• Luigi Mangione was arrested three months ago amid a tense 30 minutes at a Pennsylvania McDonald's.
• What police in Altoona did in that time is now the subject of a defense evidence-suppression effort.
• At stake is whether a gun, writings, and electronics seized at the restaurant can be used at trial.

A "red notebook manifesto." A "9 mm black Ghost handgun." A "Macbook Pro laptop." And a "USB on necklace."

The story of Luigi Mangione and the killing of UnitedHealthcare CEO Brian Thompson has been quiet in recent weeks, save for some quickly debunked news of "sex tapes" ("fake and not Luigi," a defense lawyer has said) and the continual background whir of speculation on Reddit.

But behind the scenes, as the murder suspect waits in a Brooklyn jail for his next court date, in June, a battle is brewing over the evidence vouchered from his arrest.

Police in Altoona, Pennsylvania, spent 30 minutes questioning and searching Mangione in a local McDonald's on a Monday morning three months ago before escorting him out in handcuffs. They later created an inventory listing 27 line items of property seized from his person, pockets, and backpack.

That 30-minute interaction inside the restaurant, preserved by the body-worn camera of at least one of 10 officers present, is now the subject of minute-by-minute scrutiny from his defense lawyers.

The lawyers are looking for procedural errors that could cause judges in Pennsylvania and New York to "suppress" everything Mangione had with him at the McDonald's. Prosecutors could be barred from using any of the seized property as evidence at trial.

"We are concerned that Luigi's constitutional rights were violated in Pennsylvania," his lead attorney in New York, Karen Friedman Agnifilo, told reporters after Mangione's most recent court date, on February 21 in federal court in Manhattan.

"And there are serious search and seizure issues that will be litigated in that case in Pennsylvania and in this case here," she added.

Unlikely to prevail

Suppression may be a long shot.

Business Insider asked defense attorneys and former prosecutors to review a pretrial motion filed in Pennsylvania three weeks ago. Filed by the Altoona defense attorney Tom Dickey, it claims the 27 pieces of property in the police inventory were "obtained illegally and unlawfully."

These legal experts said nothing seemed amiss in Dickey's detailed account of how Altoona police surrounded, questioned, and arrested Mangione after a five-day multistate search.

"They're unlikely to prevail, in my view," said Gary Galperin, who was a prosecutor with the Manhattan district attorney's office for 42 years and now teaches classes on evidence and forensic psychiatry at the Cardozo School of Law.

"Everything they did was absolutely reasonable," said the New York City defense attorney Ikiesha Al-Shabazz, a former narcotics prosecutor who teaches at the St. John's University School of Law.

"Good luck with that," she said of the suppression effort. "I don't see that happening."

Despite any long odds, challenging how the police approach, question, and arrest a suspect is a fundamental, Defense 101 obligation — every criminal lawyer worth her salt will make a thorough go of it.

"This is just standard — whether it's going to work, they have to do it," Al-Shabazz said. "It's their job to make applications, and challenge the evidence, and ultimately put the prosecution to their burden."

Suppression efforts are especially vital in a case like Mangione's, where the stakes are sky-high.

In Pennsylvania, the 26-year-old Maryland native faces comparatively minor felonies of firearm possession and forgery stemming from the arrest itself.

His New York charges are far more serious. Manhattan's state-level district attorney, Alvin Bragg, has charged Mangione with murder in furtherance of an act of terrorism, which could lead to a life-without-parole sentence. In a separate federal case, the top murder charge is death penalty-eligible.

A gun and a 'manifesto'

Another reason Mangione's defense will fight a pitched suppression battle is the importance of what the software developer had with him when he was arrested.

Altoona police allege that as he sat in McDonald's at 9 a.m. on that Monday — with one end of his paper COVID-19 mask lowered to allow a bite of hash brown — Mangione carried a black backpack that was a veritable "how to prosecute me" tool kit.

The defense filing, which describes and challenges the Altoona officers' actions, says deep inside the bag was a 9 mm handgun with a metal barrel and a 3D printed lower receiver, the part that contains the trigger and pistol grip. There was a separate silencer, also 3D printed, police say.

NYPD officials say this hybrid, part metal, part plastic "ghost" gun is a ballistic match to the shell casings left on the sidewalk when Thompson, a 50-year-old father of two from Minnesota, was fatally shot as he walked to a UnitedHealthcare convention at a midtown Manhattan hotel.

The shells had the words "deny," "defend," and "depose" written on them, apparent references to what critics say are the delay tactics health insurance companies can use to stall paying claims.

The backpack also contained the red spiral notebook that Altoona police called a "manifesto" in their inventory — a word the Pennsylvania lawyer is now challenging.

The federal complaint against Mangione alleges the notebook's handwritten pages "express hostility towards the health insurance industry and wealthy executives in particular."

An entry dated six weeks before Thompson's murder, the defense filing says, "describes an intent to 'wack' the CEO of one of the insurance companies at its investor conference."

Given the death penalty stakes and the heft of the evidence, suppression is a chance worth taking, Michael Scotto, a defense attorney and former rackets bureau chief at the Manhattan DA's office, said.

If a Pennsylvania judge finds the property seized from Mangione by Altoona police is inadmissible, that decision would be binding on the state judge in New York, he said.

Persuading a federal judge to suppress will be harder still.

"Federal law generally affords less rights to the suspect than state law," Scotto said. "So if the search was proper under Pennsylvania law, that should basically be the end of it."

The defense motion provides a down-to-the-minute script of Mangione's last half hour of freedom that could have been ripped from a screenplay.

Mangione was sitting in a corner of the McDonald's when the first two officers — each of them "uniformed, armed, and fully equipped" — entered and stood at his side, which resulted "in the formation of a human law enforcement wall," Dickey's filing says.

The police did not tell Mangione he was free to leave and gave a false reason for being there, saying he "looked suspicious" and had "over-stayed his welcome," the document says.

He was told to show his ID and stand with his hands on his head, the filing says. He was then frisked, "although no circumstances existed at that time justifying said action," it adds.

There was plenty of probable cause to detain and question Mangione at this point, legal experts told BI. Mangione's face had been online and on TV for days.

"He's like a rock star — everyone knows him," Scotto said. "So if somebody spots the guy at McDonald's, then the police are obviously going to come in and take defensive positions around him."

Police are also within their rights to ask what are called "investigatory" questions — such as, "What is your name?" and, "Where are you from?" and, "What's in the backpack?" — before Mirandizing a suspect.

The Pennsylvania defense filing describes a series of what are all permissible police actions, legal experts said — including any lies told about his overstaying his welcome.

"They're not obligated to explain anything to him," Al-Shabazz said. "They are allowed to lie."

Two officers, the suppression motion says, continued to "interrogate and question" Mangione, asking whether a nearby backpack, plastic bag, and other items were his. One officer, the motion adds, left briefly to run his New Jersey ID, which police would later say was fake.

Some 17 minutes passed — and nearly a dozen officers were present — by the time Mangione was read his Miranda rights. He shook his head no when asked whether he wished to speak to the police, the defense filing says.

After more questioning and another pat-down, the document adds, "he was then placed in handcuffs and was informed that he was being detained" and was "physically removed from the McDonald's."

There was probable cause for this arrest, legal experts said: the Jersey ID that police said is fake.

No guns were drawn

The police who stayed behind then took a look through his belongings — what the filing alleges was an illegal search.

"During the search of the backpack, the Altoona Police uncovered a clip wrapped up in underwear and other items," the filing says, referring to evidence later inventoried as a magazine holding 12 rounds, including three hollow-point rounds.

A computer chip was found wrapped in duct tape, which one officer removed using a knife, "without a valid search warrant," the document adds.

Mangione's bags were taken to the police department, where a search of the backpack revealed the gun, the "manifesto," and everything else on the inventory, the filing says.

