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

Xiaoyuan Bao, Jingsi Jiang, Jiao Shan, Yulong Cao, Haoyu Wang +2

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…