To meet stringent HIPAA requirements and combat the rising threat of credential-based attacks, the healthcare organization set out to significantly strengthen its identity security posture. The initiative centered on securing the most critical access points, including domain admin accounts, sensitive service accounts, and high-risk protocols such as PowerShell, SSH, RDP, and Dell DRAC. At the same time, they sought to eliminate reliance on legacy tools, streamline operations, and gain unified visibility into authentication activity across their hybrid Active Directory (AD) environment all while minimizing user friction.

Compliance mandates and privileged access risk

To meet tight HIPAA requirements and reduce identity security risk, the healthcare organization needed to enforce multi-factor authentication (MFA) protection for domain admins and other privileged users across all sensitive access points, including PowerShell, RDP, SSH, IIS, and DRAC. Legacy infrastructure and operational constraints posed significant challenges in deploying agent-based solutions, particularly on systems that couldn’t support endpoint software. Past disruptions caused by persistent, hard-to-remove agents further reinforced the need for an agentless approach.

Complying with HIPAA requirements

With Silverfort, the business enforced MFA across all critical privileged access points, including PowerShell, SSH, RDP, IIS, and DRACs, without relying on agents and reconfiguring endpoints. The IT team established policies that enabled short-term access exceptions for critical resources, minimizing administrative friction. As a result, they strengthened protection for privileged accounts used in day-to-day operations, met HIPAA compliance requirements, and reduced the risk of lateral movement across sensitive systems.

The company's MFA policy requires all access requests by domain admin accounts to be verified with MFA. During Kerberos or NTLM authentications, they see which critical server the admin is trying to access and the ID address of users

Limited visibility into service accounts

The organization relies heavily on service accounts to support homegrown applications, automation scripts and system integrations, many of which had excessive privileges. The legacy tools offered limited visibility into how these accounts behaved across the hybrid environment, what systems they accessed and whether any were overprivileged or stale. These blind spots made it difficult to enforce consistent access controls and increased the risk of lateral movement.

End-to-end visibility and security for service accounts

The healthcare organization gained full visibility into all authentication activity across both users and non-human identities (NHIs). With Silverfort, the healthcare organization discovered over 100 active service accounts and analyzed their access behaviors. This allowed them to identify excessive privileges or unnecessary permissions, and isolate high-risk accounts using a virtual fencing approach.  By segmenting service accounts based on their purpose and enforcing granular access policies, the organization gained tighter control over NHIs that reduced the attack surface and improved operational oversight.

The company's active directory service accounts dashboard in Silverfort displays all detected service accounts, including name, source, destination, number of authentications, risk score, baseline change and other account info.

Need for flexible controls without creating admin friction

The organization needed to implement strong authentication controls without introducing unnecessary friction for administrators or creating workflow disruption. Their privileged users need to access servers dozens of times per day through command-line interfaces, automation tools, or legacy applications, making strict MFA prompts impractical. The IT team also wanted to create exceptions or adjust policies temporarily during maintenance or when onboarding new tools. Without this level of control, they risked generating resistance to user adoption.

Customizing access policies to fit operational needs

With Silverfort, the healthcare organization implemented flexible, context-aware access policies that helped to balance security with usability. MFA prompts were tailored based on user role, access frequency, and resource sensitivity. Using Silverfort, their IT team configured granular access policies rules, reducing overhead during maintenance or urgent tasks. These capabilities allowed the organization to maintain strong authentication standards while supporting operational efficiency for privileged users, reducing helpdesk burden, and ensuring smoother adoption across teams.

The company's list of access based policies that set granular access rules with MFA prompts based on user roles, access frequency, and resource sensitivity.