"They searched it as part of the arrest process, as part of securing his property — they don't need a warrant for that," Scotto said.

"And this wasn't just picking him up for jaywalking. What if he had a bomb in that bag?" the former prosecutor added. "And you know, by the way, it's not like they came at him with guns drawn."

Dickey is also seeking to suppress everything Mangione told the police. A judge may disallow anything Mangione said in response to police questioning after he was Mirandized, Al-Shabazz said.

Dickey and Blair County, Pennsylvania, prosecutors did not respond to requests for comment. It's unclear when a judge in Pennsylvania will rule; prosecutors would first need to file a response.

Friedman Agnifilo declined to say when she may file her own evidence-suppression motions in Mangione's state and federal cases in New York.

The manifesto found on Luigi Mangione before he was charged with killing UnitedHealthcare CEO Brian Thompson doesn't spend much time discussing the quality of healthcare in America. It doesn't mention any of the specific health issues Mangione had complained about on Reddit or any frustrations he may have had with receiving treatment. Instead, the bulk of the note talks about the size of UnitedHealth Group, the parent company of UnitedHealthcare.

"United," the note says, is one of America's largest companies by market cap, "behind only Apple, Google, Walmart." The company, it says, has "simply gotten too powerful, and they continue to abuse our country for immense profit because the American public has allowed them to get away with it." In other words, it seems Mangione wasn't upset about healthcare, per se — but was pissed off about monopolization. The backpack that was found in Central Park, which police believe belonged to Mangione, was stuffed with Monopoly money. (Mangione has pleaded not guilty to the shooting.)

Though the manifesto gets some facts wrong — UnitedHealth actually stood at No. 14 by market cap at the time of the shooting — it references a very real trend: Over the past 40 years, the government has allowed an unprecedented level of consolidation in almost every major sector of American business. Whether we're buying office supplies or booking a vacation or searching the internet, we're often at the mercy of a handful of companies that dominate that particular corner of the economy. Despite a century of antitrust legislation and litigation, American business is bigger than ever.

That's especially true when it comes to healthcare: The Government Accountability Office found that just three companies control at least 80% of the health insurance market in most states. UnitedHealth, in particular, has spent the past several years acquiring firms from across the healthcare sector, transforming the company into a vertically integrated behemoth that controls health insurance, medical services, pharmaceuticals, and healthcare data. Last year, the Department of Justice opened an antitrust investigation into the company, prompting UnitedHealth to drop two proposed acquisitions. The DOJ also sued to block UnitedHealth's acquisition of Amedisys, a rival provider of home healthcare — a move which UnitedHealth has called an overreach it will "vigorously defend against."

Of course, companies consolidate for all sorts of reasons. For one, size allows them to take advantage of economies of scale. A report by accounting giant PwC found that large hospitals have a lower cost per patient, since they can share resources and treat patients faster. Insurance companies also save money by serving a large customer base — the more people they cover, the lower the risk (and cost) for each person. In a statement, UnitedHealth says, "The $5 trillion US health system remains deeply fragmented and rooted in fee-for-service models that result in less-than-optimal patient outcomes, higher mortality rates, poor patient experience, redundant care, and waste. We're accelerating the transition from volume to value as it's essential that we move beyond a transaction-based health system to a model that is proactive, outcomes-driven and enables people stay healthy over the course of a lifetime."

But monopolization comes at a steep cost. When a market is controlled by just a few corporations, economists have found, companies can hold customers captive and offer shoddier products and services, simply because consumers don't have any meaningful options. Farmers who buy John Deere tractors, which controls most of the tractor market, aren't permitted to fix their own equipment because the company requires farmers to use its repair services. (The practice is being challenged by a class-action lawsuit and a suit by the Federal Trade Commission.) Apple customers, similarly, are unable to repair their own phones, pushing them to buy new products rather than fix their current models. And in 2015, a study by Yale economist Zach Cooper found that costs for patients in hospitals without competition were approximately $1,900 higher than hospitals with four or more competitors.

In recent years, we have entered a new era in which monopolistic companies "crank up prices, crank down quality, service, and wages, and consumers have nowhere else to turn," says Marshall Steinbaum, an economist at the University of Utah.

Americans are well aware of the problem. In a June Gallup poll of US adults, 41% of respondents said they had "very little" trust in "big business," making it the third-least-trusted institution in America, behind only TV news and Congress. In a survey conducted this past spring, four in five respondents in rural areas of swing states agreed that "corporate monopolies now run our entire economy." And in a recent poll of registered voters, 41% of respondents under 30 said the killing of United Healthcare's CEO was "acceptable" or "somewhat acceptable."

As shocking as that might be, we've been here before. At the end of the 19th century, as major trusts consolidated entire industries, Americans turned to violence. In 1877, in response to the railroads slashing wages, workers rose up in a massive general strike that left 100 people dead. In 1894, a railway strike against the Pullman Co. grew so heated that it sparked a pitched battle with the Illinois National Guard, which killed dozens of strikers. In 1920, a wagon full of explosives was parked on Wall Street to target the banker J.P. Morgan. The bombing killed more than 30 people and injured hundreds more.

The question is: Why did the anti-corporate violence subside? What happened to tamp down the open rebellion — and why do so many Americans once again seem willing to embrace violence as a response to monopolization?

Violence against monopolies dissipated for two reasons. The first was government regulation. The second was low prices.

After the stock market crash of 1929, the government began to crack down on big corporations, breaking up monopolies in oil, tobacco, and railroads. At the same time, the New Deal enabled labor unions to fight companies on a more equal footing, with unions winning higher wages and better health insurance. Taken together, those efforts helped create a large and prosperous middle class. For decades, things seemed to be going well for regular Americans.

Then, in the 1980s, the government shifted its philosophy toward antitrust enforcement. Rather than treating consolidation as an inherent evil, it adopted what became known as the "consumer welfare" standard. If companies kept their prices low, the thinking went, it didn't matter whether markets were cornered by a few corporations. No economic harm, no legal foul.

The new philosophy allowed consolidation to soar — without sparking consumer unrest.

As Walmart and Amazon began to dominate the economy, driving small shops out of business, Americans accepted the loss of local businesses and low wages in return for an abundance of cheap and convenient goods and services. Amazon might rule the world, but who cared? The prices were low, the deliveries were fast, and the returns were free.

But now, as prices have shot up and companies have begun to take advantage of their market dominance, more and more Americans are realizing that when companies get too big, regular people end up paying the price. And when the system feels unfair, civility itself begins to crumble — especially when citizens feel they have no meaningful recourse. A sense of powerlessness, as history has repeatedly shown, breeds violence.

Keeping things civil, in fact, was an explicit reason the government decided to rein in monopolies in the first place. Speaking on the floor of the Senate in 1890, Sen. John Sherman urged his fellow lawmakers, many of whom were beholden to the rail barons, to support the statute that became the foundation of the anti-monopoly movement: the Sherman Antitrust Act. Congress had to choose, Sherman said: Either heed the public's call to break up the monopolies or "be ready for the socialist, the communist, and the nihilist." Today, with trust in big business deeply eroded and public satisfaction in the healthcare system at a 24-year low, America may find itself at a similar crossroads.

Robin Kaiser-Schatzlein is a freelance journalist who writes for the New York Times, the New Republic, and many other publications. He is writing a book about the authoritarianism of the American workplace, publishing early 2026.

• UnitedHealthcare named Tim Noel as its CEO, seven weeks after Brian Thompson's fatal shooting.
• Noel joined the company in 2007 and was most recently the head of its Medicare and retirement unit.
• Official employee pages and social media for Noel appear to have been taken down.

UnitedHealthcare named company veteran Tim Noel as its CEO, seven weeks after former CEO Brian Thompson was killed in New York.

Noel joined the company in 2007 and was most recently the head of its Medicare and retirement unit, per a Thursday announcement.

