Due to its near-universal adoption, speed, and cost-effectiveness, email remains one of the most common communication channels in healthcare. Consequently, it’s one of the most frequent targets for cyber attacks, as malicious actors are acutely aware of the vast amounts of sensitive data contained in messages – and standard email communication’s inherent vulnerabilities.

In light of this, healthcare organizations must remain aware of the evolving email threat landscape, and implement effective strategies to protect the electronic protected health information (ePHI) included in email messages. Failing to properly secure email communications jeopardizes patient data privacy, which can disrupt operations, result in costly HIPAA compliance violations, and, most importantly, compromise the quality of their patients’ healthcare provision.

With all this in mind, this post details the biggest email threats faced by healthcare organizations today, with the greatest potential to cause your business or practice harm by compromising patient and company data. You can also get our 2025 report on the latest email threats, which includes strategies on how to overcome them.

Ransomware Attacks

Ransomware is a type of malware that encrypts, corrupts, or deletes a healthcare organization’s data or critical systems, and enables the cybercriminals that deployed it to demand a payment (i.e., a ransom) for their restoration. Healthcare personnel can unwittingly download ransomware onto their devices by opening a malicious email attachment or clicking on a link contained in an email.

In recent years, ransomware has emerged as the email security threat with the most significant financial impact. In 2024, for instance, there were over 180 confirmed ransomware attacks with an average paid ransom of nearly $1 million. 

Email Client Misconfiguration

While a healthcare organization may implement email security controls, many fail to know the security gaps of their current email service provider (ESP) or understand the value of a HIPAA compliant email platform, leaving data vulnerable to email threats, such as unauthorized access and ePHI exposure, and also, subsequently, a greater risk of compliance violations and reputation damage.

Common types of email misconfiguration include:

• Lack of enforced TLS encryption: resulting in emails being transmitted in plaintext, rendering the patient data they contain readable by cybercriminals in the event of interception during transit.
• Improper SPF/DKIM/DMARC setup: failure to configure or align these email authentication protocols correctly gives malicious actors greater latitude to successfully spoof trusted domains.
• Disabled or lax user authentication: a lack of authentication measures, such as multi-factor authentication (MFA), increases the risk of unauthorized access and ePHI exposure.
• Misconfigured secure email gateways: incorrect rules or filtering policies can allow phishing emails through or block legitimate messages.
• Outdated or unsupported email client software: simply neglecting to download and apply the latest updates or patches from the email client’s vendor can leave vulnerabilities, which are well-known to cybercriminals, exposed to attack.

Social Engineering Attacks

A social engineering attack involves a malicious actor deceiving or convincing healthcare employees into granting unauthorized access or exposing patient data. Relying on psychological manipulation, social engineering attacks exploit a person’s trust, urgency, fear, or curiosity, and encompass an assortment of threats, including phishing and business email compromise (BEC) attacks, which are covered in greater depth below.

Phishing

As mentioned above, phishing is a type of social engineering attack, but they are so widespread that it warrants its own mention. Phishing sees malicious actors impersonating legitimate companies, or their employees, to trick victims into revealing sensitive patient data. 

Subsequently, healthcare organizations can be subjected to several different types of phishing attacks, which include:

• General phishing: otherwise known as bulk phishing or simply ‘phishing’, these are broad, generic attacks where emails are sent to large numbers of recipients, impersonating trusted entities to steal credentials or deliver malware. 
• Spear phishing: more targeted attacks that involve personalized phishing emails crafted for a specific healthcare organization or individual. These require more research on the part of malicious actors and typically use relevant insider details gleaned from their reconnaissance for additional credibility.
• Whaling: a form of spear phishing that specifically targets healthcare executives or other high-level employees. 
• Clone phishing:  when a cybercriminal duplicates a legitimate email that was previously received by the target, replacing links or attachments with malicious ones.
• Credential phishing: also known as ‘pharming’, this involves emails that link to fake login pages designed to capture healthcare employees’ usernames and passwords under the guise of frequently used legitimate services.

Domain Impersonation and Spoofing

This category of threat revolves around making malicious messages appear legitimate, which can allow them to bypass basic email security checks. As alluded to above, these attacks exploit weaknesses in email client misconfigurations to trick the recipient, typically to expose and exfiltrate patient data, steal employee credentials, or distribute malware.

Domain spoofing email threats involve altering the “From” address in an email header to make it appear to be from a legitimate domain. If a healthcare organization fails to properly configure authentication protocols like SPF, DKIM, and DMARC, there’s a greater risk of their email servers failing to flag malicious messages and allowing them to land in users’ inboxes.

