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The man accused of gunning down a US insurance executive on the streets of Manhattan appeared in front of a judge Thursday to face federal charges including murder.
The hearing for Luigi Mangione in a New York courtroom came two weeks after the killing which brought into focus widespread public anger with the US health care system.
Earlier Thursday, federal prosecutors announced charges against Mangione, 26, in the fatal shooting of UnitedHealthcare chief executive Brian Thompson, including murder, stalking and firearms offenses.
Wearing shackles around his ankles, Mangione appeared in court, US media reported, hours after being extradited from Pennsylvania, where he was arrested last week after a days-long manhunt.
The fresh charges expand the case against the Ivy League graduate, coming two days after prosecutors filed separate state charges against him, including one count of murder in the second degree as "an act of terrorism."
Highlighting the intense media attention the case has garnered, multiple television networks covered his trip from Pennsylvania to New York live.
Dressed in an orange prison jumpsuit and appearing calm, Mangione left the Pennsylvania courthouse in a black SUV, escorted by several police vehicles.
After being flown by plane to an airport outside New York City, he boarded a helicopter to Manhattan, where television footage showed over a dozen officers, some in tactical gear, waiting to retrieve him.
New York Mayor Eric Adams was among the officials escorting Mangione.
"This act of terrorism and the violence that stems from it is not something that will be tolerated in this city," Adams told reporters. "We wanted to personally be here to show the symbolism of leading from the front."
Thompson's murder brought into focus widespread public anger against the US health care system and many social media users have since lionized Mangione.
Outside the Manhattan courthouse, protesters rallied in his defense, holding posters that read "Health over wealth" and "Luigi freed us."
- Health debate -
Mangione was arrested in Altoona, Pennsylvania, on December 9, five days after Thompson was shot dead on a Manhattan street.
Mangione made two brief court appearances in Pennsylvania Thursday. He waived a preliminary hearing on firearms and forgery charges and then agreed to be sent back to New York.
Police say a "life-changing, life-altering" back injury may have motivated Mangione, although they added that there was "no indication" he was ever a client of UnitedHealthcare.
Mangione was arrested following a tip from staff at a McDonald's restaurant in Altoona, where he was found wearing a mask and a beanie while using a laptop, and gave officers a fake ID, charging documents showed.
When he was arrested, Mangione had a three-page handwritten text criticizing the US health care system. As officers led him away, he shouted about an "insult to the American people."
Police have said Mangione's fingerprints matched those found near the crime scene, and that shell casings match the gun found on him when he was arrested.
Reports that the casings of the bullets allegedly fired by Mangione had the words "depose, deny, delay" inscribed on them prompted horror stories on social media about health insurers who allegedly used those very tactics to get out of paying for needed medical care.
Such fights with sick and ailing consumers are only one of the gripes many have with a health system that has also been criticized for mystery billing practices, opaque middlemen, confusing jargon and costly drugs.
J.Barnes--TFWP