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
Anubis Utilizing Custom Backdoor and BYOVD Tools in Attacks
In October, researchers observed the Anubis ransomware group using a new custom backdoor named Lindnor, which masqueraded as a Chrome component and VMware file and sent the process ID, operating system version, file path, computer name, username, domain, and logon server to a command-and-control (C2) server. Threat actors dropped multiple executables to help terminate security services, along with five publicly known vulnerable drivers. They also installed the legitimate remote access tool AnyDesk and a separate tool to run it in Safe Mode, likely to maintain access when security software was not fully running.
Arete recently observed Anubis using similar tools and tactics, in particular Bring Your Own Vulnerable Driver (BYOVD) techniques and AnyDesk for remote access, alongside PowerShell-based loaders to support defense evasion, privilege escalation, and malicious payload execution.
Analyst Comments
The observed activity reflects an evolving, multi-stage intrusion approach focused on establishing persistent access, evading security controls, and enabling follow-on malicious activity. Notably, the deployment of custom backdoors such as Lindnor indicates a shift toward more tailored tooling designed to maintain covert access. BYOVD techniques and PowerShell-based loaders have also been observed facilitating defense evasion and ultimately executing malicious binary payloads. Collectively, these activities demonstrate increasingly sophisticated tradecraft focused on persistent access and circumventing endpoint security controls.
Sources
New Lindnor Backdoor and Glut of Security Killers Used in Ransomware Attack on U.S. Org
Article
Ransomware Trends & Data Insights: October 2026
Although Akira once again emerged as the most active ransomware group in October, overall ransomware and extortion activity was not dominated by any single threat group and instead remained widely distributed among a variety of threat actors, continuing the trend that began around August. Arete identified 31 unique named threat groups in October, the most observed in a single month so far in 2026. In addition to Akira, Settra, and The Gentlemen were among the three most active groups. Several new threat actors also emerged, including BYOD, Kubera Team, QWCrypt, AoQin, Emperador, Osiris Team, and Cinder, with Cinder assessed as possibly part of a threat actor cluster affiliated with the former BlackFile group.

Figure 1. Activity from the top 10 threat groups in October 2026
Throughout the month, analysts at Arete identified several trends behind the threat actors perpetrating cybercrime activities:
PHP2Shell emerged as one of the most significant threats in October, with increasing exploitation of the critical PHP vulnerabilities CVE-2026-109618 and CVE-2026-109619. Other notable vulnerabilities included CVE-2026-104286 affecting FortiMail, and CVE-2026-102255, a critical pre-authentication Server-Side Request Forgery (SSRF) vulnerability affecting SonicWall SMA1000 appliances, highlighting continued threat actor interest in internet-facing enterprise infrastructure.
International law enforcement operations against cybercriminal groups continued to make headlines in October. German authorities announced the arrest of 28-year-old Russian national Vladimir K., suspected of being a senior operator within the Qilin Ransomware-as-a-Service (RaaS) group. Separately, the FBI arrested an individual with suspected links to ShinyHunters, adding to recent law enforcement activity targeting ransomware and extortion groups, including the disruption of KillSec. While Vladimir K.’s arrest has not yet had a notable impact on Qilin’s operational activity, it could provide law enforcement with greater insight into the group’s infrastructure and affiliate network, potentially supporting further disruption efforts.
In early October, “The Luna Moth Files” exposed several files containing alleged internal communications associated with Luna Moth, also known as Silent Ransom Group, revealing insights into the group’s social engineering, data extortion, and victim negotiation operations. However, several claims remain unverified, and the exposure has not notably disrupted the group’s activity thus far, as it was among the top threat actors Arete observed throughout the month.