Domain impersonation, on the other hand, requires cybercriminals to register a domain that closely resembles a legitimate one. This may involve typosquatting, e.g., using “paypa1.com” instead of “paypal.com”. Alternatively, a hacker may utilize a homograph attack, which substitutes visually similar characters, e.g., from different character sets, such as Cyrillic. Malicious actors will then send emails from these fraudulent domains, which often have the ability to bypass basic email filters because they aren’t exact matches for blacklisted domains. Worse still, such emails can appear authentic to users, particularly if the attacker puts in the effort to accurately mimic the branding, formatting, and tone used by the legitimate entity they’re attempting to impersonate. 

Insider Email Threats

In addition to external parties, employees within a healthcare organization can pose email threats to the security of its PHI. On one hand, insider threats can be intentional, involving disgruntled employees or third-party personnel abusing their access privileges to steal or corrupt patient data. Alternatively, they could be the result of mere human error or negligence, stemming from ignorance, or even fatigue.

What’s more, insider threats have been exacerbated by the rise of remote and flexible conditions since the onset of the COVID-19 pandemic, which has created more complex IT infrastructures that are more difficult to manage and control.  

Business Email Compromise (BEC) Attacks

A BEC attack is a highly targeted type of social engineering attack in which cybercriminals gain access to, or copy, a legitimate email account to impersonate a known and trusted individual within an organization. BEC attacks typically require extensive research on the targeted healthcare company and rely less on malicious links or attachments, unlike phishing, which can make them difficult to detect.

Due to the high volume of emails transmitted within the healthcare industry, and the sensitive nature of PHI often included in communications to patients and between organizations, the healthcare industry is a consistent target of BEC attacks.

BEC attacks come in several forms, such as:

• Account compromise: hijacking a real employee’s account and sending fraudulent messages.
• Executive fraud: impersonating high-ranking personnel to request urgent financial transactions or access to sensitive data.
• Invoice fraud: pretending to be a vendor asking for the payment of a fraudulent invoice into an account under their control.

Supply Chain Risk

Healthcare organizations increasingly rely on third-party vendors, including cloud service providers, software vendors, and billing or payment providers to serve their patients and customers. They constantly communicate with their supply chain partners via email, with some messages containing sensitive patient data; moreover, some of these organizations will have various levels of access to the PHI under their care.

Consequently, undetected vulnerabilities or lax security practices within your supply chain network could serve as entry points for email threats and malicious action. For instance, cybercriminals can compromise the email servers of a healthcare company’s third-party vendor or partner, and then send fraudulent emails from their domains to deploy malware or extract patient data.

Another, somewhat harrowing, way to understand supply chain risk is that while your organization may have a robust email security posture, in reality, it’s only as strong as that of your weakest third-party vendor’s security controls.

Download LuxSci’s Email Cyber Threat Readiness Report

To gain further insight into the biggest email threats to healthcare companies in 2025, including increasingly prevalent AI threats, download your copy of LuxSci’s Email Cyber Threat Readiness Report. 

You’ll also learn about the upcoming changes to the HIPAA Security Rule and how it’s set to impact your organization going forward, and the most effective strategies for strengthening your email security posture.

Grab your copy of the report here and begin the journey to strengthening your company’s email threat readiness today.

Have you looked into what it’s costing your company to snail mail EOBs these days?

EOBs give an individual an increased understanding of their insurance coverage, the cost of care, and their out of pocket expenses. As a result, it’s absolutely critical that health insurers deliver EOBs quickly and effectively.

However, the most commonly used method for sending out EOBs, traditional mail or snail mail, has several drawbacks that can prevent important information about healthcare coverage from reaching people in a timely manner – not to mention the high cost insurers take on to send them. This can leave policyholders in the dark about their healthcare coverage, which can lead to confusion and dissatisfaction with their insurance provider when they receive an unexpected medical bill. 

Furthermore, because EOBs contain the protected health information (PHI) of policyholders or members, insurers are bound by HIPAA (the Health Insurance Portability and Accountability Act) regulations to ensure their secure delivery. Consequently, the risks inherent to sending paper EOB statements in the mail not only have security implications but also potential consequences for non-compliance.  

With all this in mind, this post discusses why healthcare insurers should send EOBs to their policyholders via secure email instead of traditional mail. We detail the various benefits of making the switch to email EOBs, which include enhanced security, better adherence to compliance regulations, higher deliverability rates, and significant cost savings. 

