UnitedHealthcare CEO Brian Thompson Assassinated in Manhattan, Exposing Public Rage at Health Insurance Industry

On December 4, 2024, Brian Thompson, CEO of UnitedHealthcare, was shot and killed outside the New York Hilton Midtown in Manhattan. The assassination, allegedly carried out by 26-year-old Luigi Mangione, exposed widespread public anger at the American health insurance industry’s systematic denial of medical care for profit. The public reaction—celebrating the killing and lionizing the suspect—revealed the depth of rage at insurance companies’ business models that prioritize denying claims over providing healthcare, making this a watershed moment in American healthcare politics.

The Assassination

Brian Thompson, 50, CEO of UnitedHealthcare since April 2021, was in New York City to attend UnitedHealth Group’s annual investor meeting. At approximately 6:45 AM on December 4, 2024, he was shot multiple times outside the Hilton hotel entrance in a targeted attack.

The shooter used a handgun equipped with a suppressor and fled the scene. Words inscribed on the shell casings—“delay,” “deny,” and “depose”—referenced the insurance industry’s standard tactics for avoiding paying claims, as described in the 2010 book “Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It.”

These inscriptions transformed the killing from a random act of violence into a political statement about health insurance industry practices, specifically the systematic denial of medically necessary care to maximize corporate profits.

The Suspect: Luigi Mangione

After a five-day nationwide manhunt, police arrested Luigi Nicholas Mangione on December 9, 2024, at a McDonald’s in Altoona, Pennsylvania. An employee recognized him from NYPD-released photos, and police found him in possession of:

• A 3D-printed “ghost gun” and suppressor matching weapons used in the shooting
• Multiple fake IDs including the one used to check into a New York hostel before the killing
• A handwritten manifesto criticizing the health insurance industry

Background: Mangione, 26, came from a wealthy Baltimore family that owns country clubs and other businesses. He graduated as valedictorian from the elite Gilman School, then earned bachelor’s and master’s degrees in computer science from the University of Pennsylvania in 2020.

Health Issues: Mangione had posted online about suffering from spondylolisthesis, a painful lower back condition requiring spinal surgery with plates and screws. His writings suggested frustration with the healthcare system and insurance coverage for treatment.

Federal and State Charges

Mangione faces both federal and state charges:

Federal Charges (filed December 2024):

• First-degree murder in furtherance of terrorism
• Stalking resulting in death
• Criminal possession of a weapon
• Using a firearm silencer in a crime of violence

Federal prosecutors are seeking the death penalty.

State Charges (New York):

• Originally included terror-related murder charges, but a New York judge dismissed these in September 2025
• Second-degree murder charges remain active

Unprecedented Public Reaction: Celebrating the Killer

The public response to Thompson’s assassination shocked media commentators and political elites, revealing widespread rage at health insurance companies:

Social Media Celebration: Within hours of the killing, social media platforms filled with posts praising the assassination, mocking Thompson’s death, and expressing solidarity with the shooter. The response was not isolated or fringe—it represented a mainstream sentiment among millions of Americans who have experienced insurance claim denials.

Folk Hero Status: After his arrest, Mangione became lionized as a folk hero and sex symbol. Supporters created fan accounts, sold merchandise, and organized legal defense funds. This celebration of an alleged murderer demonstrated how deeply Americans despise the health insurance industry.

“Delay, Deny, Defend”: The words on the shell casings became a rallying cry, with people sharing their own stories of insurance companies delaying treatment, denying necessary care, and defending indefensible claim rejections—practices that have resulted in preventable deaths and suffering for millions of Americans.

Media Disconnect: Establishment media expressed shock and horror at the public reaction, revealing the disconnect between elites who profit from the healthcare system and ordinary Americans who suffer under it. Media figures condemned the “glorification of violence” while ignoring the systematic violence of insurance companies denying life-saving care.

UnitedHealthcare’s Systematic Denial Business Model

The public’s celebratory response reflected widespread recognition that Thompson led a company whose business model depends on systematically denying medically necessary care:

Claim Denial Rates: Under Thompson’s leadership, UnitedHealthcare had some of the highest claim denial rates in the industry. The company denied claims not because they lacked medical necessity, but because denial-then-pay-if-appealed is more profitable than paying legitimate claims immediately.

