Brian Thompson shooting: Words on killer’s bullet casings spark scrutiny on US health insurance company

It was still dark when Brian Thompson, chief executive of America’s biggest health insurance company, stepped out of his luxury hotel in Manhattan’s Midtown on Wednesday morning and walked across the street towards the Hilton.

After breakfast, he and scores of executives, investors and Wall Street analysts would be gathering in the second-floor ballroom for United Health Group’s annual “investor day”.

They would hear presentations about the dazzling performance of a business with projected revenues of at least $US450 billion ($694b) next year – most of which came from UnitedHealthcare, the arm of the health empire run by Thompson.

However, as the world now knows, Thompson – a 50-year-old father of two sons, who earned an annual salary of $US10 million – never made it to the meeting.

He was just a few feet from the Hilton’s entrance at 6.46am, local time, when a masked gunman wearing a dark hoodie and grey backpack stepped from behind a parked car.

The next few moments, caught on one of the CCTV cameras that are ubiquitous in that upmarket area, continue to be scrutinised for clues.

The footage shows the assailant had been waiting for several minutes, lurking by a side entrance.

Allowing Thompson, wearing a blue suit, to pass by him first, he then pulled out a gun fitted with a silencer and shot his target in the back from just a few feet away.

His victim stumbled and looked back at his assassin, who walked calmly towards him. The killer’s 9mm pistol malfunctioned but he cleared the jam and continued firing, hitting his target in the back and leg as he collapsed on the pavement and tried to crawl away.

The assassin then coolly walked off, breaking into a run only to cross the street before fleeing down an alleyway, mounting an electric bike and riding into nearby Central Park, where CCTV coverage is sparse.

Even if he hadn’t used a silencer on his gun – in movies, always the mark of a professional hitman – the premeditated but audacious assassination in the heart of Manhattan by a killer able to swiftly vanish, had the hallmarks of a Hollywood film.

And yesterday, fresh details emerged about the murder that has gripped the US and raised startling questions about the extent of anger over its controversial health-insurance industry.

Last night, police released a picture of the grinning gunman taken in a hostel in Manhattan’s Upper West Side. Police, who have offered a $US10,000 reward for information leading to his capture, believe that the suspect stayed at the hostel.

Other clues have emerged – among them that the killer stopped off before the attack in a nearby branch of Starbucks, where he was again captured on CCTV – this time wearing a mask and buying a bottle of water and two energy bars.

Investigators also discovered a mobile phone near the shooting which they believe was his – and obtained a search warrant to analyse its contents.

Officers have confirmed it was a “targeted” and “brazen” attack in a neighbourhood that at this time of year is heaving with tourists browsing the famous Christmas window displays along nearby Fifth Avenue.

But as the manhunt continued and investigators refused to comment on a possible motive, many Americans wasted little time in concluding that the victim’s death must have been related to his job at the top of a deeply loathed, trillion-dollar industry.

Suspicions that Thompson was shot in retaliation for his company’s behaviour, perhaps for a specific denial of insurance coverage, grew after police revealed that the words “deny”, “defend” and “depose” were found “meticulously” written in marker pen on three bullet casings at the scene of the murder.

Many have suggested this is a macabre reference to a 2010 book by Professor Jay M Feinman, an insurance law expert, titled Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims And What You Can Do About It.

The book is billed as an “expose of insurance injustice and a plan for consumers and lawmakers to fight it”.

Americans pay more for healthcare than in any other country – with total spending in 2022 reaching a jaw-dropping $US4.5 trillion, more than 17 per cent of US GDP.

And much of that goes to health insurers.

Indeed it’s rare to find an American who doesn’t regard their own country’s wildly profitable health insurers as ruthless blood-suckers, charging punitive premiums while doing everything they can to avoid paying out for treatments.

And UnitedHealthcare, which has tens of millions of customers and 140,000 staff, had a particularly bad reputation in this respect.

Thompson’s estranged wife Paulette has since revealed that he had received “some threats” that she believed were about “a lack of coverage”.

She added: “I don’t know details. I just know that he said there were some people that had been threatening him.”

Unsurprisingly, the company removed the names of its other executives from its website within hours of the shooting.

Some of them have also deleted their profiles from the social networking site LinkedIn.

Insiders say it’s not uncommon for health insurance company bosses to receive threats – while Philip Klein, a security company chief who has provided bodyguard services to Thompson in the past, said he was shocked he hadn’t been protected at the time of the shooting.

It also emerged that Thompson’s mansion in Maple Grove, Minnesota – close to his company’s headquarters – was targeted in a bomb threat 12 hours after his killing.

In an email to a local official, a pipe bomb was said to have been left at the house. Police, who found no explosives at the address, also searched his wife’s home a mile away.

After Thompson’s death, many ordinary Americans went online to say how much they hated his industry.

“I’m an ER nurse and the things I’ve seen dying patients get denied for by insurance makes me physically sick,” said one.

“I just can’t feel sympathy for him because of all of those patients and their families.”

Another wrote sarcastically: “The ambulance ride to the hospital probably won’t be covered.”

A third said: “This needs to be the new norm: EAT THE RICH.”

Whoever killed Thompson certainly knew how to handle a gun, experts have said. The silencer fitted to the weapon is designed to quieten the noise and reduce flash.

The gunman also assumed a practised shooting stance and showed no sign of panic when his pistol malfunctioned, smoothly and quickly clearing the jam and continuing to fire.

The killer’s decision to cycle into Central Park, where security cameras would have had much more trouble tracking him, was astute.

The son of a grain elevator worker, Thompson had joined UnitedHealth in 2004 and worked his way up.

He took over his new job running the insurance arm of the business in 2021. His reign at UnitedHealthcare had seen the company’s profits rise – but not without considerable controversy.

It has faced various inquiries and been accused by US Congressmen and federal regulators of routinely refusing to pay for medical operations and treatments.

The company is being sued by the estates of two people who died after it denied them healthcare coverage.

The lawsuits claim the company uses a secretive but deeply flawed AI algorithm called nH Predict, which forecasts how long patients will need to stay in rehab.

Designed to maximise profits for the company, it allegedly overrides doctors’ judgments and denies critical health coverage to elderly and disabled patients.

The company says the lawsuit has “no merit” and that the algorithm “is not used to make coverage determinations”.

Brian Thompson also faced a further lawsuit from investors alleging insider trading after he sold $US15 million worth of shares in his company before it was publicly disclosed that it is being investigated by the US Justice Department over alleged anti-competitive behaviour.

As an analyst hailed a “very dark day for all of health care”, the people at the top of a reviled industry must now worry about their own health and well-being.