UnitedHealthcare is the largest health insurer in the US and provides services to over 50 million Americans, the company said. The Medicare and retirement arm contributed nearly half of the company's $74.1 billion in revenue for the three months ending in December.

Noel "brings unparalleled experience to this role with a proven track record and strong commitment to improving how health care works for consumers, physicians, employers, governments and our other partners," the company said in a statement on Thursday.

A spokesperson declined further comment.

The company's shares rose nearly 2% on Thursday.

Noel replaces Thompson, who was shot and killed outside a hotel in central Manhattan on December 4. A five-day manhunt led to the arrest of 26-year-old Luigi Mangione in a McDonald's restaurant in Pennsylvania after a worker called police.

Mangione pleaded not guilty to New York state murder and terrorism charges and to federal stalking and murder charges.

Prosecutors said two shell casings for the bullets that killed Thompson had the words "DENY" and "DEPOSE" written on them. The word "DELAY" was written on a bullet found at the crime scene.

The killing ignited a national debate about the state of the US healthcare and health insurance system and led to a flood of pro-Mangione content on social media platforms.

Since the shooting, healthcare companies including UnitedHealthcare have taken down web pages that share details about their leadership. Two days after the shooting, UnitedHealthcare's "Our leadership" page was no longer accessible.

Noel's LinkedIn and Facebook pages also appear to have been taken down.

• YouTube and Threads have taken down pro-Luigi Mangione posts they've said violate their policies.
• YouTube told Business Insider it forbids videos that glorify the murder of the UnitedHealthcare CEO.
• The different moderation approaches among platforms are leaving some users confused.

Diana "Ladidai" Umana, a content creator based in New York, has been closely following the news of Luigi Mangione — posting her thoughts on various social media accounts.

Umana's posts are pro-Luigi (and some have unorthodox angles, like saying he wasn't the shooter, which authorities have charged him with). But she was surprised when her entire YouTube account was permanently removed for what YouTube told her were "severe or repeated violations" of its rules.

YouTube's content moderation policies forbid "content praising or justifying violent acts carried out by violent extremist, criminal, or terrorist organizations."

"This means we remove content that glorifies or promotes the suspect in the murder of [UnitedHealthcare CEO] Brian Thompson, as well as content that trivializes his death," Jack Malon, a spokesperson for YouTube, told Business Insider. "This enforcement began in the immediate aftermath of the incident, as part of our standard practice to address content related to violent tragedies."

Other social platforms have also taken down content related to Mangione.

Several subreddits devoted to him have been banned — like r/luigimangione2 — although there are still other active subreddits about him. Reddit didn't respond to a request for comment on its moderation policies about the topic.

TikTok also has a policy against "promoting (including any praise, celebration, or sharing of manifestos) or providing material support" to violent extremists or individuals who cause serial or mass violence. People have complained that TikTok has removed comments saying "Free Luigi" and some videos about Mangione.

On Meta's Threads, people have said some of their posts about Mangione — like a post about his astrological sign or a video montage of him set to an Olivia Rodgigo song — were removed.

Meta has similar guidance, banning the "glorification" of dangerous organizations and individuals, which it defines as "legitimizing or defending the violent or hateful acts of a designated entity by claiming that those acts have a moral, political, logical or other justification that makes them acceptable or reasonable."

However, Meta recently updated what it calls its dangerous organizations and individuals policy to allow for "more social and political discourse in certain instances including — peace agreements, elections, human rights related issues, news reporting and academic, neutral and condemning discussion — and to ensure users are not unduly penalized for sharing it."

A spokesperson for Meta pointed to this policy but declined to comment further.

Pro-Lugi posts can be difficult to moderate

You might imagine how, when it comes to posts discussing Luigi Mangione, there are some gray areas between what's considered praise vs. discussion of social issues.

That's where the deluge of pro-Luigi posts from American users on social platforms gets a little weird.

Mangione's popularity among some people online is complicated, and I won't try to untangle it here (read this or this for some smart analysis). But you've probably already observed some of this online: There are a lot of people posting about Mangione and running afoul of content guidelines that they'd never usually run up against — rules designed for posts praising ISIS or Mexican drug cartels, for instance.

The result is some confusion and frustration among users.

Content moderation is an art, not a science, and there's a spectrum of differences between a statement like "Luigi was justified" and a meme about his looks or an ironic fan cam edit video.

Mangione has been charged with first-degree murder "in furtherance of terrorism," which may clarify things for platforms about whether to consider him as a single accused murderer or an alleged terrorist when it comes to content policy.

For now, it seems that a lot of social media users are surprised or confused by what is or isn't allowed when talking about Mangione on social media.

• Luigi Mangione's lawyer said her client's criminal case was being politicized.
• She criticized NYC Mayor Eric Adams' presence at Mangione's perp walk from a Manhattan helipad.
• Mangione pleaded not guilty to both state and federal murder charges.

A lawyer representing Luigi Mangione said law enforcement was politicizing her client's arrest and prosecution, pointing to Mayor Eric Adams of New York City's attendance at Mangione's first perp walk in the state.

"Frankly, your honor, the mayor should know more than anyone of the presumption of innocence," the attorney, Karen Friedman Agnifilo, said at a Monday-morning hearing.

Mangione pleaded not guilty at the proceeding, which took place in the courtroom of Justice Gregory Carro of the New York Supreme Court, a trial judge in Manhattan's state-level criminal court.

He was arrested in Altoona, Pennsylvania, following a five-day hunt for the person who killed United Healthcare CEO Brian Thompson on a Manhattan sidewalk. At Monday's hearing, the Ivy League graduate looked polished, wearing a maroon sweater over a white collared shirt. His wrists were bound with heavy shackles as he walked into the courtroom.

Adams, alongside Commissioner Jessica Tisch of the New York Police Department, stood for dramatic photos at the Manhattan helipad where Mangione was flown in on Thursday.

A large group of police officers walked Mangione from the helicopter, making for images that went viral on social media.

"I wanted to look him in the eye to say that, 'You carried out this terrorist act in my city, the city that the people of New York love,' and I wanted to be there to show the symbolism of that," Adams later said.

A grand jury has indicted Adams on federal corruption charges alleging he took bribes from the Turkish government. He's pleaded not guilty.

"Frankly, I submit that he was trying to detract from those issues by making a spectacle of Mr. Mangione," Friedman Agnifilo said at Monday's hearing, according to the Courthouse News reporter Erik Uebelacker.

Mangione previously appeared in Manhattan federal court Thursday afternoon on charges brought by the US Justice Department. He has been in federal custody in Brooklyn's Metropolitan Detention Center.

The Manhattan district attorney's office accused Mangione of first-degree murder "in furtherance of terrorism."

Federal prosecutors brought additional murder charges that, if Mangione is convicted, are death-penalty-eligible.

The district attorney's case will go to trial first, the Justice Department announced. A trial date has not yet been set.

• Trump says it's "terrible" that some admire Luigi Mangione, the UHC CEO shooting suspect.
• "That's a sickness, actually," Trump said.
• He speculated that some of the public reaction to the shooting was "fake news."

President-elect Donald Trump on Monday commented on the shooting of United Healthcare CEO Brian Thompson and the valorization of the suspect, Luigi Mangione.

"I think it's really terrible that some people seem to admire him," Trump told reporters at a press conference at Mar-a-Lago.

"That was a terrible thing. It was cold-blooded. Just a cold-blooded, horrible killing," Trump said of the killing.

While a broad swath of politicians have condemned the shooting, some progressive Democrats have also used the moment to take stock of Americans' frustrations with the healthcare industry, given that the public reaction to the shooting has not been universally negative.

"Of course, we don't want to see the chaos that vigilantism presents," Democratic Rep. Alexandria Ocasio-Cortez of New York told Business Insider last week. "We also don't want to see the extreme suffering that millions of Americans confront when your life changes overnight from a horrific diagnosis, and people are led to just some of the worst, not just health events, but the worst financial events of their and their family's lives."

