LeakBench: Auditing Reward Hacking through Prediction-Time Leakage in Clinical Modeling Agents

Abstract

Autonomous clinical-modeling agents can optimize predictive performance while violating conditions that make a model usable. We introduce LeakBench, an executable, guideline-derived audit suite that tests agent decisions for prediction-time leakage, calibration, site-level evaluation, support awareness, and decision-curve net benefit. LeakBench combines a synthetic task with known failure structure and two real-data settings: MIMIC-IV (430k admissions) and governed multi-hospital inpatient record front-page (MHFP) data. Our primary analysis uses reward hacking descriptively, without attributing intent: an agent selects prediction-time-invalid inputs because they improve its validation reward. A deterministic optimizer and every evaluated unconstrained local-model configuration select a fatal leaking feature. In fully logged September 2026 A/B runs, DeepSeek Flash and GPT-6-astra each leak in 10/10 unconstrained runs and 0/10 runs with an explicit admission-time constraint. This contrast is version-sensitive: a blinded Claude/Fable-5.1 chat run does not leak in either condition, while explicit-constraint violations appear only in a historical August 2026 slice lacking raw trajectories. Replacing AUROC with AUPRC does not remove leakage selection. Renaming or disguising the leaking inputs changes neither selection nor provenance-based detection; a name-based filter fails. A deterministic provenance verifier-in-loop removes the leak, making the LLM repair loop defense-in-depth. Specific verifier feedback clears fatal leakage in a hosted agent, and a three-seed ablation finds principle-only feedback clears decision-level defects, though these mitigation results are limited. LeakBench treats trustworthy clinical prediction as a property of an agent's modeling process, not merely its score; it is an audit testbed with known-failure controls, not yet an expert-validated benchmark.