Retrieval-augmented generation (RAG) is a widely adopted paradigm for enhancing LLMs in medical applications by incorporating expert multi-modal knowledge during generation. However, the underlying retrieval databases may naturally contain, or be intentionally injected with, adversarial knowledge, which can perturb model outputs and undermine system reliability. To investigate this risk, prior studies have explored knowledge poisoning attacks in medical RAG systems. Nevertheless, most of them rely on the strong assumption that adversaries possess prior knowledge of user queries, which is unrealistic in deployments and substantially limits their practical applicability. In this paper, we propose M³Att, a knowledge-poisoning framework designed for medical multimodal RAG systems, assuming only limited distribution knowledge of the underlying database. Our core idea is to inject covert misinformation into textual data while using paired visual data as a query-agnostic trigger to promote retrieval. We first propose a unified framework that introduces imperceptible perturbations to visual inputs to manipulate retrieval probabilities. Besides, due to the prior medical knowledge in LLMs, naively poisoned medical content with explicit factual errors can be corrected during generation. Thus, we leverage the inherent ambiguity of medical diagnosis and design a covert misinformation injection strategy that degrades diagnostic accuracy while evading model self-correction. Experiments on five LLMs and datasets demonstrate that M³Att consistently produces clinically plausible yet incorrect generations. Codes: https://anonymous.4open.science/r/M3Att.

Membership inference attack (MIA) has emerged as a promising tool for auditing the training data of LLMs, supporting data privacy and copyright protection. Most existing MIA methods rely on the assumption that LLMs assign higher confidence scores to training samples than to non-training ones.However, since LLMs generate text by sampling high-confidence tokens, they naturally produce AI-generated texts (AIGTs) that also satisfy this assumption.In this work, we empirically confirm that such AIGTs, regardless of whether they are generated by the target LLM, can lead existing MIAs to assign even higher membership likelihoods than those of true training samples, thereby significantly undermining their reliability.To address this challenge, we propose a robust membership inference framework for reliably identifying training data.Our method adopts a mixture-of-experts formulation to jointly model interactions across complementary features derived from multiple MIA methods and AIGT detectors, which can remain robust against adversarially generated samples.Furthermore, by leveraging expert components, our method provides explainable insights into the characteristics of member data.Experiments on various datasets and LLMs show that adversarial samples substantially degrade the performance of baselines, whereas our method preserves performance close to that of the unattacked setting.Codes and datasets are released at https://github.com/kong-hyh/MoMIA.