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The alleged killer of a US health insurance boss has tussled with police officers as they were escorting him to court.

Luigi Mangione, in handcuffs, shouted to reporters outside the Pennsylvania courthouse: “It’s completely out of touch and an insult to the intelligence of the American people and their lived experience.”

He has been charged with the murder of UnitedHealthcare chief executive Brian Thompson, who was shot dead in Manhattan last week.

Dressed in an orange prison uniform, Mangione was seen struggling with officers, who pushed him against a wall.

During an appearance at Blair County Courthouse, he decided to challenge his extradition to New York, triggering a legal process which could last weeks. He has also been denied bail.

Mangione mostly stared straight ahead at the hearing, although his attorney Thomas Dickey told him at one point to be quiet. He later said his client will be pleading not guilty to “every charge”.

“Listen, I haven’t seen any evidence that says he’s the shooter,” he told reporters, adding: “I haven’t seen anything. I have not seen one scintilla, one speck, one drop of any evidence yet.”

Commenting on Mangione’s outburst before he entered court, Mr Dickey said “hopefully there won’t be any more of that”.

Mangione was arrested on Monday after a McDonald’s worker in Pennsylvania alerted authorities to a customer, who was found with a gun, mask and writings, which police say links him to the ambush.

Sky News’ partner network NBC News has spoken to a customer who spotted Mangione in the restaurant in Altoona, around 230 miles (370km) west of New York.

The man, who only gave his name as Larry, said his friend told him “that looks like the shooter from New York”, adding that a backpack looked similar to one the suspect was carrying.

Larry added: “I thought it was one of the employees, because they go back here on break, and they put their hoods up, and he was in the corner with his hood up.”

Mangione had been charged earlier in Altoona with weapons, forgery and other offences.

During that court appearance, legal documents revealed Mangione began shaking when police challenged him at the McDonald’s about whether he had been in New York recently.

Pennsylvania prosecutor Peter Weeks said Mangione, who gave officers a fake ID, was found with a passport and $10,000 (£7,840) in cash – $2,000 of it in foreign currency.

He was also carrying a gun, similar to the one used to kill Mr Thompson, 50, last Wednesday as he walked alone to a hotel for an annual investor conference.

Investigators are still trying to establish whether he made the firearm himself or whether he received it from someone, according to NBC News.

It is reporting that two senior law enforcement officials have confirmed the gun and suppressor were both handmade.

Mangione had three pages of writings on him at the time he was taken into custody, officials also told NBC News.

Those writings say, in part, “frankly these parasites had it coming” and “I wasn’t working with anyone” during broader criticism of the US healthcare industry and large corporations, including UnitedHealthcare.

The Hawaii Department of Land and Natural Resources released a photo of Mangione receiving a penalty notice in November 2023 for a minor traffic offence in Honolulu – his last known address.

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