Key Points Question Are employees at US health care institutions susceptible to phishing attacks? Findings In this multicenter quality improvement study, more than 2.9 million simulated emails were sent to employees at 6 hospitals, with a median click rate of 16.7%. Repeated phishing campaigns were associated with decreased odds of clicking on a subsequent phishing email. Meaning Employees at US health care institutions may be susceptible to phishing emails, which presents a major cybersecurity risk to hospitals.

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Consumer fraud is the intentional deception of one or more individuals with the promise of goods, services, or other financial benefits that either never existed, were never going to be provided, or were grossly misrepresented. In contrast to ancient times when consumer fraud and other white-collar crimes were considered to be at least as serious as violence and other street crimes, today’s consumer fraudster tends to be viewed as less dangerous and deserving of harsh sanctioning. Despite several social movements against consumer fraud and a proliferation of popular and scholarly literature on the topic, contemporary U.S. society has maintained a relatively lenient stance toward white-collar crime—a “soft on crime” position that is inconsistent with conservative “tough on crime” approaches that have dominated U.S. penal policy since the 1960s.