Luigi Mangione is fighting extradition to face a murder charge in the CEO’s murder

The man accused of shooting and killing health insurance CEO Brian Thompson in New York clashed with police and shouted at reporters while in court Tuesday, as more emerged details about a possible motive for the murder.

Luigi Mangione appeared at an extradition hearing in Pennsylvania. His lawyer said the 26-year-old would contest being transferred to New York to face murder charges.

“He pleads not guilty to these crimes,” the lawyer said. “I haven’t seen any evidence that he’s the shooter.”

Different states in the US have different laws and court systems, so there is a process involved in transferring fugitives, which can take days or weeks.

Wearing an orange jumpsuit, Mangione tried to address reporters when he arrived at the hearing. He was heard shouting “completely unfair” and “insulting the intelligence of the American people” before being taken to court by officers.

Mangione was arrested Monday after he was spotted at a Pennsylvania branch of McDonald’s, following a days-long manhunt that spanned several states. He was allegedly found with a gun similar to the murder weapon, a silencer and fake identification.

Three manuscript pages were also in his possession. The New York police said they considered a claim of responsibility in Mr. Thompson’s fatal shooting because it appeared to register frustrations with the American health care system.

The 50-year-old UnitedHealthcare chief executive was gunned down by a masked man outside a Manhattan hotel in what authorities have called a targeted attack.

Mr Mangione was denied bail for the second time on Tuesday, after prosecutors said he was too dangerous to be released.

The judge then gave prosecutors 30 days to seek a warrant from New York Gov. Kathy Hochul to secure his extradition to the state.

Hochul later said he would provide her with one. “I am coordinating with the district attorney’s office and will be signing a request for a governor’s order to ensure that this person is brought to justice and held accountable,” he said.

Defense attorneys also have a two-week window to file motions against Mangione’s transfer to New York. A Pennsylvania prosecutor described the challenge as creating “more hoops … to jump through.”

Mr. Mangione looked around at the rows of reporters in court and smiled at times. At one point, he interrupted his own lawyer, who quickly calmed him down.

After the hearing Tuesday afternoon, that attorney, Thomas Dickey, spoke to reporters outside court. “You can’t rush to judgment in this case or any case,” he said. “He’s presumed innocent. Let’s not forget that.”

Mr. Mangione has been charged with several felonies in Pennsylvania, including providing fraudulent identification to police and possessing a firearm without a license. He is being held in a Pennsylvania state prison and will plead not guilty.

In New York, he faces separate charges, including murder, in the Dec. 4 killing of Mr. Thompson.

Thompson was named chief executive of the company, which is the largest private insurer in the US, in April 2021.

Before his death, he had received threats related to health care coverage, according to his widow, Paulette Thompson, but prosecutors have not suggested a motive for his killing.

On Tuesday, however, as police investigated evidence and worked to piece together Mr. Mangione’s movements after the shooting, more details emerged about his alleged grievances with the health insurance industry.

New York Police Department Chief of Detectives Joseph Kenny told Good Morning America that he had read a three-page handwritten note that was allegedly on the suspect when he was arrested.

“He gives some indication that he’s frustrated with America’s health care system,” he said. “He was writing a lot about his disdain for corporate America, and the healthcare industry in particular.”

The note, which has been seen by several US media outlets, refers to “parasites” who “made it happen”. He also allegedly writes that he acted alone.

Former friends who spoke to the BBC said Mangione had suffered a back injury. They said he had left a surfing community in Hawaii during the summer of 2023 to undergo spinal surgery.

RJ Martin, a former roommate of the suspect who met him in Hawaii, said the injury “prohibited him, at times, from doing a lot of normal things.”

Several details about Mr. Mangione’s background have emerged since his arrest. He was born in Maryland to a wealthy and well-known family, and police say he has ties to San Francisco, California. His last known address was in Honolulu, Hawaii.

He attended the University of Pennsylvania, an Ivy League university, where he earned a bachelor’s and master’s degree in software engineering.

Local media reported that Mr. Mangione’s mother had reported him missing last month, telling San Francisco authorities that she had not heard from her son since July.

“Our family is shocked and devastated by Luigi’s arrest,” Mr Mangione’s family said in a statement posted on social media by his cousin. “We offer our prayers to Brian Thompson’s family and ask people to pray for everyone involved.”

With additional reporting by Nada Tawfik