Trump expressed bewilderment at the public reaction on Monday, speculating that some of it had been falsified.

"How people can like this guy, is… that's a sickness, actually," Trump said. "Maybe it's fake news, I don't know. It's hard to believe that can even be thought of, but it seems that there's a certain appetite for him. I don't get it."

• Health insurers are coming under fire for increasingly denying patient claims for medical care.
• Investors are rushing to back startups using AI to automate the complex healthcare billing process.
• These 10 startups are helping patients, providers, and insurers improve health payments with AI.

In the wake of the fatal shooting of UnitedHealthcare's CEO last week, public hostility toward health insurers has reached a boiling point.

After Brian Thompson was shot and killed in Manhattan on December 4, social media exploded in morbid celebration. Shell casings found at the scene of the crime reportedly showed the words "deny," "defend," and "depose," mirroring a phrase commonly used by insurance critics to describe tactics used by health plans to avoid paying claims. Suspect Luigi Mangione was arrested Monday with a note in his possession containing the line, "These parasites had it coming."

It's a reckoning for how healthcare in the US is paid for — or not paid for — as health insurers increasingly deny paying for patient care. UnitedHealthcare and other health insurers have come under fire in recent years for using algorithms to deny patient claims, particularly Medicare Advantage claims. Claim denial rates have been on the rise for more than a decade, and denied or delayed payments cost hospitals hundreds of billions of dollars a year.

A growing crop of startups think AI can help.

Investors are rushing to back startups using AI to help providers, patients, and health plans more accurately and efficiently pay for medical care.

These 10 startups are using AI to automate key parts of healthcare's complex billing process, from prior authorization to claims adjudication.

Alaffia Health

Founded: 2020

Total raised: $17.6 million

What it does: Alaffia Health works with health plans to automate time-consuming tasks in claims processing, such as reviewing large patient medical records and policy documents. The startup says its generative AI tools can help insurers supercharge their in-house clinical teams and reduce claims spending.

Alaffia Health last raised a $10 million Series A round in April led by FirstMark Capital.

Anomaly

Founded: 2020

Total raised: $30 million

What it does: Anomaly uses machine learning to parse health insurers' policies and historical claims data to help clinicians predict and prevent claims denials. The startup was incubated by Redesign Health and has raised money from investors like RRE Ventures and Madrona.

Anterior

Founded: 2023

Total raised: $23 million

What it does: Anterior provides tech to clinicians working inside health insurers to automate prior authorizations for covered medical care. The startup raised a $20 million Series A led by NEA in June. It's also backed by Sequoia Capital and Microsoft AI head Mustafa Suleyman.

Claimable

Founded: 2023

Total raised: Undisclosed

What it does: Claimable launched in October to assist patients in creating appeal letters for denied medical claims. Its platform analyzes a range of data, including clinical research, insurer policies, and existing appeals data, to generate a personalized letter for $40.

The startup last raised a seed round from Walkabout Ventures, Humanrace Capital, and other investors in March. It's also part of Nvidia's startup accelerator program Inception.

Cofactor AI

Founded: 2023

Total raised: $4 million

What it does: Cofactor AI's platform analyzes information, including medical records, insurer policies, and claims data, to help hospitals appeal claims denials. The startup announced a $4 million seed round led by Drive Capital in November.

Cohere Health

Founded: 2019

Total raised: $106 million

What it does: Cohere Health contracts with health plans like Humana and Geisinger to automate prior authorizations for medical care. The startup claims its tech can reduce the number of unnecessary prior authorization denials to help patients get the care they need faster. Cohere Health last raised a $50 million Series B extension in February led by Deerfield Management.

Humata Health

Founded: 2023

Total raised: $25 million

What it does: Humata Health works with hospitals to automate the collection of documents included in requests for prior authorizations sent to insurers and flag likely denials. The startup raised a $25 million Series A in June, led by LRV Health and the Blue Venture Fund.

Dr. Jeremy Friese started Humata Health after serving as the president of health AI startup Olive, which shut down last year after selling its prior authorization business to Humata.

Goodbill

Founded: 2021

Total raised: $5.3 million

What it does: Goodbill works with patients and employers to reduce medical costs by cross-referencing medical records with incoming hospital bills to identify potential errors and overcharges. The startup last raised a $2 million funding round in March from Founders' Co-op, Maveron, and Liquid 2 Ventures.

Guardian AI

Founded: 2024

Total raised: Undisclosed

What it does: Guardian AI provides hospitals and physician groups with tools to analyze insurance reimbursement patterns and automate the handling of unpaid medical claims and denials. The startup was part of YCombinator's summer 2024 cohort; its founders previously worked on Palantir's AI revenue cycle management programs for hospitals.

Thoughtful AI

Founded: 2020

Total raised: $40 million

What it does: The startup's AI agents help healthcare clinics process medical claims, check patient insurance coverage, and record payments. Thoughtful AI last raised a $20 million Series A in July, led by Drive Capital.

• Some high-profile CEOs like Mark Zuckerberg or Elon Musk have multimillion-dollar security details.
• Health insurance companies, by contrast, don't appear to spend as much on executive protection.
• The amount public companies allocate toward executive security and private travel varies widely.

The death of UnitedHealthcare CEO Brian Thompson last week has brought a new level of attention to the question of executive protection.

Thompson's shooting outside a hotel in New York also highlights that executives who aren't as high-profile as someone like Elon Musk may not always have bodyguards with them.

That level of monitoring can be expensive, and the amount companies pay for executive security varies widely.

On the high end, Musk and other CEOs including Meta's Mark Zuckerberg, Alphabet's Sundar Pichai, and Salesforce's Marc Benioff are known for having multimillion-dollar security packages.

Others, including JPMorgan Chase's Jamie Dimon, Amazon's Andy Jassy, and Apple's Tim Cook, have more modest protection services worth hundreds of thousands of dollars — amounts that can further increase when factoring in costs associated with the use of private planes, a common CEO perk tied to security considerations.

Health insurance companies, including UnitedHealth Group, don't appear to spend as much on executive protection as some of the Big Tech giants.

However, the health insurance industry isn't an outlier. Companies in other fields, like retail, also have relatively modest security-specific compensation.

Walmart CEO Doug McMillon and McDonald's CEO Chris Kempczinski, for example, appear to have individual security expenses of less than $25,000 for 2023, according to company filings. When including the use of private aircraft, Walmart paid $192,848 for McMillon's personal use of the company jet, while McDonald's paid $319,301 for Kempczinski's usage in 2023.

Company-paid security costs are typically disclosed in annual corporate filings known as proxy statements. The documents include a breakdown of the salary, benefits, bonuses, and other perks to provide a dollar value of top executives' total compensation package, which must be approved by the board and shareholders.

Security services paid for by the company for the benefit of an individual executive are typically included in a category called "Other Compensation" along with perks like personal corporate jet usage, 401(k) matching, or tax preparation services. It's possible that some security costs may not be reported in proxy statements, particularly if they were paid for by the executives themselves and not reimbursed.

UnitedHealth Group's filings don't specify any personal security costs for Thompson last year

It's not clear if Thompson had a security detail with him on the day of his death. Video footage obtained by the New York City Police Department appears to show him walking alone on his way into an "investor day" event in Manhattan.

Although he was CEO of UnitedHealthcare, Thompson was also an executive vice president of UnitedHealth Group, for which he received $21,187 in other compensation in 2023. That amount represented $14,850 in 401(k) matching and $6,337 in health insurance premiums, with no amount indicated for personal security.

The company has yet to release its annual proxy statement outlining 2024 expenses.

Looking further up the corporate ladder, Thompson's boss, UHG CEO Andrew Witty, also did not receive payment for personal security as part of his 2023 compensation package. However, the company did make corporate aircraft available for his use.

