Luigi Mangione, the man suspected of killing the chief executive of UnitedHealthcare, underwent surgery and was reported missing in San Francisco before the shooting.
Brian Thompson, 50, CEO of the healthcare insurance giant, was gunned down last week in Midtown Manhattan, spawning a five-day manhunt that eventually led to Mangione’s arrest at a McDonald’s restaurant in Altoona, Pa.
Questions about Mangione’s alleged motives and background have swirled in the media since his arrest Monday. As prosecutors worked to bring him to New York to face charges, new details emerged about his life and his capture.
The 26-year-old Ivy League graduate from a prominent Maryland real estate family was charged with murder hours after his arrest. In New York, he also faces two counts of carrying a loaded firearm, one count of possessing a forged instrument and one count of criminal possession of a weapon.
In Pennsylvania, Mangione was initially charged with possession of an unlicensed firearm, forgery and providing false identification to police.
Before his court appearance in Pennsylvania on Tuesday, Mangione struggled with deputies. Emerging from a patrol car, he spun toward reporters and shouted, “This is clearly unjust and an insult to the intelligence of the American people!” He was forced inside by members of the Blair County Sheriff’s Department.
At the court appearance, Mangione’s attorney contested his client’s extradition to New York. The judge ruled that he had 14 days to file a writ of habeas corpus to determine whether the state’s detention was valid; if approved, a new hearing would be scheduled. Pennsylvania has 30 days to get a warrant from New York for Mangione’s extradition.
The Manhattan district attorney’s office said it’s seeking a warrant from the governor to try to force the extradition.
Mangione’s attorney said his client planned to plead not guilty to the Pennsylvania charges and not guilty to the murder charge in New York.
The slaying might have been motivated by Mangione’s anger with what he called “parasitic” health insurance companies and his disdain for corporate greed, law enforcement said in a bulletin obtained by the Associated Press.
Mangione wrote that the U.S. has the most expensive healthcare system in the world but is 42nd in life expectancy, according to the bulletin based on a review of Mangione’s handwritten notes and social media posts. Mangione wrote that UnitedHealthcare had “simply gotten too powerful, and they continue to abuse our country for immense profit.”
R.J. Martin, the owner of Surfbreak, a co-living community near Honolulu’s Ala Moana Beach Park in Hawaii, told the Honolulu Civil Beat that Mangione suffered from a misaligned vertebra that would pinch his spinal cord. Mangione underwent surgery and even texted Martin pictures of it.
Mangione lived at Surfbreak from January to June of 2022.
Martin said that, as a joke, he suggested the group’s book club read the manifesto of Ted Kaczynski, also known as the Unabomber, according to the publication. Mangione’s review of the book on his since-privated Goodreads account has been widely circulated on social media and reflects Mangione’s sympathy for Kaczynski.
“It’s easy to quickly and thoughtless write this off as the manifesto of a lunatic, in order to avoid facing some of the uncomfortable problems it identifies,” Mangione wrote. “But it’s simply impossible to ignore how prescient many of his predictions about modern society turned out.”
Mangione stayed in touch with members of Surfbreak after he left, but he stopped responding over the summer, according to Martin.
“He went radio silent in June or July,” he said.
Those who knew Mangione also sounded the alarm over his apparent silence in the weeks leading up to the shooting.
“Hey, are you ok? Nobody has heard from you in months, and apparently your family is looking for you,” one user wrote on X on Oct. 30, tagging Mangione’s account. The user’s account was private as of Tuesday.
Mangione’s mother filed a missing person report for her son in November in San Francisco, the Associated Press confirmed using two law enforcement sources. The San Francisco Police Department didn’t respond to requests for comment.
Posts from a since-deleted Reddit account, with details matching Mangione’s university, health condition, age and college major, indicate that the Reddit user suffered from spondylolisthesis — a condition in which a vertebra in the spine, usually in the lower back, slips out of place. The Reddit user wrote that his condition got worse after a surfing accident.
“My back and hips locked up after the accident,” the Reddit user wrote in July 2023. “I’m terrified of the implications.”
The Reddit user said he underwent spinal surgery weeks later, which appeared to have improved his symptoms. Mangione also posted an image of spinal fusion surgery as the banner for his X account.
Mangione’s Goodreads list included at least five books on grappling with chronic back pain, including “Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery.”
Mangione was the class valedictorian in 2016 at Gilman School, a private all-boys school in Baltimore, according to the Baltimore Sun. He is the grandson of Nicholas Mangione, a real estate developer who owned nursing homes, country clubs and a radio station in the area. Mangione graduated cum laude from the University of Pennsylvania. And he is the cousin of Republican delegate Nino Mangione in Maryland.
Mangione’s family said they couldn’t comment on the news and “only know what we have read in the media.”
“Our family is shocked and devastated by Luigi’s arrest,” the statement said. “We offer our prayers to the family of Brian Thompson and we ask people to pray for all involved.”
According to public records, Mangione spent time at Stanford University in 2019 and once worked for the Santa Monica company TrueCar, a digital marketplace for automobiles.
A spokesperson for Stanford confirmed that a person named Luigi Mangione was employed as a head counselor under the Stanford Pre-Collegiate Studies program between May and September 2019, and a TrueCar spokesperson confirmed Mangione worked for the company and left sometime in 2023.
A former co-worker at Stanford Pre-Collegiate Studies said Mangione seemed like a “really nice, goofy guy” during their time there. They asked to not be identified, as they had not spoken with him for several years.
The slaying of Thompson, who led the United States’ largest medical insurance company, has sparked a larger conversation about the shortcomings of the health insurance industry, as outcry and vitriol following his killing were aimed at UnitedHealthcare for having denied people treatment in their time of need.
Officials found bullet casings at the scene of the slaying that had the words “depose,” “deny” and “defend” engraved on them — similar to the phrase commonly used by critics of the insurance industry to describe how payments are delayed, claims are denied and insurers defend their actions.
UnitedHealthcare has faced backlash for using artificial intelligence to review claims and issue denials. The company faced a lawsuit last year brought by two families who said their now-deceased relatives were denied care by the insurer that was deemed necessary by their doctors.
Times staff writer Nathan Solis and the Associated Press contributed to this report.
