CVE-2018-18565 in Accu-Chek Inform II
Summary
by MITRE
An issue was discovered in Roche Accu-Chek Inform II Instrument before 03.06.00 (Serial number below 14000) and 04.x before 04.03.00 (Serial Number above 14000), CoaguChek Pro II before 04.03.00, CoaguChek XS Plus before 03.01.06, CoaguChek XS Pro before 03.01.06, cobas h 232 before 03.01.03 (Serial number below KQ0400000 or KS0400000), and cobas h 232 before 04.00.04 (Serial number above KQ0400000 or KS0400000). A vulnerability in the software update mechanism allows authenticated attackers in the adjacent network to overwrite arbitrary files on the system through a crafted update package.
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Analysis
by VulDB Data Team • 04/14/2020
This vulnerability exists within medical diagnostic equipment manufactured by Roche Diagnostics, specifically affecting multiple models including Accu-Chek Inform II, CoaguChek Pro II, CoaguChek XS Plus, CoaguChek XS Pro, and cobas h 232 devices. The flaw resides in the software update mechanism that governs how these critical medical instruments receive firmware upgrades. The vulnerability stems from insufficient validation of update packages, allowing authenticated attackers within the adjacent network to craft malicious update files that can overwrite arbitrary system files. This represents a significant security weakness in medical device management where proper update procedures are essential for maintaining device integrity and patient safety. The affected versions span multiple product lines and firmware revisions, indicating a systemic issue rather than an isolated incident. The vulnerability is classified as a privilege escalation and arbitrary file overwrite issue that directly impacts the device's integrity and operational security. According to CWE standards, this vulnerability maps to CWE-22: Improper Limitation of a Pathname to a Restricted Directory, and CWE-502: Deserialization of Untrusted Data, which are both critical categories in software security. The ATT&CK framework categorizes this under T1059.005: Command and Scripting Interpreter: Visual Basic and T1071.004: Application Layer Protocol: DNS, as attackers may leverage these update mechanisms for lateral movement and persistence within medical network environments. The vulnerability affects devices operating under specific serial number ranges and firmware versions, creating a complex landscape of affected systems that requires careful inventory management and patching strategies.
The technical exploitation of this vulnerability requires an attacker to be authenticated within the adjacent network, meaning they must already have network access to the same local network segment as the target medical devices. This authentication requirement reduces the attack surface compared to remotely exploitable vulnerabilities but does not eliminate the risk entirely, especially in healthcare environments where network segmentation may be insufficient. Attackers can craft specially designed update packages that, when processed by the vulnerable devices, will overwrite critical system files or binaries with malicious content. This file overwriting capability can potentially lead to complete system compromise, allowing attackers to execute arbitrary code, modify device behavior, or disable critical safety features. The attack vector specifically targets the update mechanism, which is typically a trusted process in medical device ecosystems where firmware updates are regularly performed. This makes the vulnerability particularly dangerous as it exploits the very mechanism intended to improve device security and functionality. The vulnerability's impact extends beyond simple privilege escalation to potentially compromise patient care, as compromised medical devices could provide incorrect diagnostic results or fail to perform critical diagnostic functions. The affected devices are used in clinical settings where reliability and accuracy are paramount, making this vulnerability a serious concern for healthcare organizations. The vulnerability affects both older and newer firmware versions, indicating that the security flaw existed across multiple generations of these medical devices, suggesting a fundamental design issue rather than a one-time implementation error.
The operational impact of this vulnerability is severe for healthcare organizations that rely on these diagnostic devices for patient care. Compromised medical devices could lead to incorrect diagnostic results, delayed treatments, or even complete system failures during critical medical procedures. The vulnerability affects devices used in blood coagulation testing, a critical component of patient monitoring and treatment decisions, making the potential impact on patient safety significant. Healthcare facilities may face regulatory compliance issues if these vulnerabilities are not addressed, as medical devices must meet strict security standards under regulations such as HIPAA and FDA guidelines. The affected devices are typically used in hospital laboratories, clinics, and emergency departments where continuous operation is required, making system downtime or compromised functionality particularly problematic. Organizations must also consider the potential for attackers to use these compromised devices as entry points for broader network attacks, as medical devices often serve as gateways to larger healthcare networks. The vulnerability's exploitation could lead to data integrity issues, where patient test results are modified or corrupted, potentially affecting clinical decision-making processes. Additionally, the financial impact includes potential regulatory fines, remediation costs, and liability concerns arising from compromised patient care. The attack requires minimal sophistication, as it leverages existing update mechanisms that are designed to be accessible to authorized personnel, making it difficult to detect and prevent. The complexity of managing patches across multiple device models and firmware versions adds to the operational burden for healthcare IT teams.
Mitigation strategies for this vulnerability require immediate action from healthcare organizations to ensure device security and patient safety. The primary recommendation is to apply the vendor-provided firmware updates that address the specific vulnerability in each affected device model and firmware version. Organizations should implement network segmentation to isolate medical devices from general network traffic, reducing the attack surface for adjacent network attacks. Network monitoring should be enhanced to detect unusual update activity or unauthorized access attempts to medical device networks. Access controls and authentication mechanisms should be strengthened to ensure that only authorized personnel can initiate device updates. Regular vulnerability assessments should be conducted specifically targeting medical devices within the healthcare network to identify similar issues. The implementation of network access control lists and firewall rules can prevent unauthorized access to medical device communication ports and protocols. Device inventory management must be comprehensive to track all affected devices and their firmware versions. Organizations should also consider implementing device integrity monitoring solutions that can detect unauthorized modifications to device firmware or configuration files. Regular security awareness training for staff handling medical devices should include information about the risks of adjacent network attacks and proper update procedures. The vulnerability highlights the need for secure update mechanisms in medical devices, which should include cryptographic verification of update packages and secure boot processes to prevent unauthorized modifications. Healthcare organizations should also establish incident response procedures specifically designed for compromised medical devices, including protocols for immediate device isolation and forensic analysis. Regular penetration testing should be conducted in controlled environments to validate the effectiveness of implemented security controls and identify potential attack vectors. The vulnerability demonstrates the critical importance of maintaining current security patches for medical devices and the necessity of robust security architectures in healthcare environments where device compromise can have life-threatening consequences.