"Witty is required for personal security reasons to use corporate aircraft for all business travel and is encouraged to use corporate aircraft for all personal travel," the proxy statement says, adding that Witty did not make personal use of the company plane in 2023.

A UHG spokesperson told BI the company is "partnering with local law enforcement to ensure a safe work environment and reinforce security guidelines and building access policies."

CVS, which owns Aetna, does not disclose the compensation of Aetna's president. However, CVS did provide its former CEO Karen Lynch with $44,148 for "personal protection" in 2023, as well as $243,281 for personal use of the company jet and $106,086 for personal use of a company car. A CVS spokesperson declined to comment.

Cigna CEO David Cordani received $310,437 in "other compensation" in 2023, largely constituted of $178,704 in personal travel on the company aircraft. Roughly $95,000 in other costs were provided for residential security system monitoring and maintenance, as well as expanded personal liability coverage.

Proxy statements for Humana and Elevance (owner of Anthem) did not specify personal security costs, while Kaiser Permanente is a nonprofit and not subject to the same reporting requirements.

Musk-level security can cost millions

Former Secret Service agent Joseph LaSorsa, who now runs the private security firm LaSorsa & Associates, previously told BI that an around-the-clock detail can cost $100,000 a month and isn't always enough to stop a motivated attacker.

At those rates, the annual cost of protection could balloon to $1.2 million — comparable to the base salaries of UnitedHealth's executive officers.

In other words, company-provided personal security can be an expensive proposition, and typically reserved only for a small number of top leaders. Different executives may also have their own personal preference for the level of security they travel with.

"Protection is very much driven on what a executive really wants," said John Orloff, a former US Secret Service agent who now leads security risk consulting at Jensen Hughes.

Orloff told Business Insider that his firm typically works with corporate security departments to develop their executive protection strategies in response to relevant threats.

Musk, the world's wealthiest person, has spoken out about personal security concerns in recent years. He told Tesla shareholders at the annual shareholder meeting that "two homicidal maniacs" had threatened to kill him and things were "getting a little crazy these days."

Filings show Tesla paid a Musk-owned personal security company $2.4 million to protect him in 2023. However, the agreement is not structured as compensation for his services as CEO and is unusual among public companies (Tesla is fighting to reinstate Musk's 2018 compensation package after a Delaware judge ruled against it for the second time).

Musk travels with multiple bodyguards — sometimes as many as 20, according to a recent report. Employees at X, formerly Twitter, reported seeing his security follow him into the bathrooms at the company's headquarters.

While executives at health insurance companies may not be as recognizable as someone like Musk or Zuckerberg, Thompson's death could lead board members and CEOs to review executive protection costs in a different light. The matter could feature more prominently as compensation committees draft proposals for their companies' future annual meetings.

• UnitedHealthcare CEO Brian Thompson was fatally shot outside a Manhattan hotel on December 4.
• Police arrested Luigi Mangione, who now faces a murder charge for the killing.
• Mangione has hired prominent New York lawyer Karen Friedman Agnifilo to defend him.

Luigi Mangione, the man police say murdered UnitedHealthcare CEO Brian Thompson, has hired high-profile attorney Karen Friedman Agnifilo.

Friedman Agnifilo is married to Marc Agnifilo, lead lawyer defending Sean "Diddy" Combs against federal sex-trafficking charges.

The Combs and Mangione cases will be handled by the same Manhattan law firm, Agnifilo Intrater LLP, and can be expected to dominate legal news headlines in the coming year.

In getting retained, Friedman Agnifilo bested some half-dozen other prominent attorneys who had been interviewed by the Mangione family last week, according to multiple sources who asked not to be named due to their connection with the case.

Friedman Agnifilo last week left her previous law firm, Perry Law, to join her husband's firm as counsel, representatives for both firms told Business Insider.

Friedman Agnifilo had been a CNN commentator as recently as Wednesday, when she suggested that an insanity defense would be Mangione's best bet.

She told journalist Kaitlan Collins, "It looks like to me there might be a 'not guilty by reason of insanity' defense that they're going to be thinking about because the evidence is going to be so overwhelming that he did what he did."

On Friday night, Collins broke the news that Friedman Agnifilo had been hired by the Mangione family.

Friedman Agnifilo worked as the chief assistant district attorney at the Manhattan District Attorney's Office for seven years before pivoting to private practice in 2021.

Mangione faces a second-degree murder charge in New York for the fatal December 4 shooting of Thompson, a 50-year-old father of two from Minnesota. That charge carries a maximum sentence of life in prison.

(A charge of first-degree murder is reserved for those accused of killing a law enforcement official or witness of a crime, or for when a murder is committed during the commission of another high-level crime, including robbery, rape, or kidnapping.)

Mangione is fighting extradition to New York City. The 26-year-old Ivy League graduate appeared for a hearing on December 10 at Pennsylvania's Blair County Courthouse, where a lawyer, Thomas Dickey, told the judge that Mangione was contesting his extradition. Police arrested Mangione in Altoona, Pennsylvania, on December 9 on local charges and later arraigned. Mangione made a bail request, which the judge denied during the hearing.

The suspect will remain at Pennsylvania's Huntingdon State Correctional Institution during the extradition proceedings. Dickey told reporters on December 10 that Mangione would plead not guilty to all the charges in Pennsylvania.

In an interview with CNN that evening, Dickey also said that he anticipates Mangione would plead not guilty to the murder charge in New York and that he hadn't seen any evidence that officials in New York "have the right guy."

Mangione also faces four other charges related to the killing of the insurance CEO: two counts of criminal possession of a weapon in the second-degree, one count of second-degree criminal possession of a forged instrument, and one count of criminal possession of a weapon in the third-degree.

A gun found on Mangione matched the three shell casings found at the site of the shooting, New York Police Department Commissioner Jessica Tisch said during a December 11 press conference.

Tisch added that the suspect's fingerprints also matched those found on a water bottle and snack bar wrapper discarded near the crime scene.

During Mangione's arrest, officers found a three-page handwritten document "that speaks to both his motivation and mindset," Tisch said at a separate press conference on December 9.

An internal NYPD report obtained by The New York Times gave the clearest view of the potential motive yet. Based on the so-called manifesto discovered, Mangione "likely views himself as a hero of sorts who has finally decided to act upon such injustices," the NYPD report said, as reported by the Times.

Mangione "appeared to view the targeted killing of the company's highest-ranking representative as a symbolic takedown and a direct challenge to its alleged corruption and 'power games,' asserting in his note he is the 'first to face it with such brutal honesty,'" according to the NYPD report by the department's Intelligence and Counterterrorism Bureau, the Times reported.

In a statement to Business Insider, representatives for Nino Mangione — a Maryland state legislator and a cousin of Mangione's — declined to comment on the news of Mangione's arrest.

"Unfortunately, we cannot comment on news reports regarding Luigi Mangione," the statement read. "We only know what we have read in the media. Our family is shocked and devastated by Luigi's arrest."

Recognized at a McDonald's

Mangione was eating in an Altoona McDonald's when an employee recognized him from the several surveillance images that authorities released in the aftermath of Thompson's killing and called the police, New York police said at the December 9 press conference.

Altoona police found Mangione in the McDonald's with multiple fake IDs and a US passport, as well as a firearm and a suppressor "both consistent with the weapon used" in the shooting of Thompson in the heart of Manhattan, Tisch, the NYPD commissioner, said.

The gun appeared to be a "ghost gun" that may have been made on a 3-D printer. NYPD Chief of Detectives Joseph Kenny said at the press conference that such a gun could fire a 9-millimeter round.

A Pennsylvania criminal complaint filed against Mangione said officers found a black 3-D-printed pistol and 3-D-printed silencer inside the suspect's backpack.

