Vectors Are Not Neutral: Sensitive-Information Inference from Exported LLM Representations in Summarization

Large language models (LLMs) are increasingly used for medical summarization, but their outputs can omit medically important information and introduce unsupported claims. Existing error-detection methods produce heuristic or uncalibrated scores, providing no formal control over missed errors and no principled way to trade off safety against clinician review burden. We introduce Conformal Assessment for Risk Evaluation (CARE), a post-hoc, model-agnostic safety layer that uses conformal risk control to overlay calibrated omission and hallucination flags onto summaries from any LLM without retraining. CARE provides finite-sample, distribution-free guarantees through two controllers: a hallucination controller that bounds the probability of a document containing any unflagged hallucinated sentence, and an omission controller that bounds the expected fraction of important omissions not surfaced for review. Unlike hallucination detection, omissions depend jointly on whether a source sentence is important and whether it is covered by the summary. We show that calibrating only one dimension can violate the target risk bound, while marginal decompositions remain valid but overly conservative. By jointly calibrating over the full $(τ,γ)$ threshold space, CARE preserves formal guarantees while surfacing up to 5$\times$ fewer sentences than alternative calibrated baselines. Across five medical summarization tasks, CARE satisfies the target risk bound at $α= 0.15$ with 95% confidence across 100 calibration/test resplits, using only ~100 labeled documents per domain. In a preliminary clinician study (75 document reviews), calibrated flags improved omission detection by 28.6 percentage points on average. These results show that sentence-level safety guarantees are feasible for LLM-assisted medical summarization and offer a tunable mechanism for balancing residual risk and review effort.

Prior white-box studies show that large language models can retain latent traces of target knowledge after unlearning, even when the knowledge is no longer expressed in their outputs. However, existing audits remain limited to one-off diagnostics: it is unclear whether these residual signals can predict future recovery under continued training or serve as reliable optimization targets. Resolving this gap is essential to determine whether internal auditing can move beyond post-hoc evaluation toward proactive risk monitoring and safer unlearning. We propose J-Access, an inference-time audit that uses the Jacobian lens to map intermediate representations into vocabulary space and measures how often target concepts remain accessible along the model's output pathway. We hypothesize that residual accessibility reflects recovery susceptibility: knowledge that remains closer to the output pathway requires less fine-tuning to restore, leading to faster recovery. We audit 398 public unlearned models spanning eight unlearning methods. We find that: (1) most unlearned models retain access above the retain-only gold level; (2) pre-attack accessibility predicts recovery speed and extent at the model level, but cannot identify which specific facts will be recovered; and (3) directly minimizing J-Access does not promote genuine deletion. Instead, the model learns to hide knowledge from the audit, producing lower audit scores but greater post-attack recovery. These findings position J-Access as a model-level diagnostic for assessing residual susceptibility in unlearned models. We argue internal audits should serve as an independent diagnostic dimension in unlearning evaluation, and should not be converted into optimization targets without validation.

Medical language models (LMs) can memorize and reproduce protected health information, but privacy evaluations often focus on recovery of training text rather than disclosure under realistic threat models. We introduce a clinically grounded framework that evaluates leakage along a graded axis of adversarial access, ranging from publicly inferable demographics to leaked note fragments. At each tier, we measure verbatim memorization of patient-specific text and semantic leakage of sensitive diagnoses. Applying the framework to an LM pretrained on 378k clinical notes, we find that routine encounter metadata (i.e. name, date of birth, provider, practice, visit date) elicits high rates of verbatim memorization across a patient's timeline and sensitive-diagnosis recovery (AUROC 0.91 for abortion, 0.81 for HIV). At the same time, exact-match memorization can overstate disclosure: 36% of memorized tokens reflect templated documentation. Our work highlights the risks of training on longitudinal clinical data, providing a practical framework for contextual privacy evaluation of medical LMs.