VFR-Audit: Verdict-Level Reliability for Fairness Audits in Hospital Length-of-Stay Prediction

External evaluations are becoming increasingly central to the governance of AI systems. In practice, however, independent auditors often have limited access to deployed models and must rely on query-based interactions. Most existing fairness evaluation methods assume static datasets and fixed-sample statistical tests, making them poorly suited to real-world auditing scenarios in which evidence must be collected sequentially under query constraints. In this work, we formulate fairness auditing as a tolerance-aware sequential hypothesis-testing problem under limited model output access. We develop a sequential generalized likelihood-ratio framework that allows auditors to accumulate evidence from a finite audit pool and stop once sufficient support for compliance or violation has been obtained. The framework is instantiated for decision-based Statistical Parity and Equal Opportunity audits, and extended to score- and logit-based proxy audits when richer observables are available. Our results show that both the fairness metric and the level of model access significantly affect audit efficiency, and that the benefits of richer output information are not uniform across auditing settings. In particular, richer outputs can substantially reduce the number of queries required for some fairness metrics and operating regimes, while offering limited gains in near-threshold cases. This work provides a practical statistical framework for sequential fairness auditing under realistic deployment constraints.

Fairness audits are a key component of responsible machine-learning deployment. Yet, audit-recommendation reliability under incomplete protected-label access is still poorly understood. In this work, we focused on protected-label missingness in fairness mitigation audits. We introduced a seed-calibrated stress test to separate missingness effects from seed-to-seed movement already present under complete labels. Across ACS/Folktables tasks, missingness settings that retain some protected labels usually do not move selected mitigation methods beyond a complete-label seed-to-seed baseline. At $0$ protected-label access, candidates collapse to an empirical-risk-minimization baseline and deterministic tie-breaking rather than revealing a broad missingness effect. We also found that threshold optimization can turn fairness gains on a single protected axis into intersectional harm above a seed baseline, and this threshold-optimizer finding persists under random-forest validation. Overall, our results highlight that protected-label missingness should be reported with seed-null calibration, candidate-set context, and intersectional consequences before it is treated as evidence of audit fragility.

Objective: To propose and retrospectively validate an integrated framework addressing three barriers to clinical translation of readmission prediction: lack of explainability, absence of deployment reliability infrastructure, and inadequate demographic fairness evaluation. Materials and Methods: We constructed a cohort of 415231 adult admissions from the MIMIC-IV database (30-day readmission prevalence 18.0%), split 70/15/15. Logistic regression, XGBoost, and LightGBM models were trained on 26 features. SHAP provided per-patient explanations. Fairness was evaluated across 16 subgroups using AUC-ROC, false negative rate (FNR), and positive predictive value (PPV). Calibration was assessed using Brier scores and calibration curves. Results: XGBoost achieved AUC-ROC 0.696 (95% CI 0.691-0.701), outperforming or matching the LACE baseline (AUC 0.60-0.68). LightGBM achieved best calibration (Brier 0.146). Prior admissions were the dominant predictor. All subgroups met equity thresholds (delta AUC <= 0.05, delta FNR <= 0.10). Conclusion: This framework delivers competitive performance, clinically actionable explanations, and strong demographic equity. Code is publicly available at https://github.com/Tomisin92/readmission-prediction.