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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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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.

Article

WinRAR Path-Traversal Vulnerability Exploited in Ransomware Attacks

CISA has warned that CVE-2025-8088, a path-traversal vulnerability in WinRAR, is being exploited in ransomware attacks. The vulnerability allows attackers to use specially crafted archive files to place malicious executables in locations such as the Windows Startup folder, enabling code execution when the system restarts. WinRAR addressed this vulnerability in version 7.13, but exploitation has continued due to challenges in updating the software. CISA's updated KEV entry now specifically identifies the vulnerability as being used in ransomware attacks. 

What’s Notable and Unique

  • The vulnerability was initially exploited as a zero-day by the Russia-linked RomCom group, enabling malware execution at user logon and supporting credential theft, cyberespionage, and ransomware-related activities.

  • CVE-2025-8088 continues to be actively exploited by both government-backed and financially motivated threat actors. Observed campaigns have been attributed to Russian- and Chinese-linked groups targeting several organizations.

  • Phishing campaigns leveraging weaponized RAR attachments exploited CVE-2025-8088 to silently place malicious payloads in autorun locations using directory traversal and Alternate Data Streams (ADS). 

  • The widespread exploitation of CVE-2025-8088 highlights strong demand for effective WinRAR exploits, with multiple underground vendors previously supplying exploit capabilities to a diverse range of threat actors. One such vendor, zeroplayer, advertised a WinRAR exploit in July 2025. 

Analyst Comments

Organizations should immediately upgrade WinRAR to version 7.13 or later and conduct an enterprise-wide inventory to identify unmanaged installations. Given that WinRAR lacks automatic updates, Group Policy support, and integration with common enterprise patch management platforms, manual verification and remediation may be required to ensure all vulnerable instances are addressed. Security teams should also enhance defenses against archive-based phishing attacks by blocking or scrutinizing unsolicited compressed files, monitoring for suspicious file creation in Windows Startup directories, and detecting abuse of ADS. With CISA now linking CVE-2025-8088 to ransomware activity, organizations should treat remediation as a high priority and actively monitor for indicators of WinRAR-based exploitation across their environments.

Sources

  • CISA Adds Three Known Exploited Vulnerabilities to Catalog

  • WinRAR vulnerability being exploited in ransomware attacks, CISA warns