Planning on doing your first healthcare penetration test? It can be confusing.
Most healthcare teams don’t skip pen testing, but the problem is, they end up unsure on what was covered in their test.
A lot of the time, pentesting ends up being one of those things that sound solid on paper, but doesn’t really tell you where the real risk is. It is not always clear what a healthcare penetration test is supposed to include. Questions like ‘is it just infrastructure?’, or ‘are APIs part of it?’, are quite common. For someone looking to get started on their first penetration test, all this could be very overwhelming.
We’re breaking down what healthcare penetration testing actually covers, what should be in scope, how to tell if a proposal is legit or just ticking boxes and what your final report should include.
The healthcare attack surface is not what most pen tests assume
Before getting into specific testing areas, it is important to get the scope right.
Historically, penetration testing focused heavily on network and infrastructure like open ports, firewalls etc. It is useful but that’s not where most healthcare risks actually sit. Applications, APIs and authenticated workflows are a completely different layer and they need to be treated that way.
Network and infrastructure is the floor, not the ceiling
Traditional pen testing comes from a network security mindset. So naturally, reports tend to focus on exposed ports, misconfigurations and unpatched services. These are the kind of issues you can find without ever touching the application itself.
But for healthcare organizations running EHR platforms, patient portals and API connected third party systems, that’s only part of the picture. Those findings matter, but they don’t tell you how your actual product behaves under real use.
The application layer is where the sensitive data lives. And that’s where most of the breaches happen.
The shift to application layer and API risk in healthcare
Modern healthcare systems rely heavily on web applications and APIs. Patient portals, telehealth platform, scheduling systems, billing integrations, FHIR-connected third parties; all these expand the attack surface beyond the network layer. These areas can’t be tested the same way.
They require a different approach, something that looks at how the application works, how data flows and how users interact with the system. That’s where frameworks like OWASP Top 10 and OWASP API Security Top 10 come in.
How to define scope for a healthcare pen test
Scope is where most pen tests quietly go wrong. It should be clear, because otherwise, it just becomes guesswork.
If it’s defined too narrowly, you end up testing a fraction of the actual system. And in healthcare, where applications, APIs and integrations are tightly connected, that gap matters.
A proper scope should clearly identify every application and APIs being tested and not just a list of URLs. It should define which user roles are included, especially for authenticated testing, since most sensitive functionality sits behind login flows.
What to look for in a pen test proposal
What a complete proposal includes
Once you get a proposal, consider a checklist of these questions to ask yourself if your report includes the following.
- Does it clearly list every application and APIs in scope?
- Does the report specify which user roles will be tested in authenticated sessions?
- Does it describe how the internal applications will be accessed?
- Does it define the testing methodology (OWASP, CVSS, PTES etc)?
- Does it define the rules of engagement for production systems?
- Does it specify the deliverable format and whether compliance-mapped reporting is included?
Red flags in proposal
If you see any of the following below, pause.
- Scope is defined as a URL count rather than application surfaces and roles.
- No mention of authenticated testing for login-gated applications.
- API testing is listed, but there’s no detail on what’s actually covered.
- Compliance testing is listed as an add-on rather than a default option.
If you are ticking even one of these, you are probably getting a generic standard engagement and not something tailored to healthcare.
Questions to ask before signing
- How will authenticated user flows be tested and what roles will be covered?
- How will the testing team access the internal applications that are not publicly accessible?
- What does the API testing methodology cover (discovery, authorization, data exposure)?
- How will findings be mapped to HIPAA or other applicable frameworks?
- What’s the retesting policy for critical findings?
If a vendor can’t answer these questions clearly, there’s your answer.
What your findings report should contain
Findings structure and risk scoring
A good report should make it easy to understand what it means so teams can act on it promptly.
Findings should be recognized by risk level: critical, high, medium, low - with OWASP and CVSS scores mapped for context. Each issue should include a clear description, evidence of exploitation, business impact in plain terms and specific remediation guidance.
If a report just lists vulnerability names without showing how they were exploited, it’s not telling you much. And if remediation is just ‘patch this’ with no context, it’s not helping your team fix anything.
What healthcare specific reporting should include
For healthcare specific cases, reporting should go a step further.
Findings should be mapped to frameworks like HIPAA Security Rule requirements and where relevant, to PCI DSS controls or ISO 27001 domains. This makes it easier for teams to plug the results directly into compliance and risk workflows without extra translation between frameworks.
For example, Beagle Security’s AI driven pen testing reports for compliance generates audit ready reports for frameworks like HIPAA, PCI DSS and more, without the wait or excessive cost of traditional pen testing.
What to do with the report after remediation
A report isn’t something you file away and forget. It has a shelf life.
Fixes made months after a test may not reflect the current state of the application, especially in an environment where things can change frequently. This is why retesting is important because it confirms that vulnerabilities are actually resolved.
Relying on once-a-year tests leaves gaps that can be exploited. Continuous coverage helps catch new issues as they’re introduced and not months later.
Final thoughts
If there’s one thing this comes down to, it’s this: most healthcare pentests don’t fail because they weren’t done. They fail because they don’t cover what actually matters.
Take for example, testing a few endpoints, skipping authenticated flows, barely touching APIs or defining scope by number of URLs; none of this reflects how healthcare systems work. If the scope, the proposal and the reporting isn’t clear, then you are not getting a real picture of your risk.
So the idea here is to change the thinking from ‘we ran a pentest’ to ‘what exactly did we test and does it reflect our application?’
And that’s where platforms like Beagle Security fit in, not by replacing your generic pen testing, but by making sure the right things are continuously tested.
FAQs
Why are traditional penetration tests not enough for healthcare systems?
Traditional pentests often focus on infrastructure like ports and servers. But healthcare platforms rely heavily on applications and APIs, where sensitive patient data and workflows exist. If those aren’t tested, major risks can go unnoticed.
What are common mistakes in healthcare penetration testing?
Common mistakes include testing only unauthenticated endpoints, ignoring APIs, skipping business logic testing, relying on one-time audits, and assuming infrastructure testing is enough.
What should a healthcare pentest report include?
A strong report includes risk-based findings, CVSS scoring, proof of exploitation, real-world impact, and clear remediation steps. It should also map findings to frameworks like HIPAA for compliance alignment.
How often should healthcare applications be penetration tested?
Healthcare applications should be at least tested regularly, especially after a major update. One time testing has become outdated in today’s fast changing SaaS environments.
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