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A message left at the scene of a health insurance executive’s fatal shooting — “deny,” “defend” and “depose” — echoes a phrase commonly used to describe insurer tactics to avoid paying claims.
The three words were written on the ammunition a masked gunman used to kill UnitedHealthcare CEO Brian Thompson, according to two law enforcement officials who spoke to The Associated Press on condition of anonymity Thursday. They’re similar to the phrase “delay, deny, defend” — the way some attorneys describe how insurers deny services and payment, and the title of a 2010 book that was highly critical of the industry.
Police haven’t officially commented on the wording or any connection between them and the common phrase. But Thompson’s shooting and the messages on the ammunition have sparked outrage on social media and elsewhere, reflecting a deepening frustration Americans have over the cost and complexity of getting care.
🚨UPDATE: Below are photos of a person of interest wanted for questioning regarding the Midtown Manhattan homicide on Dec. 4. This does not appear to be a random act of violence; all indications are that it was a premediated, targeted attack.
— NYPD NEWS (@NYPDnews) December 5, 2024
The full investigative efforts of… pic.twitter.com/K3kzC4IbtS
What does the phrase mean?
“Delay, deny, defend” has become something of a rallying cry for insurance critics. The terms refer to insurers delaying payment on claims, denying claims, and defending their actions.
The phrase has been used to describe many types of insurers — auto, property, and health.
“The longer they can delay and deny the claim, the longer they can hold onto their money and they’re not paying it out,” said Lea Keller, managing partner at Lewis and Keller, a North Carolina-based personal-injury law firm.
“Delay, Deny, Defend” is also the title of a 2010 book by Jay Feinman that delves into how insurers handle claims.
“All insurance companies have an incentive to chisel their customers to increase profits,” says an excerpt on the book’s website.
How does the phrase relate to UnitedHealthcare?
UnitedHealthcare provides coverage for more than 49 million Americans and brought in more than $281 billion in revenue last year as one of the nation’s largest health insurers. UnitedHealthcare and its rivals have become frequent targets of criticism from doctors, patients, and lawmakers in recent years for denying claims or complicating access to care.
Critics say insurers are increasingly interfering with even routine care, causing delays that can, in some cases, hurt a patient’s chances for recovery or even survival.
What is the criticism of insurers?
Doctors and patients have become particularly frustrated with prior authorizations, which are requirements that an insurer approve surgery or care before it happens.
UnitedHealthcare was named in an October report detailing how the insurer’s prior authorization denial rate for some Medicare Advantage patients has surged in recent years. The report from the U.S. Senate Permanent Subcommittee on Investigations also named rivals Humana and CVS.
Insurers say tactics like prior authorization are needed to limit unnecessary procedures and prevent the overuse of care to help control costs.
Frustrations extend beyond the coverage of care. Expensive breakthrough medications to slow Alzheimer’s disease or help with obesity are frequently not covered or have coverage limits.
“Many Americans view these companies as driven by profit rather than a commitment to serve their customers,” said Mario Macis, a Johns Hopkins economist who studies trust in the health care system. “And this creates a big disconnect.”
What reactions have emerged on social media?
Anger and vitriol against health insurers filled social media in the wake of Thompson’s killing. Users’ reactions — and in many cases jokes — populated comment sections teeming with frustration toward health insurers broadly and UnitedHealthcare in particular.
“I would be happy to help look for the shooter but vision isn’t covered under my healthcare plan,” one comment read on Instagram.
“Thoughts and prior authorizations!” wrote another user.
How do Americans feel about insurers?
In the U.S. healthcare system, patients get coverage through a mix of private insurers such as UnitedHealthcare and government-funded programs such as Medicaid and Medicare. That can prove particularly frustrating for doctors and patients because coverage often varies by insurer.
Polls reflect those frustrations with the healthcare system in general and insurance companies in particular.
About two-thirds of Americans said health insurance companies deserve “a lot of blame” for high health care costs, according to a KFF poll conducted in February.