AI-Driven Denials: UnitedHealthcare deployed AI tools like “nH Predict” to automatically deny coverage for post-acute care, overriding physicians’ medical judgments. A lawsuit alleges the company knew the AI had a 90% error rate but continued using it because most patients wouldn’t appeal, making systematic wrongful denials profitable.

Prior Authorization Delays: The company implemented burdensome prior authorization requirements that delayed necessary care, leading to patient deaths while paperwork was processed. These delays served as de facto denials—patients often died, deteriorated beyond treatment, or gave up before receiving authorization.

Medicare Advantage Fraud: UnitedHealthcare engaged in systematic upcoding fraud, adding false diagnoses to increase government payments while denying care to the same patients they claimed were sick. This represented fraud in both directions—claiming patients were sicker to get higher payments, while denying them care based on claims they weren’t sick enough.

Thompson’s Role and Compensation

Brian Thompson joined UnitedHealth Group in 2004 and became CEO of UnitedHealthcare in April 2021. During his tenure, he oversaw:

• Expansion of Medicare Advantage enrollment to nearly 8 million beneficiaries
• Implementation of AI-driven claim denial systems
• Vertical integration of physician practices through Optum
• Systematic upcoding fraud that generated billions in government overpayments

Executive Compensation: Thompson’s compensation reflected profits generated by denying care. In 2023, his total compensation exceeded $10 million. This compensation came directly from denying medically necessary care to sick people—the more claims denied, the higher the profits and executive bonuses.

Stock Sales Before Death: Reports indicated Thompson sold significant UnitedHealth stock in the months before his death, potentially due to knowledge of impending DOJ investigations into the company’s fraud. This raised questions about insider trading alongside the fraud investigations.

Institutional Violence vs. Individual Violence

The public’s response highlighted a moral framework that many Americans apply to healthcare: insurance companies’ systematic denial of care represents violence against patients, making violence against insurance executives comprehensible as retaliation.

Deaths from Claim Denials: Studies estimate tens of thousands of Americans die annually due to insurance companies denying or delaying medically necessary care. These deaths result from corporate decisions to prioritize profits over patient survival—a form of institutional violence rarely prosecuted or even acknowledged by authorities.

Preventable Suffering: Beyond deaths, millions of Americans suffer needlessly when insurance companies deny treatments, medications, or procedures their doctors deem necessary. This suffering is not accidental but designed into the business model—making patients jump through hoops in hopes they’ll give up or die before the company has to pay.

Legal vs. Moral: The distinction many Americans drew was that while Mangione allegedly committed illegal violence, Thompson committed legal violence through a business model that kills and harms people for profit. The public reaction suggested many view the latter as worse than the former.

Healthcare as a Business vs. a Right

The assassination and public response exposed the fundamental contradiction in American healthcare: treating healthcare as a for-profit business creates incentives to deny care, while treating it as a human right requires providing care regardless of profitability.

Profit Maximization: As a publicly traded company, UnitedHealth Group has a fiduciary duty to maximize shareholder returns. In health insurance, maximum profits come from collecting premiums while denying claims. Thompson’s job was to maximize claim denials—making him effective at his role while harming millions of patients.

Captive Customers: Most Americans get health insurance through employers, giving them no choice of insurers. This captive market eliminates competitive pressure to provide good service, allowing companies like UnitedHealthcare to deny claims without losing customers.

Medical Bankruptcy: The U.S. is the only developed nation where medical bills cause personal bankruptcy. This results directly from insurance companies denying coverage for expensive treatments, leaving patients to pay or die.

Media and Political Class Response

The stark divide between public celebration and elite condemnation revealed class dynamics in American healthcare:

Media Condemnation: News outlets uniformly condemned the killing and expressed shock at public support for the suspect, framing it as “glorification of violence” without acknowledging the violence of systematic claim denials.

Political Deflection: Politicians issued statements condemning the murder while avoiding discussion of healthcare industry practices that generated the public rage. This deflection protected insurance industry donors while performing concern for the victim.

Missing Context: Media coverage focused on Mangione’s background, mental state, and the “senselessness” of the killing, while avoiding context about UnitedHealthcare’s business practices, claim denial rates, and the patients who died or suffered due to coverage denials.

