Foundation Models that are capable of processing and generating multi-modal data have transformed AI's role in medicine. However, a key limitation of their reliability is hallucination, where inaccurate or fabricated information can impact clinical decisions and patient safety. We define medical hallucination as any instance in which a model generates misleading medical content. This paper examines the unique characteristics, causes, and implications of medical hallucinations, with a particular focus on how these errors manifest themselves in real-world clinical scenarios. Our contributions include (1) a taxonomy for understanding and addressing medical hallucinations, (2) benchmarking models using medical hallucination dataset and physician-annotated LLM responses to real medical cases, providing direct insight into the clinical impact of hallucinations, and (3) a multi-national clinician survey on their experiences with medical hallucinations. Our results reveal that inference techniques such as Chain-of-Thought (CoT) and Search Augmented Generation can effectively reduce hallucination rates. However, despite these improvements, non-trivial levels of hallucination persist. These findings underscore the ethical and practical imperative for robust detection and mitigation strategies, establishing a foundation for regulatory policies that prioritize patient safety and maintain clinical integrity as AI becomes more integrated into healthcare. The feedback from clinicians highlights the urgent need for not only technical advances but also for clearer ethical and regulatory guidelines to ensure patient safety. A repository organizing the paper resources, summaries, and additional information is available at https://github.com/mitmedialab/medical hallucination.

The advancement of large language models (LLMs) has made it difficult to differentiate human-written text from AI-generated text. Several AI-text detectors have been developed in response, which typically utilize a fixed global threshold (e.g., {\theta} = 0.5) to classify machine-generated text. However, we find that one universal threshold can fail to account for subgroup-specific distributional variations. For example, when using a fixed threshold, detectors make more false positive errors on shorter human-written text than longer, and more positive classifications on neurotic writing styles than open among long text. These discrepancies can lead to misclassification that disproportionately affects certain groups. We address this critical limitation by introducing FairOPT, an algorithm for group-specific threshold optimization in AI-generated content classifiers. Our approach partitions data into subgroups based on attributes (e.g., text length and writing style) and learns decision thresholds for each group, which enables careful balancing of performance and fairness metrics within each subgroup. In experiments with four AI text classifiers on three datasets, FairOPT enhances overall F1 score and decreases balanced error rate (BER) discrepancy across subgroups. Our framework paves the way for more robust and fair classification criteria in AI-generated output detection.