and early 2025, appears to have resurfaced, with similar activity more recently observed in intrusions linked to the Akira and Payouts King ransomware groups.
What’s Notable and Unique
Initial access is achieved by leveraging external collaboration features in Microsoft Teams to allow impersonation of internal support personnel, tricking users into bypassing security warnings. This reflects abuse of legitimate functionality rather than exploitation of a Microsoft Teams vulnerability.
Following initial access, attackers conduct rapid reconnaissance using Command Prompt and PowerShell to assess privileges, domain membership, and opportunities for lateral movement. Persistence is maintained through Windows Registry modifications, after which attackers leveraged WinRM for lateral movement, targeting domain-joined systems and high-value assets, including domain controllers.
Malicious payloads were staged in user-writable directories and executed through DLL side-loading via trusted, signed applications, enabling covert code execution while blending with legitimate activity. Additional remote management tools were also deployed to support broader access, while Rclone or similar utilities were used to stage and exfiltrate sensitive data to external cloud storage.
Analyst Comments
This activity highlights how modern threat actors can leverage trusted collaboration workflows, remote management tools, and stealthy exfiltration techniques to conduct intrusions through a combination of social engineering and misuse of legitimate functionality. Effective defense depends on layered mitigations that combine identity controls, restricted remote administration, endpoint hardening, network protections, and user awareness measures to disrupt attacker activity at multiple stages of the intrusion lifecycle. To mitigate the risk of this and similar campaigns, users should treat external Teams contacts as untrusted by default, and administrators should restrict or closely monitor remote assistance tools while limiting WinRM usage to controlled systems.
Sources
Cross‑tenant helpdesk impersonation to data exfiltration: A human-operated intrusion playbook
Microsoft: Teams increasingly abused in helpdesk impersonation attacks
Payouts King Takes Aim at the Ransomware Throne



