Organizations: Shanwei Institute of Technology, Shanwei, China · Guangdong Provincial People’s Hospital, Guangzhou, China
Abstract
Detecting hallucinations in clinical text is increasingly framed as an explainability problem: systems should not merely flag an unreliable response but point to the offending span. Architectures built around knowledge-graph (KG) triple decomposition are marketed for exactly this auditability, yet their localization ability is typically assumed rather than measured. We introduce MedHal-Loc, a benchmark and metric for localization faithfulness -- whether a detector's top-ranked error unit actually overlaps the erroneous span. The controlled subset comprises 300 PubMedQA-derived statements with single, span-level errors injected across four localizable types (entity substitution, relation error, mechanism misattribution, invention), yielding gold spans by construction; a complementary natural subset documents that real hallucinations are dominated by diffuse conclusion-flips that resist span localization (a human expert accepted 1/18 candidate spans). Evaluating four fine-grained paradigms, we find that NLI-per-clause, consistency-per-sentence, and the dedicated span detector FAVA all localize well above chance, whereas an elaborate KG-triple pipeline localizes no better than chance (+3.3pp, n.s.), bottlenecked by ~59% entity-extraction coverage -- despite competitive detection F1 (0.609). Detection competence does not imply faithful localization; architectural explainability must be validated, not presumed.
Ensuring factuality remains a critical challenge for deploying LLMs in high-stakes settings. Existing hallucination detectors usually operate at a single level: claim-level methods provide interpretable factual units, while span-level methods localize unsupported text. Bridging these views is costly, as LLM-heavy pipelines require multiple decomposition and verification calls, and modular systems need additional claim-to-span alignment. We propose Enoki, an Open Information Extraction framework for multi-level hallucination detection. Enoki extracts text-anchored relational facts, verifies them against evidence, and projects unsupported facts back to hallucinated spans. This shared representation enables claim-level verification and span-level localization without requiring separate alignment. Enoki supports LLM-based, encoder-based, and rule-based extraction regimes, balancing accuracy and inference cost through a common interface. Experiments show that Enoki remains competitive with strong claim-level systems while using fewer resources and achieves superior performance on fine-grained span- and entity-level localization. We also release EnokiQA, a dual-granularity dataset with aligned claim-level verification and span-level localization annotations.
Large language models (LLMs) hallucinate with confidence: their outputs can be fluent, authoritative, and simply wrong. In medical, legal, and scientific applications this failure causes direct harm, and detecting it from internal model states offers a path to safer deployment. A growing body of work reports that this problem is increasingly tractable, with recent methods achieving high detection performance on widely used benchmarks. We show, however, that much of this apparent progress does not survive scrutiny. Four of the six corpora embed the ground-truth answer directly in the input prompt. A naïve text-similarity baseline we call \textsc{TxTemb} exploits this to achieve near-perfect detection scores without any access to model internals. To measure what genuine detection capability remains once these artifacts are controlled, we conduct a large-scale evaluation spanning twenty-two detection methods, twelve open-source models spanning six architectural families, and six corpora. We further introduce \textbf{DRIFT}, a supervised probe over inter-layer hidden-state transitions, as a point of comparison for live-generation detection. Our findings suggest that the field's reported progress on hallucination detection is substantially explained by benchmark construction artifacts in widely used corpora, and that the majority of established baselines perform near chance under controlled conditions; the consistent exceptions are SAPLMA and DRIFT, both supervised probes on upper-layer hidden states.
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.