When Altoona officers asked Mangione if he had been to New York recently, he "became quiet and started to shake," the criminal complaint said.

Clothing, including a mask, was also recovered "consistent with those worn" by the suspect wanted for Thompson's killing, along with a fake New Jersey ID matching the ID that the murder suspect used to check into a Manhattan hostel before the attack, Tisch said.

Based on the handwritten document that police found on Mangione, according to Kenny, "it does seem that he has some ill will toward corporate America."

During a December 10 interview on NBC's "Today" show, Tisch said the "manifesto" revealed "anti-corporatist sentiment" and "a lot of issues with the healthcare industry."

"But as to like particular, specific motive that'll come out as this investigation continues to unfold over the next weeks and month," the NYPD commissioner said.

NBC News and The New York Times, each citing an unnamed senior law enforcement official, reported that the handwritten document read in part: "These parasites had it coming."

"I do apologize for any strife and trauma, but it had to be done," it added, according to the reports.

Police believe that Mangione acted alone.

NYPD investigators traveled to Altoona last week to interview Mangione after Altoona officers took him into custody.

Blair County District Attorney Peter Weeks said at Mangione's Pennsylvania arraignment that Mangione was carrying $10,000 in cash, including foreign currency, according to the Associated Press.

Mangione disputed the amount in court.

Mangione was active on social media

Mangione posted and amplified posts about technological advances like artificial intelligence on X. He also posted about fitness and healthy living.

He frequently retweeted posts by the writer Tim Urban and commentator Jonathan Haidt about the promise and perils of technology. He also appeared to be a fan of Michael Pollan, known for his writing about food and ethics.

Other deleted social media posts showed support for Robert F. Kennedy Jr. and expressed skepticism toward both President Joe Biden and President-elect Donald Trump.

At the top of his profile was a header image with three images: a photo of himself, smiling, shirtless on a mountain ridge, a Pokemon, and an x-ray with four pins or screws visible in the lower back.

Mangione founded a company called AppRoar Studios in 2015 while still in high school. AppRoar released an iPhone game called Pivot Plane that is no longer available.

The two other cofounders of AppRoar could not be reached for comment.

Mangione's X account has been deactivated. A spokesperson for YouTube said his three accounts on the platform were also terminated, but that they had not been active for about seven months.

A manhunt

Mangione's arrest followed a nearly week-long manhunt.

According to police, Manigone was born and raised in Maryland, and has ties to San Francisco, California. His last known address was in Honolulu, Hawaii.

The New York Post, citing law-enforcement sources, reported that Mangione's mother reported him missing in mid-November.

Law-enforcement sources told ABC News that FBI agents and members of the NYPD spoke to the mother a day before Mangione's arrest, following a tip, and that in the conversation she indicated that the person in the surveillance photos could be her son.

Kenny, the NYPD's chief of detectives, said that Manigone has no prior arrest history in New York and no known arrests in the US.

A Luigi Mangione with a matching birthday and address received a citation for simple trespass for entering a forbidden area of a state park in Hawaii in November 2023. He pleaded no contest and paid a $100 fine.

"For just over five days, our NYPD investigators combed through thousands of hours of video, followed up on hundreds of tips, and processed every bit of forensic evidence — DNA, fingerprints, IP addresses and so much to tighten the net," Tisch said at Monday's press conference announcing the arrest of Manigone.

Thompson was shot multiple times on a Midtown sidewalk as he was walking toward the Hilton hotel. He was steps away from a side entrance to the hotel — where he was set to speak at UnitedHealth Group's investor conference — when a hooded gunman opened fire on him from behind.

The chief executive of the nation's largest health insurer was struck at least once in the back and at least once in the right calf, police said.

Surveillance footage showed the gunman firing his weapon as Thompson, wearing a blue suit jacket, walked several feet in front of him.

The gunman fled the scene, first on foot and then on an electric bike, which he rode into Central Park before ultimately escaping from New York City, police said.

Shell casings and bullets found at the scene had the words "deny," "defend," and "depose" written on them, according to multiple reports citing unnamed sources. BI couldn't independently confirm these details.

In the aftermath of the attack, the NYPD offered a $10,000 reward for tips leading to the gunman's arrest, with the FBI offering a reward of up to $50,000 for information leading to his arrest and conviction.

A spokesperson for UnitedHealth Group, the parent company of UnitedHealthcare, reacted to news of Manigone's arrest in a statement to BI, saying: "Our hope is that today's apprehension brings some relief to Brian's family, friends, colleagues and the many others affected by this unspeakable tragedy. We thank law enforcement and will continue to work with them on this investigation. We ask that everyone respect the family's privacy as they mourn."

• Executive security is getting a closer look after the fatal shooting of UnitedHealthcare's CEO.
• Private security companies say they've gotten an influx of calls.
• Executive security spending at S&P 500 companies has been on the rise — doubling from 2021 to 2023.

Update: A "person of interest," 26-year-old Luigi Mangione, was arrested in connection with Brian Thompson's death in Altoona, Pennsylvania, on Monday.

Following the fatal shooting of United Healthcare CEO Brian Thompson this week, some high-level executives are ramping up their own security.

The host of a series of national and international executive leadership summits told Business Insider that a surge of corporate leaders has been reaching out to him this week to inquire about security at the events.

Jeffrey Sonnenfeld — a professor and senior associate dean for Leadership Studies at Yale who also heads Yale's Chief Executive Leadership Institute — has been hosting summits for top company executives for decades.

He said that over the last few years the institute has significantly increased the security it provides executives at its events in the US. But things have shifted this week ahead of the institute's coming CEO Summit in Manhattan in December.

"What's really different for us, this coming one, is so many people inquiring to make sure we have it" Sonnenfeld said, in reference to event security. "We never used to get inquiries about it."

Sonnenfeld said the institute had increased security at its events long before Thompson's fatal shooting because company leaders have increasingly faced threats and general hostility from the public.

"Sadly, CEOs have been made into foils or scapegoats for the far-left and the far-right," he said, "so that the political grandstanding has looked to make excuses for whatever unhappiness people have."

This year marks the first time the December CEO Summit will have armed and uniformed NYPD officers all around it, Sonnenfeld said. But, he added, the CEOs are thrilled to get together to compare notes with other CEOs on what they're doing about security.

Meanwhile, the fatal shooting has led to a surge of interest in beefed-up security for company leaders, people at private security firms said.

Michael Kozhar, the vice president of operations at International Security Services, Inc., of Brooklyn told BI that in the past few days, his company has seen a rise in calls from executives and companies looking to upgrade their security.

Still, because the attack on the healthcare executive appears to have been targeted, Kozhar said there hasn't been a lot of action so far in terms of companies actually engaging in more security services beyond inquiries. "If these incidents become more frequent, the atmosphere surrounding the purchase of security services will change drastically," he cautioned.

Matthew Dumpert, managing director at Kroll Enterprise Security Risk Management, told CNBC on Thursday, that he'd also received calls.

"We had CEOs and other executive-level and board members reaching out to us all throughout yesterday and today to increase their own executive protection, their own personal security around the clock, 24/7," he said.

Because executives are the face of an organization, they can receive the brunt of the blame for their customers' frustrations, Dumpert told the outlet. And for organizations that deal in life and death matters — like health insurance companies — that ire can be even more potent.

Allied Universal, which provides a range of security and protection services to Fortune 500 companies, saw a surge of potential clients reaching out on Wednesday following the attack on Thompson, company leaders told The New York Times.

But it's not just the events of this week that are giving executives cause for concern.

Targeted attacks — both online and offline — on executives and their families have risen dramatically in the last five years, Chris Pierson, the CEO of digital executive protection agency BlackCloak, told the Times. The firm's data shows that the most frequently targeted executives work in the health care, biomedical, and pharmaceutical industries, according to the outlet.

