As large companies grapple with fears about safety in the aftermath of the killing of UnitedHealthcare CEO Brian Thompson Wednesday morning in Manhattan, recent investigations have indicated that UnitedHealthcare may have made its coverage policies and procedures more stringent during Thompson’s tenure. Observers have speculated as to whether the insurer’s policies may have been a motive in the tragic death of the Minnesota father of two boys.

UnitedHealthcare, which insures more than 29 million Americans, and its parent company UnitedHealth Group, are no strangers to scrutiny. A ProPublica investigation published last month found UnitedHealthcare effectively culled or limited some therapy expenses using an algorithm, jeopardizing mental health coverage for many Americans. California, Massachusetts, and New York deemed the practice illegal. A Senate majority staff report released in October revealed that numerous insurers failed to cover the cost of care for older people who fell or had strokes. UnitedHealthcare in particular denied coverage for post-acute care, or services and support needed after a hospitalization. In 2019, the insurance provider’s initial denial rate for post-acute care prior authorization requests was 8.7%; by 2022, it had increased to 22.7%.

The recent reports add fuel to the fire of UnitedHealth’s reputation for coverage denial, which forces its customers to pay for more of their medical expenses out of pocket. According to personal finance platform ValuePenguin, UnitedHealthcare denies 32% of claims compared to the industry average of 16%.

In May the Hollywood Firefighters’ Pension Fund sued Thompson as well as UnitedHealth Group CEO Andrew Witty and executive chairman Stephen Hemsley, alleging they plotted to inflate the company stock by choosing not to disclose that the Justice Department was investigating the company for antitrust practices. According to the lawsuit, Thompson was allegedly aware of the investigation and sold 31% of his shares 11 days before the Wall Street Journal reported the probe in February, which sunk the company’s stock by 5%. Thompson allegedly netted $15 million from selling stock.

Thompson’s tenure as CEO of the insurer began April 2021 and marked a period of growth for the company. Under his leadership, profits for UnitedHealthcare surged from $12 billion in 2021, to more than $16 million in 2023. Thompson received an annual compensation package in 2023 valued at $10.2 million, ranking him among the highest-paid executives at the health care giant.

Speculation on social media has emerged that the insurer’s policies toward its customers could be a motive in the 50-year-old’s death. Many people aren’t pleased with their insurance. More than half of Americans view their health care coverage as mediocre at best, according to a 2023 Gallup survey, with 36% of respondents rating health insurance services as just fair. Another 32% rated the services as poor.

As more evidence emerges in the investigation into Thompson’s death, it’s could be these sentiments are not just a response to his killing, but possibly the motive behind it.

Past threats

Along with scrutiny toward United Health came personal threats to Thompson, according to Paulette Thompson, Brian Thompson’s wife.

“Yes, there had been some threats,” Thompson told NBC News Wednesday. “Basically, I don’t know, a lack of coverage? I don’t know details. I just know that he said there were some people that had been threatening him.”

Thompson did not have a security detail, reinforcing fears about the safety of executives.

Police investigated a bomb threat targeting Thompson’s home in Maple Grove, Minn., about 12 hours after his death.

An emerging motive

Evidence is mounting that the gunman who fatally shot Thompson may have shared the negative sentiments toward U.S. private insurers.

Police found “deny,” “defend” and “depose,” written on the bullet casings used to kill Thompson, words that make up the “Three D’s,” a phrase used by industry critics to refer to tactics insurers use to get out of paying claims.

Early signs of a targeted attack

Police are zeroing in on the gunman, still at large and last seen in Central Park early Wednesday morning. Police told the New York Times they are pursuing multiple leads and released a photo Thursday morning showing the suspect’s face. The person shown checked out of an Upper West Side hostel the morning of the shooting.

Even early into the investigation, it was clear Thompson’s death was not a random act of violence.

New York police commissioner Jessica Tisch, who was sworn in just 10 days ago, said in a Wednesday morning press conference the shooting was a “brazen targeted attack.”

“I want to be clear at this time,” she said. “Every indication is that this was a premeditated, preplanned, targeted attack.”

According to police reports, the gunman arrived at the New York Hilton Midtown Hotel, the site of the shooting, 10 minutes before Thompson arrived at around 6:45 a.m. The shooter fired multiple rounds at Thompson, hitting him in his back and right calf. Thompson was rushed to Roosevelt Hospital and pronounced dead there shortly after.

As the gunman was shooting, his gun, which appeared to have a silencer, jammed. He was able to quickly fix it and continue shooting, indicating to Joseph Kenny, the New York Police Department’s chief of detectives, he was a proficient shooter.

The gunman’s escape route

Following the attack, the gunman—described by police as a light-skinned man wearing a brown jacket, a black face mask, black-and-white sneakers, and a gray backpack—fled the scene, first walking into an alleyway between 54th and 55th Streets before heading toward Sixth Avenue and getting on what appeared to be an electric bike. He drove on Sixth Avenue toward Central Park.

Police also identified and recovered a cell phone and water bottle at the crime scene.

Photos released by the NYPD last night show the suspect at a nearby Starbucks standing at the coffee shop counter in a black coat and black face mask wearing a gray backpack.