A 2023 KFF survey of insured adults found that most give their health insurance an overall rating of “excellent” or “good” — but a majority also said they experienced a problem using their insurance in the previous year. That included denied claims, provider network problems, and pre-authorization problems. Nearly half of insured adults with insurance problems said they were unable to resolve them satisfactorily.
The day after Thompson was shot and killed, UnitedHealth Group said it was focused on supporting his family, ensuring the safety of its employees, and working with law enforcement to "bring the perpetrator to justice."
"So many patients, consumers, health care professionals, associations, government officials, and other caring people have taken time out of their day to reach out," the company said in a statement today. "We are thankful, even as we grieve."
UnitedHealth said it will continue to serve those who "depend on us for their healthcare."
Tens of thousands of people have expressed support on social media for the killing of UnitedHealthcare’s CEO, or sympathized with it, in what at least one researcher is calling a worrying sign of radicalization among segments of the U.S. population.
“And people wonder why we want these executives dead,” Taylor Lorenz, a former New York Times and Washington Post journalist, wrote on Bluesky a few hours after the CEO, Brian Thompson, 50, was gunned down in Manhattan by a man with a silenced pistol. After a backlash, Lorenz later posted, “No, that doesn’t mean people should murder them.”
The Network Contagion Research Institute at Rutgers University identified thousands of similar posts on X within hours of the killing. The posts, which could have been viewed by more than 8.3 million accounts, garnered 180,000 likes and 24,400 reposts, according to the institute.
“The surge of social media posts praising and glorifying the killing of UnitedHealth CEO Brian Thompson is deeply concerning,” said Alex Goldenberg, a senior adviser for the institute and a fellow at Rutgers. (Thompson was CEO of UnitedHealthcare, not of UnitedHealth Group, its parent company.)
“We’ve identified highly engaged posts circulating the names of other healthcare CEOs and others celebrating the shooter," he said. "The framing of this incident as some opening blow in a class war and not a brutal murder is especially alarming.”
Law enforcement officials have been warning for years of a heightened risk of political violence from a small minority of Americans, mainly on the right, radicalized on social media and marinating in conspiracy theories. (Police have not revealed information about the killer’s possible motive.)
These posts appeared to come mostly from accounts that have expressed far-left views, but some came from far-right accounts as well, noted Tobita Chow, a climate activist whose post summing up the sentiment reached millions of accounts.
“My notifications are mostly a cascade of populist rage,” he posted. “Checking people’s profiles, it’s coming from across the political spectrum: leftists, normie Dems, MAGA, a libertarian or two, and many people whose presence on here is otherwise entirely apolitical.”
The main theme animating many of the posts about the Thompson killing was that UnitedHealthcare and other insurance companies harm and kill Americans by denying coverage in the name of profit. Many posts raised an announcement last month by Anthem Blue Cross Blue Shield — which covers consumers in Connecticut, New York, and Missouri — that it would no longer pay for anesthesia care if a surgery or procedure goes beyond an arbitrary time limit, regardless of how long the procedure takes. (Anthem BCBS reversed course on the policy Thursday.)
“Then people wonder why a health insurance CEO was gunned down … because insurance companies pull this garbage,” one X user wrote.
On the official Facebook post about Thompson’s death from UnitedHealth Group, the parent company of UnitedHealthcare, most people reacted with the “laughter” emoji. Out of approximately 40,000 reactions on the post, 35,000 used the “Haha” emote and 2,200 used the “Sad” emote.
Some of the top sitewide posts on Reddit after the shooting were celebratory, ranging from memes that congratulated the shooter to top replies in subreddits like “r/nursing” that created a mock coverage review and claim denial for Thompson’s care. “This fatal shooting has been reviewed by a peer and is considered a non-covered experimental procedure,” read a reply with over 2,400 upvotes.
Thompson was the father of two teenagers. Law enforcement officials told NBC News they found the words “deny,” “defend” and “depose,” written on the shell casings found at the shooting scene. Those words seem to echo the title of a 2010 book, “Delay Deny Defend,” whose subtitle is, “Why insurance companies don’t pay claims and what you can do about it.” The author declined to comment.