Sources
Arete Internal
Article
PHP2Shell Exploitation Update
PHP2Shell exploitation activity continues to increase globally, with threat actors targeting the critical PHP remote code execution (RCE) vulnerabilities CVE-2026-109618 and CVE-2026-109619. Researchers recently identified low-volume scanning targeting unpatched or partially mitigated hosts across multiple countries and sectors, and the activity is assessed with moderate confidence as linked to a Korean-speaking operator associated with the Lazarus Group ecosystem. While PHP2Shell (CVE-2026-109618 and CVE-2026-109619) has been patched in PHP 8.5.12, 8.4.27, 8.3.36, and 8.2.35, the separately identified CVE-2026-115560 remains unpatched.
What’s Notable and Unique
PHP2Shell vulnerabilities can cause memory corruption due to improper error handling, potentially allowing threat actors to achieve remote code execution on vulnerable PHP servers.
Observed activity includes mass scanning, PHP environment fingerprinting, exploitation attempts, credential and secret theft attempts, and attempts to deliver second-stage payloads and malware.
Successful in-the-wild exploitation has also been reported against honeypots, resulting in shell command execution and the retrieval of additional payloads, demonstrating the potential for follow-on malicious activity.
Mitigations
Organizations should prioritize upgrading internet-facing PHP deployments to patched versions, migrating unsupported PHP versions, updating embedded and containerized PHP runtimes, and implementing available Web Application Firewall (WAF) protections as a temporary defense-in-depth measure.
Analyst Comments
PHP2Shell poses a significant security concern due to its potential to enable unauthenticated remote code execution on vulnerable PHP servers. The progression from mass scanning and exploitation attempts to reports of successful command execution demonstrates the potential for these vulnerabilities to support initial access and subsequent malicious activity. Arete has been closely monitoring PHP2Shell exploitation activity and regularly reviewing and updating related indicators to support detection and blocking efforts. Given the potential for remote exploitation and follow-on activity, PHP2Shell represents a high-priority initial-access risk, emphasizing the importance of timely patching and remediation of affected PHP environments.
Sources
PHP shares mitigation for new RCE vulnerability with no patch
PHP2Shell Exploitation Attempts Continue Amid Suspected N. Korea Global Scanning Activity
PHP2Shell Exploit Attempts Hit Millions as Attackers Try to Deploy Mirai Malware
Advisory: PHP2Shell Vulnerabilities (CVE-2026-109618, CVE-2026-109619)
Article
LiteLLM Supply-Chain Compromise
A software supply-chain attack compromised the release pipeline of LiteLLM, a widely used open-source Python SDK and AI gateway. Attackers leveraged the compromised pipeline on October 21st to publish a malicious LiteLLM version through PyPI and associated Docker registries. The affected release, LiteLLM 1.107.0, contained malware designed to steal credentials, sensitive configuration data, private keys, browser information, and other secrets from compromised systems.
What’s Notable and Unique
The incident is particularly significant because LiteLLM provides a common API for applications to interact with AI models from multiple providers. It is reported that the project had approximately 61,800 GitHub stars and 92 million monthly PyPI downloads.
Rather than modifying the core LiteLLM application source code, the threat actors reportedly tampered with the installation package itself. The malware was designed for broad credential and information theft and encrypted the collected data before uploading it to the attacker's endpoint.
The compromise went beyond one-time credential theft. A malicious Python component launched a detached loader that checked a GitHub-hosted pointer every hour and could download Python code from an external server for execution on the compromised machine. This provided threat actors with a mechanism for subsequent remote code execution.
Analyst Comments
Although the malicious packages were subsequently removed, simply uninstalling or deleting the affected LiteLLM package may not be sufficient, because malicious Python startup files or the detached loader could remain on the host. All exposed information should be rotated immediately, and infected systems should be isolated and rebuilt from clean backups. The most recent clean release prior to the attack, LiteLLM 1.106.2, is currently the suggested recovery version.
Sources
LiteLLM release pipeline hacked to distribute info-stealer malware
LiteLLM 1.107.0 Compromised: Python Startup Hooks Steal Cloud, AI, and Proxy Credentials
The Collector Reaches Beyond Provider API Keys