Blame Shifting: Some commentators blamed “online radicalization” or “extremist rhetoric” for the killing, rather than examining how health insurance companies’ systematic denial of care creates justified rage among patients.

Regulatory Capture Enabler

Thompson’s assassination highlighted how regulatory capture enables insurance industry abuses:

No Regulation of Denials: Neither state insurance commissioners nor federal regulators impose meaningful limits on claim denial rates, prior authorization requirements, or denial review processes. Insurance companies can deny claims at will with minimal oversight.

Legal Immunity: ERISA (Employee Retirement Income Security Act) preempts state lawsuits against employer-provided health plans, giving insurance companies immunity from state court damages for wrongful denials. Patients cannot sue for compensatory or punitive damages even when wrongful denials cause death.

Weak Enforcement: State insurance departments rarely penalize insurance companies for excessive denials, and penalties when imposed are trivial compared to profits from denied claims.

Industry Lobbying: Health insurance companies spend hundreds of millions on lobbying to prevent regulations that would require them to pay legitimate claims, demonstrating regulatory capture where regulators protect industry profits rather than patients.

Vertical Integration and Conflicts of Interest

Thompson oversaw UnitedHealth’s strategy of vertical integration—owning both the insurance company and healthcare providers through Optum. This created systematic conflicts of interest:

Physician Employment: When UnitedHealth employs physicians through Optum while insuring patients through UnitedHealthcare, doctors face pressure to minimize care to reduce insurance costs—placing corporate profits above patient welfare.

Prior Authorization Self-Dealing: UnitedHealthcare requires prior authorization for treatments but processes these authorizations through Optum-employed physicians who are financially incentivized to deny care, creating an inherent conflict where the company judges its own payment obligations.

Data Exploitation: Vertical integration gives UnitedHealth access to detailed patient medical records, which it uses to identify opportunities to deny claims and upcode diagnoses for higher government payments.

Impact on Healthcare Discourse

The assassination and public reaction shifted American healthcare discourse:

Legitimized Rage: The widespread support for the alleged killer legitimized public anger at insurance companies, making it politically costly for politicians to defend industry practices without proposing reforms.

“Delay, Deny, Depose”: The phrase became shorthand for insurance industry practices, with patients sharing stories of how companies delayed urgently needed care, denied medically necessary treatments, and defended indefensible decisions to maximize profits.

Class Consciousness: The reaction revealed class dynamics where working Americans who suffer insurance denials have fundamentally different views from wealthy elites who profit from the system or can afford to bypass it.

Corporate Accountability: The killing raised questions about accountability for corporate executives whose decisions to maximize profits through claim denials result in patient deaths—legal killing versus illegal killing.

Systematic Corruption Exposed

Thompson’s death exposed systematic corruption in American healthcare:

Business Model Based on Harm: Health insurance companies’ core business model depends on denying medically necessary care, making patient harm a feature rather than a bug.

Government Enablers: Medicare Advantage programs like UnitedHealthcare’s use government funds (taxpayer money) while providing worse care than traditional Medicare, demonstrating government complicity in privatization schemes that harm beneficiaries.

Regulatory Failure: The absence of meaningful regulation of claim denials, prior authorization abuses, and denial appeal processes shows regulatory capture where government protects corporate profits rather than patient welfare.

Legal Immunity: ERISA preemption and limited state enforcement give insurance companies effective immunity for wrongful denials that cause patient deaths, demonstrating legal system capture.

Aftermath and Continuing Investigation

Following Thompson’s death:

• UnitedHealth Group faced intensified scrutiny of its Medicare Advantage fraud, AI-driven denials, and vertical integration conflicts of interest
• Multiple DOJ investigations continued into the company’s billing practices and potential antitrust violations
• Public attention focused on insurance industry practices, with patients sharing denial stories that revealed systematic patterns
• Insurance companies increased security for executives while making no changes to claim denial practices

The assassination did not result in healthcare reform or changes to insurance industry practices, demonstrating that even spectacular violence against an industry executive could not overcome regulatory capture and corporate political power. However, it revealed that millions of Americans view health insurance companies as legitimate targets of public rage due to business models that prioritize profits over patient survival.