Claim-Selective Certification for High-Risk Medical Retrieval-Augmented Generation

Retrieval-augmented generation (RAG) grounds answers in retrieved passages, but retrieval is not verification: a passage can be topical and still fail to justify the answer. We frame this gap as evidence sufficiency verification for selective RAG answering: given a question, a candidate answer, and retrieved evidence, predict whether the evidence supports, refutes, or is insufficient, and abstain unless support is established. We present SURE-RAG, a transparent aggregation protocol built on the observation that evidence sufficiency is a set-level property: missing hops and unresolved conflicts cannot be detected by independent passage scoring. A shared pair-level claim-evidence verifier produces local relation distributions, which SURE-RAG aggregates into interpretable answer-level signals -- coverage, relation strength, disagreement, conflict, and retrieval uncertainty -- yielding a three-way decision and an auditable selective score. We evaluate on HotpotQA-RAG v3, a controlled multi-hop benchmark, under an artifact-aware protocol (shortcut baselines, counterfactual swaps, no-oracle checks, GPT-4o audits). Calibrated SURE-RAG reaches 0.9075 Macro-F1 (0.8951 +/- 0.0069), substantially above DeBERTa mean-pooling (0.6516) and a GPT-4o judge (0.7284), while matching a strong but opaque concat cross-encoder (0.8888 +/- 0.0109) with full auditability. Risk at 30% coverage drops from 0.2588 to 0.1642, a 37% reduction in unsafe answers. To deliberately probe the task boundary, we further contrast SURE-RAG with GPT-4o on HaluBench unsafe detection: the ranking reverses (0.3343 vs 0.7389 unsafe-F1), establishing that controlled sufficiency verification and natural hallucination detection are distinct problems.

Retrieval-augmented generation evaluation checks whether model claims are factually grounded in retrieved documents. It does not check whether retrieved evidence is attributed to the correct entity. A clinical RAG response can pass every automated check (zero hallucinations, near-perfect faithfulness, real citations) while presenting drug Y's clinical evidence as evidence about queried drug X. We term this deceptive grounding (DG): a failure invisible to faithfulness, hallucination, and citation checks because every claim is sourced from a real document, about the wrong entity. Using a controlled factorial benchmark across 13 models, we find DG rates spanning 8-87% at peak adversarial conditions. Medical and biomedical fine-tuned models reach up to 86.7%; domain specialization amplifies the failure rather than mitigating it. A controlled ablation identifies the mechanism: removing entity-specific clinical evidence from retrieved documents eliminates entity-attribution failure entirely, shifting all failures to confabulation. The two failure modes respond to the same trigger, taking different paths. Production measurement across 740 drug-disease pairs finds 7.8% overall DG in a deployed RAG system, rising to 13.6% for recently approved drugs. Entity-attribution verification (checking that cited evidence applies to the queried entity) detects DG at 97.0% precision and 98.7% DG recall (IPW-adjusted human gold standard); no existing framework implements it.

In medical multiple-choice question answering (MCQA), Retrieval-Augmented Generation (RAG) can supplement the domain knowledge of language models (LMs). However, since vanilla RAG indiscriminately utilizes retrieved documents, it can degrade LM performance. To address this, we propose MedJudgeRAG. Our framework represents retrieved documents as a dynamic knowledge graph (KG) composed of entities and relations. For each option, the model judges an evidence verdict from the retrieved documents and the KG. Based on the verdict combination, the model determines a knowledge utilization strategy to reason toward the final answer. These capabilities are trained via supervised fine-tuning using structured reasoning traces generated by a teacher LM. The training employs a weighted cross-entropy loss that differentially weights the KG and reasoning segments. Experiments on two medical MCQA benchmarks demonstrate that MedJudgeRAG consistently outperforms both vanilla RAG and parametric baselines. Furthermore, ablation analysis reveals that the dynamic KG is more effective as graph-conditioned supervision at training time than as an explicit output at inference time. Our code is available at https://github.com/hyu-amllab/medjudgerag, and the generated reasoning traces are released at https://huggingface.co/datasets/youarethewon/medjudgerag.