Lorenz, who was a technology reporter for The New York Times from 2019 to 2022 and a columnist for the Washington Post from 2022 to earlier this year, also posted the photo of another insurance company CEO with a birthdate and a blank date of death. (That post has since been removed.) And she reposted a post that said: “hypothetically, would it be considered an actionable threat to start emailing other insurance CEOs a simple, ‘you’re next’?”
Lorenz, who now hosts a popular podcast for Vox Media and has a Substack newsletter, said in an email to NBC News that she was not seeking to justify violence. She noted that she later posted: “I hope people learn the names of all of these insurance company CEOs and engage in very peaceful letter writing campaigns so that they stop ruthlessly murdering thousands of innocent Americans by denying coverage.”
In the email to NBC News, she said she didn’t intend to suggest that she personally wanted healthcare executives dead.
“My post that you cited below uses the royal ‘we’ and explains the public sentiment surrounding the event. People absolutely want healthcare executives dead because these executives are responsible for unfathomable levels of death and suffering. … People have a very justified hatred toward insurance company CEOs because of the death and suffering they facilitate. It’s interesting how you don’t consider that violence.”
She added, “Me surfacing commentary that OTHER people post like Jenny, is not me endorsing those people and their posts. I can’t believe I have to explain to a reporter in 2024 that retweets are not endorsements.”
One of the most read X posts on the subject came from Chow, the climate activist. In an interview, he said he was not condoning the killing but was calling attention to populist anger about the private health insurance system.
“Saw mainstream news coverage about the killing of the CEO of United Healthcare on TikTok and I think political and industry leaders might want to read the comments and think hard about them,” he wrote in a post that got 137,000 likes.
“Compassion withheld until documentation can be produced that determines the bullet holes were not a preexisting condition,” one user responded.
“My take is that there is a great deal of populist anger about the way corporations in private health insurance can just abuse people and ruin people’s lives and in the case of health insurance even potentially leave them to die with impunity and for profit,” Chow said. “Obviously I don’t think the solution to that is vigilante assassinations, but I think business and political leaders need to take seriously where this sentiment is coming from.”
He said the killing produced an outpouring of complaints about UnitedHealthcare specifically.
Many social media users shared a chart from the finance website ValuePenguin that showed UnitedHealthcare had the highest claims denial rate among major insurance companies.
While the gunman’s motive is not yet known, healthcare industry professionals have experienced escalating threats, said Drew Neckar, a principal consultant at Cosecure, a security and risk management company.
“The health care sector specifically has seen a pretty significant increase in violence, whether that be physical violence, threats, et cetera. It’s been a problem for decades, but it has significantly increased since the pandemic,” he said.
Neckar noted that the threats are usually aimed at front-line providers such as doctors and nurses, though he said he has also noticed an increase in threats against healthcare executives.
“There isn’t a healthcare organization I’ve worked with in the past several years that hasn’t experienced at least a 25 to 50% increase in actual violence against staff and threats of violence against staff,” he said.
Shannon Watts, founder of the gun violence prevention group Moms Demand Action, vividly recalls the endless, losing battles loved ones waged against UnitedHealthcare for coverage sought by her late stepfather, who was dying from glioblastoma in the early 2000s.
Despite her bitterness over UnitedHealthcare’s treatment of her stepfather, Watts was horrified to read the vitriol aimed at the slain executive.
“You know it was really across all platforms. It was shocking to me to see prominent people, not just bots, defending, condoning, mocking, celebrating gun violence,” she said.
“Two things can be true: The health insurance system is broken and must be fixed, and also gun violence and murder is wrong.”
As law enforcement officials continue to search for the gunman who killed Thompson outside the New York Hilton Midtown in Manhattan, the site is preparing to host an annual federal law enforcement luncheon tomorrow.
The annual event is a gathering of federal and local law enforcement members.
After officials said investigators believe the gunman may have traveled to New York by bus, Greyhound told NBC News in a statement that it was "fully cooperating with authorities on this active investigation."
A spokesperson said the company was not able to give more information, citing the investigation.
Officials are working to determine whether they can find a passenger name among the tickets purchased for an Atlanta-to-New York trip late last month.
