Luigi Mangione, who is accused of killing UnitedHealthcare CEO Brian Thompson in Manhattan, pleaded not guilty Monday to murder charges in New York state that also charge him with terrorism.
Mangione was brought into a courtroom in lower Manhattan, escorted by several police officers. He was handcuffed.
When he was due to plead guilty, he leaned over the microphone and said he was "not guilty" of 11 counts, including the charge of murder as an act of terrorism.
If convicted, he faces a maximum sentence of life in prison without the possibility of parole.
Monday's hearing was Mangione, 26,'s second appearance in a New York court since he was arrested at a McDonald's in Altoona, Pennsylvania, five days after Thompson's murder.
Mangione was also indicted on a four-count federal indictment for Thomson's murder. He has not yet entered a plea to the charges in that case, and if found guilty, he could be sentenced to death.
According to the federal complaint, Manggione was found in a notebook with several handwritten pages that "expressed hostility toward the health insurance industry, and particularly toward wealthy executives."
The Oct. 22 memo allegedly described an intent to "punch" an insurance company executive during an investor conference in New York.
A small group of protesters gathered outside the Manhattan courthouse to show support for Mangione and displeasure with health insurance companies.
Kara Hey, a 42-year-old teacher who protested outside the courtroom, thinks it's wrong that Manggione was charged with terrorism.
"Just because he killed the CEO of a company doesn't make him a terrorist, and it doesn't make me feel like a terrorist," Haye said as she held up an "innocent until proven guilty" sign.
One person held a sign that read "deny, defend, remove" - words police say were etched into the bullet casings that killed Thompson.
Those words allude to the title of the book, which talks about how insurance companies try to avoid covering the costs of the insured, in order to achieve the highest possible profit.
While Thompson's killing was condemned by officials, Mangione was hailed as a national hero by some Americans.
Separate federal and state proceedings will be conducted against Mangione, and the trial is expected to begin first in the state proceedings in New York.
Mangione's attorney, Karen Friedman Anjifilo, said at the federal court hearing that the two sets of charges appear to be based on conflicting theories.
State charges charge him with intent to "intimidate the civilian population" and influence politics, while federal charges charge him with stalking and killing an individual.
She also said that the spectacle being made, as well as the statements of the officials, could lead to her client not having a fair trial.
"They are using him for political purposes, creating a spectacle. He is not a symbol, he is someone who has the right to a fair trial," said Anjifilo.
After a 30-minute hearing, Manggione was led out of the courtroom in handcuffs. He is being held at the Metropolitan Federal Prison in Brooklyn.
The next hearing is scheduled for February 21.
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