In the last few years, companies have been increasing the amount they spend on security for their top executives.

Between 2021 and 2023, the median total value of security benefits provided to named executive officers at S&P 500 companies doubled, according to data shared with Business Insider from executive compensation research firm Equilar.

The prevalence of companies offering security benefits also increased modestly — by around 4% over the same timeframe, according to Equilar.

The shooting of Thompson, who didn't appear to have security protection when he was killed in Midtown Manhattan on Wednesday morning, sparked a dayslong manhunt for the suspect. As of Friday afternoon, the suspect is still at large, though authorities believe he has fled the city.

On Thursday, United Health Group, the parent company of UnitedHealthcare, issued a statement: "Our priorities are, first and foremost, supporting Brian's family; ensuring the safety of our employees; and working with law enforcement to bring the perpetrator to justice."

• Some health insurance companies are removing executive bios from their websites.
• The deletions came after the fatal shooting of UnitedHealthcare CEO Brian Thompson.
• CVS Health and BlueCross Blue Shield are among those who have removed executive bios.

Some health insurance companies have removed executive leadership bios from their websites after the fatal shooting of UnitedHealthcare CEO Brian Thompson.

Thompson died on Wednesday after a gunman shot him outside a Hilton hotel in New York City. Thompson was scheduled to speak at the company's investor conference.

The New York Police Department said the shooting appeared to be "a brazen, targeted attack." Police say the gunman left the scene on foot before using an electric bike. The gunman remains at large.

As of Friday, the "Our leadership" section on UnitedHealthcare's "About Us" page is no longer accessible. Clicking on the link through Google will redirect to the company's homepage. An archive of the page shows that the leadership section was publicly visible as recently as Wednesday.

When asked for comment, a UnitedHealthcare representative pointed Business Insider toward two separate statements published this week regarding Thompson's death. Neither addressed the removal of the leadership page on its website.

UnitedHealthcare's parent company, UnitedHealth Group, appears to have followed suit.

Following links to UnitedHealth Group's "Our Leaders" and "Board of Directors" pages from Google now read "Page Not Found." An archive link shows that the leadership section was visible as recently as Tuesday.

Blue Cross and Blue Shield, another major American health insurance company, also appeared to have removed the executive bio section from its website. An archive link for the company's site shows that its "Our Leadership" section was visible earlier this year. However, it's inaccessible at the time of writing.

Some of Blue Cross and Blue Shield's regional offices, including its Massachusetts branch, have also made their leadership web pages inaccessible to the public.

Clicking on a link to the "Company Leadership" page for the Massachusetts branch through Google will now lead to the message: "You are not authorized to access this page."

Medica, which provides health insurance plans in states like Iowa and Minnesota, confirmed to BI that it had removed its leadership page.

"The safety of Medica employees is our top priority and we have increased security for all of our employees," the statement read. "Although we have received no specific threats related to our campuses, our office buildings will be temporarily closed out of an abundance of caution."

Other companies like CVS Health still have executive leadership bios on their websites but have removed photos. A representative from CVS Health confirmed the decision to BI, but had no additional comment.

Centene also appeared to have removed photos of its top executives. An archive of the "Executive Leadership" page shows that photos were visible in September.

Representatives for UnitedHealth Group, Blue Cross and Blue Shield, and Blue Cross Blue Shield of Massachusetts did not immediately respond to a request for comment from Business Insider.

On Wednesday, moments after the news broke that Brian Thompson, the CEO of UnitedHealthcare, had been fatally shot in Midtown Manhattan, social media unleashed a barrage of caustic commentary about his death. In lieu of condolences, Americans from all walks of life shared barbed jokes, grim memes, and personal anecdotes about their own experiences with giant insurers like UnitedHealthcare.

On Facebook, UnitedHealthcare's statement about the murder of its chief executive elicited 46,000 reactions — 41,000 of which employed the laughing emoji. The company quickly turned off comments on the post, but hundreds of users shared it with arch commentary.

"The amount of laugh reacts on the original post speaks volumes lol," one user wrote.

"My thoughts & prayers were out of network," wrote another.

While the motive behind Thompson's murder remains unknown, the internet treated it as an occasion for ghoulish schadenfreude. America's health insurance system is so broken and cruel, people openly declared, that the death of one of its most powerful executives merited nothing but scorn and derision. "He was CEO when he was shot," read one tweet that received more than 120,000 likes. "Preexisting condition. Claim denied."

"The UnitedHealthcare CEO might be the most celebrated death on this app since Henry Kissinger," wrote another user on X.

Given the nature of social media, where the most provocative and emotion-laden commentary is engineered to rise to the top, it's not surprising that platforms from TikTok to Reddit would be filled with hateful invective. What's striking, however, is how the backlash revealed the depth of the bitterness toward health insurers. In the face of a man being gunned down in the street, people didn't keep their feelings toward insurers in check; rather, they seized on it as a moment to vent their rage. Everyone from right-wing influencers to tenured Ivy League professors responded to Thompson's killing by posting about what they saw as the injustices of America's health insurers. Even on LinkedIn, one of the internet's last bastions of civility and professionalism, hundreds of business executives, HR leaders, and tech managers shared deeply personal stories about how they and their loved ones had suffered at the hands of a healthcare bureaucracy that often delays and denies reasonable claims.

In one exchange, a hospital executive acknowledged that many Americans are fed up with health insurers. "As healthcare security professionals, we know that many see healthcare as a target for their anger," he wrote. "Family members who have lost a loved one may feel as though a physician, healthcare facility, or insurer is responsible for that loss."

Jill Christensen, a former vice president at Western Union, responded to the post by forcefully rejecting its wording. "In many instances, it's not feel, it's ARE responsible for that loss," she wrote. "I was diagnosed with Stage 4 cancer and UHC denied every claim. While today's event is tragic, it does not come as a surprise to the millions of people — like myself — who pay their OOP costs and premiums, only to be turned away at their greatest time of need."

The joking language of the internet has become a standard way for Americans to process tragic events, whether the September 11, 2001, attacks or the July 2024 assassination attempt on Donald Trump. But Thompson's murder sparked something different: an unparalleled public reckoning with one of the country's largest and most profitable industries. "When you shoot one man in the street it's murder," wrote one user on X. "When you kill thousands of people in hospitals by taking away their ability to get treatment you're an entrepreneur."

To some observers, the outpouring of ire also appeared to have an immediate effect on the industry itself. One day after Thompson's murder, Anthem Blue Cross Blue Shield announced that it was rescinding a controversial plan to limit coverage for anesthesia. "When patients become financially responsible because a health plan cuts how much they pay providers, that's what breeds all this anger," Marianne Udow-Phillips, a former Blue Cross executive, told Axios. An Anthem Blue Cross Blue Shield spokesperson told Business Insider, "It never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services. The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines."

The storm of invective surrounding Thompson's killing will soon subside, as online malice always does. But it's also possible that the CEO's death will mark an inflection point in the debate over America's privatized system of health insurance. On X, one user drew a direct line between the callousness of the internet's response to Thompon's murder and an industry that makes it hard for many Americans to receive the medical treatment they need.

"All jokes aside," the user tweeted, "it's really fucked up to see so many people on here celebrating murder. No one here is the judge of who deserves to live or die. That's the job of the AI algorithm the insurance company designed to maximise profits on your health."

Scott Nover is a freelance writer based in Washington, DC. He is a contributing writer at Slate and was previously a staff writer at Quartz and Adweek covering media and technology.

• The killer of UnitedHealthcare's CEO appears to have planned carefully, experts in NYPD manhunts told BI.
• He took key precautions that delayed his capture, they said — including fleeing into Central Park.
• The park is the only part of Manhattan not blanketed by surveillance cameras, they said.

Update: A "person of interest," 26-year-old Luigi Mangione, was arrested in connection with Brian Thompson's death in Altoona, Pennsylvania, on Monday.

