Hallucinations in medical large language models (LLMs) pose serious risks for clinical decision support, particularly when models must reason over complex electronic health records (EHRs). However, existing benchmarks often lack a realistic clinical context and provide limited insight into how hallucinations can be mitigated in practice. We introduce Med-HEAL, a framework for systematically identifying, analyzing, and mitigating hallucinations in medical LLMs using clinically grounded data. Building on the EHRNoteQA benchmark derived from MIMIC-IV discharge summaries, we construct a hallucination dataset by evaluating BioMistral-7B on open-ended clinical question answering tasks. Model outputs are labeled through a dual evaluation pipeline that combines LLM-as-a-Judge assessment (GPT-4o) with human auditing by medical student reviewers, producing correctness judgments and annotations of reasoning errors via a custom web-based evaluation system. We then leverage this dataset to investigate mitigation strategies: a self-critique pipeline, in which the test model reviews its own answers to detect potential errors and regenerates responses for flagged cases, and retrieval-augmented in-context learning (RA-ICL), which exposes the model to hallucinated and corrected examples. Experiments across five open-source LLMs-BioMistral, Llama-3.1, DeepSeek, Qwen2.5, and Qwen3, show that the self-critique strategy improves accuracy for three of five models (p < 0.05) without requiring parameter updates. Med-HEAL provides both a reusable hallucination dataset and a practical framework for studying and mitigating hallucinations in medical LLMs, supporting safer deployment of AI systems in clinical environments. Our code and data are publicly available at https://github.com/yimingliao-blad/med-heal.git.
Building trustworthy medical multimodal large language models (MLLMs) is critical for reliable clinical decision support. Existing medical hallucination benchmarks mainly focus on data collection, but often ignore where hallucinations originate within the reasoning process. We find that hallucination sources vary across samples: errors may arise from visual misrecognition, incorrect medical knowledge recall, or flawed reasoning integration. To enable source-level hallucination diagnosis, we introduce ClinHallu, a benchmark for stage-wise hallucination diagnosis in medical MLLM reasoning. ClinHallu contains 7,031 validated instances, where each instance is augmented with a structured reasoning trace decomposed into Visual Recognition, Knowledge Recall, and Reasoning Integration. We also use stage-replacement interventions to measure how correcting specific stages affects the final answer. Beyond evaluation, we show that trace-supervised fine-tuning reduces stage-wise hallucinations. ClinHallu provides a fine-grained hallucination testbed for diagnosing and mitigating reasoning failures in medical MLLMs. The benchmark is publicly available at https://github.com/alibaba-damo-academy/ClinHallu.
Medical large language models (LLMs), including custom medical GPTs (MedGPTs) and open-source models, are increasingly deployed on web platforms to provide clinical guidance. However, they pose risks of hallucination, policy noncompliance, and unsafe design. We conduct a large-scale assessment of 6,233 MedGPTs, evaluating a stratified sample of 1,500, together with 10 open-source LLMs. We introduce two frameworks: MedGPT-HEval for hallucination detection and an LLM-based pipeline for assessing policy violations and developer intent. Our results show that 25-30% of MedGPTs exhibit low factual accuracy, with bottom- and middle-tier models at highest risk; 33.6-54.3% violate operational thresholds, and 57.06% of Action-enabled models lack adequate privacy disclosures. Compared with open-source models, MedGPTs achieve higher factual accuracy and semantic alignment, though open-source models are more stable. These results reveal systemic gaps in hallucination and compliance, highlighting the need for multi-metric evaluation and stronger safeguards. We release HAA-MedGPT, a structured dataset that supports future research on the safety of web-facing medical LLMs.
Sunday Oyinlola Ogundoyin, Muhammad Ikram, Rahat Masood
Hallucinations can undermine clinician trust in LLMs, making it important that evaluation methods capture clinically relevant errors. Rubric-based evaluation has become the leading approach for assessing LLMs in medicine, but it is unclear whether rubric scores reflect such errors. We first study this in a controlled setting using MedHallu, finding that more specific rubrics better distinguish correct from hallucinated responses. To test this systematically, we develop a taxonomy of medical hallucination types and a clinician-validated error-injection pipeline that creates matched correct and error-injected responses. Across HealthBench, HealthBench Professional, and LiveMedBench, our clinically relevant hallucinations are missed by rubrics, often leaving scores unchanged. We find that rubrics are most effective when explicitly checking facts, and are less effective for additional or unexpected errors they do not anticipate. A preliminary retrieval-based factuality check recovers some of the rubric-blind errors, suggesting a complementary approach. These findings reveal systematic blind spots in current medical evaluation of LLMs and suggest that rubric scores alone are insufficient to establish clinical reliability, potentially undermining clinician trust and confidence in clinical deployment.