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.

In healthcare marketing, effective engagement is crucial. It’s imperative that healthcare providers, payers, and suppliers know how to connect with their patients and customers, keeping them aware of all aspects of their healthcare journey – and empowering them to participate as much as possible. 

This is where segmentation comes in. 

Instead of sending out healthcare marketing email communications that appeal to as many people as possible, segmentation enables healthcare companies to appeal to specific individuals or groups. It opens the doors for scenarios in which patients and customers see a message in their inbox and think, ‘this message is for me’. 

With that goal in mind, this post explores use cases and best practices in segmentation, why it’s so important for healthcare companies, and different ways that marketers can segment their audiences for optimal patient and customer engagement.

What is Segmentation?

Segmentation is the process of dividing your contact list, or audience, into smaller groups based on shared data, including protected health information (ePHI) characteristics. This could include demographics (age, gender, geographic location, etc.), medical conditions, risk factors, behaviors, and so on. 

Why Segmentation is Essential in Healthcare Email Marketing

For healthcare organizations, segmentation is a highly effective, and essential, strategy for sending patients and customers personalized email messaging. Personalized emails are more relevant to the recipient, which greatly increases the chance of them capturing their attention and subsequent engagement. 

This allows healthcare companies to successfully achieve the objective of their email campaigns, whether that’s reducing the number of appointment no-shows, increasing adherence to care plans, securing payments, or boosting sign-ups or sales. More importantly, patients and customers are more involved in their healthcare journey, staying on top of upcoming appointments, receiving applicable advice and recommendations, and becoming aware of products and services that may prove beneficial to their health, improving overall outcomes. 

Additionally, dividing audiences into distinct groups gives healthcare organizations invaluable insights into the behaviour and needs of different segments at different stages of the healthcare journey. 

For instance, an email campaign targeting a particular segment may reveal that they’re more likely to miss appointments than other groups. Similarly, segmentation may highlight that a certain high-risk group neglects to book recommended health screenings. Such insights enable healthcare providers, payers, and suppliers to improve their email engagement strategies, to drive more desirable outcomes and, ultimately more satisfied, loyal, and, above all, healthier patients and customers. 

How Can Segmentation Aid HIPAA Compliance?

Another considerable benefit of segmentation for healthcare organizations is that it supports their HIPAA compliance efforts. Because segmentation necessitates setting precise rules that control which individuals receive particular emails, it greatly mitigates the risk of accidentally sending sensitive patient data to the wrong person. 

Let’s say, for instance, that you want to conduct an email campaign targeting expectant mothers. By creating a segment comprised of pregnant patients or customers using the appropriate data field, you ensure that sensitive, pregnancy-related information is only sent to relevant parties. By reducing the likelihood of disclosing PHI to the wrong individuals, segmentation not only helps maintain regulatory compliance, but also preserves patient trust and confidence in your organization.

Different Ways to Segment Your Audience 

Demographic Segmentation

This involves grouping individuals by shared demographic attributes such as:

• Age
• Gender
• Location
• Ethnicity
• Education Level
• Employment Status
• Marital Status
• Family Status
• Socioeconomic Status (Income)
• Spoken Languages / Preferred Language
• Income
• Insurance Coverage Type
• Religious or Cultural Affiliations

Demographic information is a very powerful way to segment audiences to send them valuable, highly relevant information, for example:

• Sending mammogram or prostate screening recommendations to women or men over a certain age. 
• Sending health alerts to people in a certain region or ZIP code in response to the emergence of a disease in their area (e.g., flu, a new COVID strain). 
• Making educational material easy to understand and informative. 

Clinical Segmentation

Here, individuals are grouped according to medical criteria, such as:

• Health conditions
• Prescribed medications
• Treatment plans
• Recent surgeries or medical procedures 
• Recent lab test results
• Hospitalization history
• Vaccination status

This enables healthcare organizations to craft a wide range of specific communications that hone in on particular patients and customers, including:

• Disease management and preventative care advice for people suffering from certain conditions, e.g, how diabetic patients can best monitor and manage their blood sugar.
• Recovery guidance for post-operative patients. 
• Feedback requests for individuals on particular treatment plans, in an effort to optimize them. 

Healthcare Journey Stage Segmentation

This divides individuals according to their position in their care journey within your organization. 

For healthcare providers, new patients should receive onboarding materials, explanations of services and how to make the most of them, and similar materials that help them feel welcome and informed. Existing patients, meanwhile, can be further segmented into active, overdue (inactive), or high-risk groups – all of which have different needs and ways in which they should be communicated with: 

• Active patients: appointment reminders, educational materials, event and service recommendations, satisfaction surveys, etc. 
• Overdue and inactive patients: appointment or payment reminders, re-engagement communications, etc. 
• At risk patients: more frequent communications, care coordination messages, or support service referrals

Behavioral Segmentation

This method of segmentation is based on how recipients interact with emails or services, including:

• How often they open emails.
• If they click through on links.
• If they use patient portals.
• If they complete forms.
• How often they attend scheduled appointments. 

This segmentation empowers healthcare organizations to tailor the content type, frequency, and calls-to-action based on real engagement insights, and also carry out automated workflows based on each individual’s interaction with an email.

Supercharge Your Segmentation with LuxSci

LuxSci’s empowers healthcare organizations to effectively segment their contact lists into distinct target audiences for greater engagement in the following ways:  

• LuxSci Secure Marketing features powerful hypersegmentation capabilities for granular targeting that increase opens, clicks and conversions for your healthcare marketing campaigns. 
• LuxSci Secure High Volume Email enables companies to execute campaigns encompassing hundreds of thousands or millions of emails, targeting specific groups and audiences. 
• Easy integration with EHR, CDP, and CRM systems to leverages deeper levels data for highly targeting, highly personalized email campaigns. 

Reach out today to learn how LuxSci can help you reach more patients and customers, drive more engagement and conversions, and improve overall outcomes.