The suspect accused of fatally shooting UnitedHealthcare CEO Brian Thompson pleaded not guilty on Dec. 23 to state charges of terrorism and murder.
Luigi Mangione faces 11 counts in New York, including one count of first-degree murder in furtherance of terrorism and two counts of second-degree murder, one of which is charged as killing as an act of terrorism.
On Dec. 17, a Manhattan grand jury indicted Mr. Mangione for the murder of Mr. Thompson, which occurred on Dec. 4 outside the New York Hilton Midtown, where UnitedHealth Group was hosting its annual investor day conference.
"This was a frightening, well-planned, targeted murder that was intended to cause shock, attention, and intimidation," Manhattan District Attorney Alvin Bragg said on the day of the indictment.
Following his arrest, officers recovered a handwritten manifesto outlining Mr. Mangione's motivations and mindset, in which he expressed disdain for corporate America and the healthcare industry. Investigators also discovered the words "deny," "defend," and "depose" written on shell casings at the crime scene.
Mr. Mangione's first appearance in New York state trial court came after federal prosecutors brought their own charges over the shooting, including murder through the use of a firearm — a charge that could make him eligible for the death penalty if convicted, according to CNN. The state charges have a maximum sentence of life in prison without parole. In addition to the state and federal cases, the suspect also faces charges in Pennsylvania, where he was arrested and is accused of forgery and possession of an unlicensed firearm.
The murder has sparked a firestorm of online vitriol and hostility toward the insurance industry more broadly.
"In the nearly two weeks since Mr. Thompson's killing, we have seen a shocking and appalling celebration of cold blooded murder," NYPD Commissioner Jessica Tisch said at a Dec. 17 press conference. "Social media has erupted with praise for this cowardly attack."
On Dec. 10, a Florida woman was arrested and charged after telling a Blue Cross Blue Shield employee over the phone, "Delay, deny, depose. You people are next," in response to a denied claim, ABC News reported.
In Nashville, an HCA Healthcare sign was vandalized with the words "Deny," "Defend," and "Depose," WSMV reported Dec. 23.
"The safety of all of our colleagues remains our highest priority," HCA told the outlet. "As a company, we have various security measures in place to protect all colleagues and we regularly explore additional means to safeguard our colleagues. Last night, one of our corporate campus monument signs was vandalized. In response, we are working closely with local law enforcement to investigate this incident thoroughly."
AHIP, the trade association representing health insurers, wrote on LinkedIn on Dec. 12: "Those in positions of leadership must condemn violence without qualification or equivocation. Anything short of that is not only irresponsible — it's dangerous."
Since the fatal shooting, health systems and insurers have tightened security around their executives, canceling conferences or moving them to virtual formats, temporarily closing offices, and removing biographical information online.