Suspect in UnitedHealthcare CEO killing tussles with police outside Pennsylvania extradition hearing

The prime suspect in the killing of UnitedHealthcare CEO Brian Thompson struggled with police and yelled out as he entered an extradition hearing Tuesday afternoon in Pennsylvania.

Luigi Mangione, 26, faces charges of murder and four other crimes, according to a criminal complaint filed Monday in New York.

Mangione is accused of gunning down Thompson last week in front of a Midtown Manhattan hotel. Thompson, of Maple Grove, was headed to an investors conference about 6:45 a.m. Dec. 4 when he was shot from behind by a man. That man then ran off and was seen on surveillance cameras shortly after riding a bicycle into Central Park.

While being led into court Tuesday, Mangione could be heard shouting about an "insult to the intelligence of the American people." Mangione and his defense attorney are fighting attempts to have him extradited to New York. His attorney Thomas Dickey said Mangione wants a hearing on the issue. Mangione was denied bail.

"You can't rush to judgment in this case or any case," Dickey said after Tuesday's court appearance. "He's presumed innocent. Let's not forget that."

A dayslong manhunt ended Monday when authorities arrested Mangione at a McDonald's in Altoona, Pa. Mangione was in possession of a "written admission about the crime" when he was taken into custody the criminal complaint said.

In New York, Mangione was charged with one count of second-degree murder, two counts of second-degree possession of a weapon, one count of second-degree possession of a forged document and one count of third-degree criminal possession of a firearm, the court documents said. In Pennsylvania, Mangione was charged with possession of an unlicensed firearm, forgery and providing false identification to police.

Police found a three-page handwritten document that allegedly spoke to the suspect's motivation in the killing. The document criticized health care companies for putting profits above care and mentioned UnitedHealthcare specifically, according to the New York Times and CNN. Joseph Kenny, chief of detectives with the New York Police Department, said the document did not target other individuals.

"It does seem he has some ill will toward corporate America," Kenny said at a news conference Monday.

According to police, the document said: "I do apologize for any strife or traumas but it had to be done. Frankly, these parasites simply had it coming."

According to the New York criminal complaint, Mangione with "intent to cause the death of another person" carried out the killing by firing several times, hitting Thompson and causing the executive to collapse to the ground. An autopsy listed Thompson's cause of death as a gunshot wound to the torso, the complaint said.

The killing has sparked a surge of vitriol against health insurance companies. In Minnesota, Minnetonka-based Medica said it was temporarily shutting down its headquarters in Minnetonka and offices in other states. Minneapolis-based UCare also announced it was closing offices after receiving a "concerning" phone call.

An NYPD report pointed to fear that Mangione could inspire other acts of violence.

"Based on observed initial online reactions to the shooting, including celebrations of the killing of a health insurance executive, there is a risk that a wide range of extremists may view Mangione as a martyr and an example to follow," the NYPD report said, according to the New York Times.

Private funeral services for Thompson were held Monday in the Twin Cities.

Thompson's killing set off a weeklong search for the gunman. In a news conference Monday afternoon, New York City Police Commissioner Jessica Tisch identified the man as 26-year-old Mangione.

Mangione's family said in a statement "we are devastated by this news."

"Unfortunately, we cannot comment on news reports regarding Luigi Mangione," the family said in a statement issued by Maryland State Delegate Nino Mangione, apparently a cousin of Luigi Mangione. "We only know what we have read in the media. Our family is shocked and devastated by Luigi's arrest. We offer our prayers to the family of Brian Thompson and we ask people to pray for all involved."

Mangione had used a fake New Jersey driver's license sporting the name "Mark Rosario" when he checked into a New York hostel Nov. 24. Police in Pennsylvania, who responded to the McDonald's after an employee recognized Mangione and called them, found him in possession of a forged driver's license with the name "Mark Rosario" on it, and determined it was the same ID he used when he checked into the HI New York City Hostel. Officers also found a semi-automatic pistol with what appears to be a 3D-printed loaded receiver with a metal slide and silencer, similar to the weapon shown in surveillance video that captured the shooting outside the Hilton Hotel.

Luigi Mangione is due to appear in a New York court later this month.

Christopher Snowbeck and the Associated Press contributed to this story.