It happened in the gray, freezing dawn of a Wednesday in Midtown Manhattan. Brian Thompson, the 50-year-old CEO of UnitedHealthcare, was walking alone toward the New York Hilton Midtown for an investor conference. He never made it inside. A masked gunman, lying in wait, stepped out and fired. Thompson died, but the physical evidence left behind on the sidewalk sparked a firestorm of speculation and internet sleuthing that hasn't really quieted down since.
Honestly, the most chilling part wasn't just the brazenness of the attack. It was the three words meticulously scrawled on the united healthcare ceo shell casings.
"Deny," "Defend," and "Depose."
These weren't just random marks. They were a message. To the police, it looked like a clear motive. To the public, it felt like a manifestation of the deep-seated rage millions feel toward the American healthcare system.
The Words on the Brass
When the NYPD crime scene units arrived, they found more than just a body and a frantic crowd near the Rockefeller Center Christmas tree. They found six pieces of ammunition in total: three spent 9mm shell casings and three live rounds that had been ejected when the shooter’s gun jammed.
The shooter had apparently used a permanent marker—likely a Sharpie—to write on the brass.
Investigators later clarified that the word "Depose" was found on a casing from a round actually fired into Thompson. The word "Delay" was reportedly marked on one of the unfired cartridges that hit the pavement when the killer was clearing the jam. It’s a level of premeditation that moves this from a simple "crime of passion" into something much more theatrical.
Why those three words?
If you've ever dealt with a medical claim, these words might sound familiar. They are part of a mantra long used by critics of the insurance industry. Specifically, they mirror the title of a 2010 book by Jay M. Feinman: Delay, Deny, Defend: Why Insurance Companies Don't Pay Claims and What You Can Do About It.
The industry is often accused of a three-step dance:
- Delay the processing of the claim as long as possible.
- Deny the claim on a technicality or by using an algorithm.
- Defend the denial in court, knowing the patient likely doesn't have the resources to fight back.
By adding "Depose" to the mix, the shooter was likely referencing the legal process of taking sworn testimony, a stage many patients never reach because they give up or run out of money first.
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The Suspect and the "Ghost Gun"
The manhunt ended in a Pennsylvania McDonald's when a customer recognized 26-year-old Luigi Mangione. When he was tackled, police found more than just the 3D-printed "ghost gun" used in the shooting. They found a manifesto.
Mangione, a Ivy League-educated data engineer from a wealthy Baltimore family, wasn't exactly the "profile" of a typical hitman. He was a guy who reportedly suffered from chronic, debilitating back pain and had grown to despise what he called "parasitic" insurance companies.
The gun itself was a marvel of modern, DIY lethality. It was a partially 3D-printed Glock 19 clone, equipped with a 3D-printed suppressor. These "ghost guns" are notoriously hard to track, but the ballistic fingerprints matched the united healthcare ceo shell casings found on 54th Street perfectly.
The Public Reaction: A Divided Nation
This is where things got weird.
Usually, when a CEO is assassinated on a public street, there is a universal outpouring of grief. But as the details of the shell casings leaked, the internet's reaction was... polarized, to put it lightly. On platforms like X and Reddit, Mangione was briefly transformed into a folk hero for the "broken" generation.
People started sharing their own horror stories of UnitedHealthcare denying life-saving surgeries or medication. One Senate report from late 2024—just months before the shooting—actually showed that UnitedHealthcare’s denial rate for certain Medicare Advantage patients had jumped from roughly 11% to over 22% in just two years.
That’s a lot of angry people.
But we have to be clear: Thompson was a father of two. He was a human being walking to a meeting. Regardless of how one feels about the ethics of the American insurance model, the act was a cold-blooded murder. The tragedy is two-fold: a life was lost, and the systemic issues in healthcare were momentarily eclipsed by a violent act that solves exactly zero policy problems.
What Happens Now?
The legal proceedings against Mangione are still winding their way through the New York court system. While some of the more extreme "terrorism" charges were dismissed in late 2025, he still faces second-degree murder charges.
But the legacy of those shell casings remains.
They forced a conversation about "prior authorization" and the "denial-by-algorithm" culture that has become standard in big-box insurance. UnitedHealth Group has since vowed to make healthcare "better for everyone," but trust is a hard thing to rebuild when the primary evidence in a murder case is a direct quote of your own alleged business strategy.
Actionable Insights for the Average Patient
If you're reading this because you're frustrated with your own insurance denials, don't look to the sidewalk of 54th Street for answers. There are legitimate ways to fight back:
- Request the "Internal Criteria": By law, insurance companies must provide the specific clinical guidelines they used to deny your claim.
- The Power of the External Review: Most people don't know they have a right to an independent third-party review. If the external reviewer says the procedure is necessary, the insurance company must pay.
- Engage Your Doctor: Many denials happen because of "coding errors." Ask your provider's billing office to review the claim for "medical necessity" keywords.
The united healthcare ceo shell casings will likely end up in a museum of American corporate history or a high-profile evidence locker. They serve as a grim reminder of a moment when the frustration of a nation boiled over into a very personal, very permanent tragedy.
Stay informed about your rights as a patient. Don't wait for a crisis to understand how your policy works. The "Deny, Delay, Defend" strategy only works if the patient gives up—so don't.