Brian Thompson's chilling warning to UnitedHealthcare executives before he was assassinated

UnitedHealthcare CEO Brian Thompson had warned his fellow executives at the insurance company about its negative public image months before he was shot dead.

Thompson, 50, tried to focus on each individual patients' needs during his time as CEO of the massive insurance company, colleagues told the Washington Post.

He also argued in internal discussions with fellow executives earlier this year that average Americans did not understand UnitedHealthcare's role in the nation's healthcare system - and urged executives to focus on the steps it was taking to eliminate out-of-pocket costs for lifesaving drugs.

'He understood that the public was frustrated with what they perceived the company's actions to be,' an unidentified insider told WaPo.

'He was actively articulating a vision that helped better educate and help people understand what the company is doing.' 

The company and its parent, UnitedHealth Group, was receiving bad publicity at the time amid a Department of Justice investigation and claims that Thompson was engaging in insider trading.

It was also facing outrage among its members over claims that it made billions of dollars by denying healthcare to the ill and elderly.

Police now say that outrage led 26-year-old Luigi Mangione to open fire at Thompson at point-blank range as he was walking outside of a hotel in midtown Manhattan on December 4.

The alleged assassin was caught while eating at a McDonald's in Altoona, Pennsylvania, where staff members and patrons recognized Mangione as the suspect caught on surveillance footage.

He was then taken into custody on firearm charges in the state, with police saying he had a 3D-printed pistol and black silencer loaded with one Glock magazine comprising six 9mm full-metal jacket rounds.

New York police officers were later able to match that ammunition with the ones from Thompson's death - when Mangione allegedly labeled 'depose,' 'deny' and 'defend.'

Mangione also reportedly had a manifesto outlining his grievances against UnitedHealthcare.

'To save you a lengthy investigation, I state plainly that I wasn't working with anyone. This was fairly trivial: some elementary social engineering, basic CAD, [and] a lot of patience,' he allegedly wrote in the manifesto, according to the Daily Beast. 

He went on to say he had 'respect' for federal investigators, and apologized for causing any 'traumas,' but seemed to defend his alleged actions.

'Frankly these parasites had it coming,' the manifesto wrote. 

It also reportedly claimed that the United States had the 'most expensive healthcare system in the world,' but blasted the system for making America only the 42nd in life expectancy.

New York City police now say they have 'no indication' to suggest Mangione was ever a client of the insurance company.

Chief Joseph Kelly, though, noted to NBC New York that the manifesto 'does make mention that it is the fifth largest corporation in America, which would make it the largest healthcare organization in America.

'So that's possibly why he targeted the company,' Kelly suggested. 

But UnitedHealth Group has fought back against the hatred in the aftermath of Thompson's death.

A spokesperson for the company told the Washington Post that its insurance division pays about 90 percent of medical claims when they are submitted, and of the remainder, only 0.5 percent are 'due to medical or clinical reasons.'

Allies of the company also say the complexities of the healthcare system in the US is to blame - arguing that many of the price hikes that consumers blame on insurance companies could be traced back to hospitals and doctors raising their own prices, which are then passed on to patients.

'Together with employers, governments and others who pay for care, we need to improve how we explain what insurance covers and how decisions are made,' UnitedHealth Group CEO Andrew Witty wrote in an op-ed for the New York Times on Friday.

'Behind each decision lies a comprehensive and continually updated body of clinical evidence focused on achieving the best health outcomes and ensuring patient safety.'

He had earlier made similar remarks to employees following Thompson's death, saying UnitedHealthcare would keep putting 'patients, consumers and members' first in the company's 'journey to help everyone who needs it within the health environment.'

Witty had argued in a video that the insurance company's 'mission... is truly to make sure that we help the system improve by helping the experiences of individuals get better and better.'

He said its 'role is a critical role' in making sure that care is 'safe, appropriate and is delivered when people need it.

'We guard against the pressures that exist for unsafe care or for unnecessary care to be delivered in a way which makes the whole system too complex and ultimately unsustainable,' Witty argued.

'So we continue to make that case,' Witty said. 'We will continue to do the work we do.' 

In a follow-up memo, Witty reiterated that the company would stay its course, despite Thompson's shooting - and the public support for Mangione.  

'We're going to make sure medicines are filled, infusions are administered and people can navigate their therapies for the rarest states of disease. 

'And we'll be there when people are coming out of the hospital — if only just to hold their hand as they get back on their feet.' 

Yet the insurance company is once again in hot water over previously undisclosed internal documents that show UnitedHealth Group had been planning to limit coverage for the 'gold standard' in therapy for children on the autism spectrum.

Costs to the company have ballooned in recent years alongside autism spectrum disorder diagnoses due to greater awareness and improved screening.

The cost-cutting initiative targets children enrolled through the company’s state-contracted Medicaid plans that serve the country’s poorest people, including 10,000 children with autism.

The specific therapy that internal documents target is applied behavior analysis, which the company itself admits is the ‘evidence-based gold standard treatment for those with medically necessary needs.’

Internal documents show that Optum, which manages mental health benefits for United, aims to ‘prevent new providers from joining the network’ and ‘terminate’ existing ones, even while acknowledging a national shortage of covered counselors. 

The company is also mounting ‘rigorous’ clinical reviews to determine the medical necessity of each patient's therapy, which can lead to coverage denials.