Investigators believe the man sought in connection with yesterday's shooting may have traveled to New York City from Atlanta by bus last month, three senior law enforcement officials familiar with the case told NBC News.
Officials are working to see whether they can find a name from the tickets purchased for a Nov. 24 Greyhound trip that might help identify the gunman.
Chief executives and other high-level corporate officers are seeking additional security protection after the brazen slaying of UnitedHealthcare’s chief executive officer in New York, according to a top risk management firm.
“We had CEOs and other executive level and board members reaching out to us all throughout yesterday and today to increase their own executive protection, their own personal security around the clock, 24/7,” said Matthew Dumpert, managing director at Kroll Enterprise Security Risk Management.
“An executive is the face of the organization,” he said in an interview. “A CEO is the lightning rod that attracts the ire regardless of the product or services sold.”
The killing of UnitedHealthcare CEO Brian Thompson occurred amid an increase in threats to people in the healthcare industry.
“The ire and the animosity that our front-line healthcare workers experience every day in the hospital in the critical care environment does extend to the insurance industry to a degree,” said Dumpert. “And it’s because of a lot of those same red-flag indicators of potential violence.”
Thompson’s company, a division of UnitedHealth Group, is the largest payer of health insurance benefits in the United States.
Police believe the gunman who fatally shot the 50-year-old Thompson on Wednesday morning outside a midtown Manhattan hotel targeted him for some unknown reason as Thompson walked to a UnitedHealth Group investors meeting unaccompanied by any security.
But there was immediate public speculation after the slaying that Thompson had been shot in connection with his company’s relatively high rate of denial of beneficiaries’ healthcare claims.
Bullet casings found at the shooting scene carried the words “deny,” “defend” and “depose,” a possible reference to the title of a 2010 book about insurance companies denying claims benefits. The gunman remained at large as of Thursday afternoon
“The loss of life here ... the impact of family, impact of company, impact of friends, is just overwhelming, absolutely overwhelming,” Pearson said in an interview with CNBC.
“I personally have not seen anything like this,” he said. “I don’t think we’ve seen anything to this level in the United States.”
Pearson said Thompson’s slaying could affect security arrangements for executives and how protection firms evaluate their risks at public events, board meetings, conferences and speaking engagements “where their physical presence is known or likely to be anticipated.”
“I think that’s really the new risk that has to be dimensioned today,” he said.
Thompson did not have a dedicated security detail, in contrast to some other executives in the health insurance sector.
Dumpert said the companies who have sought extra protection from Kroll in the past 36 hours range across industry sectors.
Twenty percent of S&P 500 companies list some kind of security benefit for chief executives, according to recent proxy statements.
A CNBC analysis of data from market intelligence firm AlphaSense found this is around 7 percentage points higher than a decade ago.
UnitedHealth’s two most recent proxy statements do not show any current or former executives receiving regular company-funded security services.
Most companies disclose private jet services for executives’ security if it is provided.
In health care, Cigna, Humana, and UHG disclose such benefits in their proxy statements for their CEOs.
Vaccine makers Moderna and Pfizer in 2023 revealed that they spent upwards of $1 million on executive security for their CEOs.
In a proxy filing two days before the shooting, Walgreens said it provides home security services for the pharmacy company’s CEO, Tim Wentworth.
“To protect Mr. Wentworth against possible security threats to him and his family members, the company requires that Mr. Wentworth accept such personal security protection while he serves as CEO,” Walgreens said in its filing.
“The company believes that the costs of this security were appropriate and necessary, particularly in light of the heightened risk environment in the retail pharmacy industry,” said Walgreens.
CVS Health disclosed in a proxy statement in 2023 that it required then-CEO Karen Lynch to use its corporate aircraft “under an executive security program,” for both business and personal travel.
“Similar to our approach to aircraft, Ms. Lynch uses a corporate driver for travel as part of our executive security program to minimize and more efficiently use travel time, protect the confidentiality of travel and our business, and enhance the CEO’s personal security,” that filing said.
Lynch was replaced as CEO in October by David Joyner.