The 26-year-old man accused of gunning down UnitedHealth executive Brian Thompson in Manhattan intends to fight his extradition to New York to face murder charges from Pennsylvania, where he was arrested, his defense lawyer told a judge at a hearing on Tuesday.
The suspect, Luigi Mangione, was also denied bail for the second time, a day after he was taken into custody at a fast food restaurant after a sprawling five-day manhunt.
As he entered the courthouse surrounded by officers, Mangione shouted in the direction of journalists, yelling in part, ."..completely out of touch and an insult to the intelligence of the American people!" It was not clear to what he was referring.
Mangione's refusal to waive extradition on Tuesday triggers a formal process that could last weeks, though he is unlikely to succeed in preventing his eventual transfer, according to legal experts.
Investigators were trying to retrace Mangione's movements in Pennsylvania over the past few days, as well as whether the suspect was helped by an accomplice either before or after the brazen shooting outside a midtown hotel.
Mangione was spotted at a McDonald's on Monday by an employee who thought he looked like the gunman in surveillance images released by police. A gun, clothing and fake identifications found in his possession all closely match those used by the shooter, police said.
He faces gun and forgery charges in Pennsylvania and was arraigned in Altoona on Monday. An arrest warrant for Mangione filed on Tuesday in Manhattan criminal court listed one count of second-degree murder, three counts of criminal possession of a weapon, and one count of criminal possession of a forged instrument.
While the gunman's motive remains unclear, police have said Thompson, the CEO of one of the nation's largest health insurers, was deliberately targeted.
Mangione suffered from chronic back pain that limited his daily life, according to several news accounts. His profile on X shows a background image of an x-ray with what appears to be screws and plates inserted in a lower back.
An employee at TrueCar said Mangione worked at the car buying website as a data engineer from 2022 to late 2023. In mid-2023, Mangione took about two months off for what the employee's manager described as back-related issues.
The employee, who asked not to be named, described Mangione as "incredibly smart" and very friendly to his co-workers.
He said that the company offered employees health insurance through UnitedHealth as well as other choices, such as Aetna.
From January through June 2022, Mangione lived at the Surfbreak co-living community, similar to an adult dormitory, where he led a book club and surfed, hiked and rock-climbed, according to the Hawaiian online news site Civil Beat and other media.
The founder of the group, R.J. Martin, said Mangione's pain lingered for years, caused by misaligned vertebrae that would pinch Mangione's spinal cord, and he left for the mainland at some point for surgery.
But he went "radio silent" in June or July, Martin told Civil Beat.
At one point, Mangione suggested the group's book club read the manifesto of Ted Kaczynski - the Unabomber - as a joke, Martin said. Mangione, when arrested, was in possession of his own manifesto that offered insight into his motives, according to police. The New York Times reported that an internal New York City Police report analyzing the handwritten document concluded that Mangione viewed the killing as a challenge to the healthcare industry's corruption.\
Mangione, an Ivy League graduate who was also the valedictorian of a private all-boys school in Maryland, had a loaded ghost gun - a firearm assembled from parts, making it untraceable - and a silencer, officials said on Monday. Both the weapon and his clothing closely resembled those used by the gunman.
He also had a large sum of cash and multiple fake identifications, including a fraudulent New Jersey ID that matched the one used by the gunman to check into a Manhattan hostel days before the shooting, according to authorities.
Mangione's family released a statement saying they knew only what had been reported in the media.
"Our family is shocked and devastated by Luigi's arrest," the family said in a statement posted to the X account of Maryland lawmaker Nino Mangione. "We offer our prayers to the family of Brian Thompson and we ask people to pray for all involved."
The gunman managed to elude capture for days after the attack last Wednesday outside the Hilton hotel in midtown Manhattan.
After lying in wait for Thompson, the masked suspect shot him in the back before fleeing on foot, riding a bicycle into Central Park and eventually making his way to a bus station in northern Manhattan, where police believe he boarded a bus and left the city.
The words "deny," "defend" and "depose" were carved into shell casings found at the scene, several news outlets have reported. The words evoke the title of a 2010 book critical of the insurance industry, "Delay, Deny, Defend: Why Insurance Companies Don't Pay Claims and What You Can Do About It." Thompson's murder unleashed a wave of frustration from Americans struggling to afford medical care and those who have been denied claims or care.
Thompson, a father of two, had been CEO of UnitedHealth Group's insurance unit since April 2021, part of a 20-year career with the company. He had been in New York to attend the company's annual investor conference.
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