Security Benefits

Insurance companies that send out EOBs via email as opposed to traditional mail are less likely to be at risk for a data breach or leak of PHI.  Firstly, sending an EOB via email drastically decreases the risk of interception. When sent in paper form, an EOB could be:

• Lost, stolen or damaged in transit
• Delivered to the wrong address
• Not properly deposited in a letter or mailbox, then stolen
• Intercepted within the intended address by another individual who lives at or has access to the residence. 

Conversely, as detailed later in this post, email allows for various controls and processes, which mitigate the risks of unsuccessful message delivery.

Additionally, secure, HIPAA compliant email provides data encryption, which safeguards the sensitive patient data within EOBs during transmission and at rest by rendering it unreadable to malicious actors who might intercept it or gain access to it. Physical mail, in contrast, offers no such protection, as someone who intercepts a paper EOB notice can simply open it and freely read its contents. 

Finally, secure email delivery platforms, such as LuxSci, feature identity verification and access controls that enable healthcare insurers to restrict access to PHI, limiting its exposure. Similarly, HIPAA compliant email also provides auditing logging capabilities to track access to patient data, to quickly identify the source of security breaches.

Increased Delivery

Once a person opts-in, sending an EOB by email greatly increases its deliverability, up to 98% or more – almost instantly. By better ensuring a policyholder receives their EOBs, healthcare insurers increase the chance of successfully communicating the intended information they contain, namely, the cost of a service and how much they’re required to cover.

Additionally, the ability to track secure email in near real-time also enhances its deliverability, as it allows organizations to determine the cause of delivery failure and make subsequent attempts to get the EOB delivered. At the same time, the process of determining the reason for the message failure may also reveal security concerns; a process that is very difficult, if not impossible, to achieve with traditional physical mail.

Radical Cost Savings 

Simply put, sending EOBs via email instead of traditional mail can save health insurers massive amounts of money. By saving a dollar or more per EOB, the cost savings can quickly add up to millions of dollars per month in savings.

If you’re curious about just how much you can save with email EOBs, try our just-released email EOB ROI calculator. You can see how much your company can save with just a 30 percent shift from physical mail

The most significant cost reduction is the money saved on printing and mailing paper EOB statements. Additionally, the cost of administering the delivery of EOB notices is lowered when it’s done electronically. Resending EOBs in the event of their non-delivery also is much easier, faster and cheaper via email.

Compliance Benefits

Because sending an EOB via email requires HIPAA compliance, your communications are encrypted by default, protecting patient privacy and keeping PHI out of the hands of malicious actors, all while reducing the risk of HIPAA compliance violations. The security features built into HIPAA compliant email platforms, such as encryption, access control, and audit logs, help insurers satisfy the requirements of HIPAA’s Privacy and Security Rules in their compliance efforts.  

Another considerable benefit of using secure email to send policyholders their EoBs, or, in fact, any communication containing PHI, is that it’s far easier to implement breach notification protocols. HIPAA compliant email delivery platforms provide real-time tracking, so companies can pinpoint email message failures quickly and act accordingly. Similarly, intrusion detection systems and other cybersecurity measures that support email systems enable the faster detection and containment of data breaches. 

In stark contrast, physical mail is far more difficult to track. Consequently, security breaches via mail could go unnoticed for days or even weeks. If you’re unaware of a data breach, let alone have not yet contained or mitigated it, you’re unable to inform all affected parties, resulting in further HIPAA violations and a loss of customer trust. 

Reduced Carbon Footprint

It’s difficult to highlight the cost benefits of sending EOBs to policyholders by email without recognizing the positive environmental impact, too. Email EOBs cuts down on paper usage, for both the notices themselves and the envelopes they’re mailed in. Then there’s the matter of the electricity and ink involved in printing them, the emissions produced in their delivery, etc.  Opting to send EOBs via email reduces all these factors, which enables healthcare organizations to lower their carbon footprint and, where applicable, meet their sustainability obligations. 

Now’s the Time to Move to Email EOBs

LuxSci’s HIPAA compliant Secure High Volume Email solution enables healthcare insurers to instantly send EOBs to policyholders securely and at scale, extending into hundreds of thousands and millions of messages a month. 

Our HIPAA compliant email delivery platform features:  

• Dedicated IPs that isolate critical transactional messages, such as EOBs, from other email traffic, allowing our clients to reach deliverability rates of 98% or more. 
• Real-time tracking for determining the delivery status of EOBs, as well as troubleshooting unsuccessful delivery attempts.
• Flexible encryption through LuxSci’s proprietary SecureLine Technology, which automatically adjusts encryption according to the recipient to better ensure the protection of sensitive data, including for EOBs or any sensitive healthcare communication.

Contact us today to learn more about how your organization can begin the transition to electronic EoBs, reducing costs and improving the customer experience.