As the search for the killer of UnitedHealthcare CEO Brian Thompson enters its third day, the New York Police Department continues to release key evidence in hopes that the public will help.

They've shared crisp, full-color surveillance photos of the suspect and dangled offers of $10,000 for tips leading to his capture. They've described his movements down to the minute, detailing how he stopped at a Starbucks before opening fire on the sidewalk outside the New York Hilton Midtown, then hopped on an electric bike, fleeing into nearby Central Park.

But the ongoing release of information is just a glimpse of what's taking place in the nation's largest police department: a round-the-clock mobilization mixing old-fashioned shoe-leather investigation with high-tech sleuthing.

Two veterans of high-profile NYPD murder manhunts described these efforts to catch the insurance giant CEO's killer to Business Insider, and they said it was no surprise that he remained at large nearly two days after the shooting.

Both said the shooter appeared to have planned carefully— and one raised the possibility that he had professional firearms training.

"First of all, it's a big-ass gun, and the way he's holding it speaks of the military to me — it's clear he knew what he was doing," said Joan Illuzzi, a former homicide prosecutor.

"That — and having his getaway so well planned — says to me that this is a well-thought-out assassination," said Illuzzi, who was chief of the Manhattan district attorney's trial division before leaving for private practice in 2022.

"He absolutely planned this out," said Salvatore Tudisco, a retired NYPD homicide detective.

Tudisco was chief investigator the last time there was a dayslong manhunt for the killer of a CEO in New York City — the millionaire tech founder Fahim Saleh.

Both Illuzzi and Tudisco said they thought the suspect would be identified soon, thanks to the clear surveillance images police have released to the national media.

"That's their best option — send it across the country. Someone will know him," Tudisco said of the photos.

Once he's ID'd, it may take a few days longer to actually apprehend him, the two said.

"To ride into Central Park, that's really bright," said Tudisco. "It's the only blind spot in a city where there's cameras everywhere."

"There are pockets of Central Park that don't have video," said Illuzzi, who's now of counsel at Perry Law in Manhattan.

Thompson's shooter most likely had a change of clothing in the gray backpack he wore, Illuzzi said.

As soon as they realized he biked into the park, the NYPD would have dispatched a small army of officers to pull video from the street surveillance cameras surrounding every footpath and roadway on its perimeter, Tudisco said.

The resulting scouring of surveillance video may have led police to an Upper West Side youth hostel two blocks west of the park, where the suspect is reported to have stayed the night before, Tudisco said.

Many key clues would have stemmed from tracing the shooter's path on the trail of cameras that recorded his movements before and after the shooting, Tudisco said.

A water bottle and burner phone that may have been discarded by the suspect are also reportedly being tested for clues, he said.

Then there are the clues left on the bullet shells themselves. Police said three shells had words written on them. One read "Deny," another "Delay," and the third "Depose."

These could suggest a motive, Illuzzi said. She said it was likely investigators were immersed in scouring litigation records and contested insurance claims for more clues.

• Brian Thompson, the CEO of UnitedHealthcare, was shot and killed in Manhattan Wednesday morning.
• Thirteen hours later, his home and that of his wife were targeted with bomb threats, police said.
• Police determined the threats were a hoax.

The homes of UnitedHealthcare CEO Brian Thompson and his wife in a suburb outside Minneapolis were targeted with fake bomb threats Wednesday evening, more than 13 hours after Thompson was shot and killed in Manhattan, police said.

Around 7 p.m. Wednesday, city employees in the Minneapolis suburb of Maple Grove received emails threatening to bomb Thompson's home and the home of his wife, according to incident reports released by the Maple Grove police department. Thompson and his wife lived in separate houses less than a mile apart.

Police checked both homes and determined the threats were a hoax. In a statement, Maple Grove police called the threats a form of "swatting," a kind of harassment.

The New York Police Department said Thompson was gunned down at about 6:45 a.m. Wednesday outside the Hilton hotel in midtown Manhattan. The shooter fled the scene before police arrived, and a manhunt is ongoing.

UnitedHealthcare is the largest private insurer in the US, and Thompson was in New York for an investor meeting when he was killed.

• UnitedHealthcare CEO Brian Thompson was killed by a gunman in New York City on Wednesday morning.
• Thompson worked at UnitedHealthcare for 20 years and was named its CEO in 2021.
• He grew up in Iowa and is survived by his wife and their two sons.

UnitedHealthcare CEO Brian Thompson died on December 4 after he was shot by a gunman in New York City in what the New York City Police Department called a "brazen, targeted attack." He was 50 years old.

The shooting took place at 6:46 a.m. outside a Hilton hotel in Midtown Manhattan, where Thompson was scheduled to speak at the company's investor conference.

A "person of interest," 26-year-old Luigi Mangione, was arrested in connection with Thompson's death in Altoona, Pennsylvania, on Monday.

UnitedHealth Group said in a statement that the company was "deeply saddened and shocked" by Thompson's death.

Here are five things to know about Thompson's life and career, and the homicide investigation.

Early life and education

Thompson attended South Hamilton High School in Jewell, Iowa, where he was named valedictorian. The school district released a statement memorializing him as "a star student, athlete, homecoming king, and a respected leader."

Thompson graduated from the University of Iowa in 1997 with a Bachelor's degree in business administration and accounting.

Accounting career

Thompson worked at the accounting firm PricewaterhouseCoopers, or PwC, from 1997 to 2004 as a manager in the firm's audit and transaction advisory services groups, according to his LinkedIn profile.

CEO of UnitedHealthcare

Thompson worked at UnitedHealthcare for 20 years, joining as a director on UnitedHealth Group's corporate development team in 2004. He rose through the ranks, becoming the CEO of the company's Medicare and retirement business in 2017 and of its government programs in 2019.

He was named CEO of UnitedHealthcare in 2021.

Thompson was one of four UnitedHealthcare executives named in a lawsuit filed by the City of Hollywood Firefighters' Pension Fund in May regarding allegations of insider trading. The suit alleges that Thompson sold $15 million of his shares in company stock before news of the Department of Justice's antitrust investigation into UnitedHealth became public, tanking its shareholder value.

UnitedHealthcare did not respond to a request for comment.

Shooting in New York City

Thompson was shot on Wednesday morning outside a Hilton hotel in New York City, where he was scheduled to speak at UnitedHealth Group's investor conference.

New York City Police Department commissioner Jessica Tisch said at a press conference on Wednesday that the shooting "does not appear to be a random act of violence."

"We are deeply saddened and shocked at the passing of our dear friend and colleague Brian Thompson, the CEO of UnitedHealthcare," the company said in a statement on Wednesday.

The statement continued: "Brian was a highly respected colleague and friend to all who worked with him. We are working closely with the New York Police Department and ask for your patience and understanding during this difficult time. Our hearts go out to Brian's family and all who were close to him."

At a press conference on Monday, the New York Police Department named Luigi Mangione as a "person of interest" in the shooting.

Mangione was arrested on firearms charges at a Pennsylvania McDonald's after an employee recognized him from surveillance images shared by authorities, police said.

Mangione was found to be in possession of a firearm and a suppressor that were "both consistent with the weapon used" in the shooting, the NYPD said.

Wife and family

Thompson is survived by his wife, Paulette Thompson, and their two sons. The couple lived in separate homes in Maple Grove, Minnesota, The Wall Street Journal reported.

"We are shattered to hear about the senseless killing of our beloved Brian," Paulette Thompson told Minnesota affiliate Fox 9. "Brian was an incredibly loving, generous, talented man who truly lived life to the fullest and touched so many lives. Most importantly, Brian was an incredibly loving father to our two sons and will be greatly missed. We appreciate your well wishes and request complete privacy as our family moves through this difficult time."

Paulette Thompson told NBC News that her husband had received "some threats" but that she didn't know the details.