Luigi Mangione, the man accused of killing the CEO of UnitedHealthcare, was charged in New York with murder as an act of terrorism, prosecutors announced Tuesday.

Mangione, 26, is being held without bail in Pennsylvania, where he was arrested at a McDonald's on Dec. 9 after a broad search following the Dec. 4 ambush of Brian Thompson in midtown Manhattan.

As Mangione was led into Pennsylvania court last week to face gun and forgery charges, he struggled with deputies and shouted about an "insult to the intelligence of the American people."

At the time, his lawyer said he would fight extradition to New York. But Manhattan prosecutors said Tuesday there were indications that he may waive his right to an extradition hearing, hastening the transfer process.

Mangione’s New York lawyer, Karen Friedman Agnifilo, declined to comment.

The case has captured the American imagination, setting off a cascade of resentment and online vitriol toward U.S. health insurers while rattling corporate executives concerned about security.

The indictment announced by Manhattan prosecutors Tuesday builds on previous charges against Mangione. He now faces 11 counts, including murder in the second degree as a crime of terrorism.

At a press conference, Manhattan District Attorney Alvin Bragg said the suspect had carried out a “frightening, well-planned, targeted murder.”

“In its most basic terms, this was a killing that was intended to evoke terror,” Bragg said. “And we’ve seen that reaction.”

In the wake of the killing, police officials in New York and elsewhere have described an increase in threats aimed at corporate leaders, including “Wanted” posters in Manhattan that showed the faces of other executives next to a crossed-out photograph of Thompson’s face.

“We don’t celebrate murderers, and we don’t lionize the killing of anyone,” New York Police Commissioner Jessica Tisch said Tuesday. “Any attempt to rationalize this is vile, reckless and offensive to our deeply held principles of justice.”

New York police also confirmed that during the search for the suspect, investigators had spoken to Mangione's mother in San Francisco after receiving a tip from San Francisco police that a surveillance image of the shooter appeared to match a missing person's report filed by his family in November.

Mangione’s mother “didn’t indicate that it was her son in the photograph, but she said it might be something that she could see him doing,” according to NYPD Chief of Detectives Joseph Kenny.

Police have said Mangione was arrested carrying a gun like the one used to kill Thompson and the same fake ID the shooter had used to check into a New York hostel, along with a passport and other fraudulent IDs.

Mangione possessed a handwritten document expressing anger with what it called “parasitic” health insurance companies and expressing disdain for corporate greed and power, according to a law enforcement bulletin obtained by The Associated Press.

The 3D-printed ghost gun found on Mangione matched shell casings at the shooting scene, according to authorities. Two of those casings had the words "DENY" and "DEPOSE" written on them, while a bullet was emblazoned with the word "DELAY," prosecutors said, echoing a phrase commonly used to describe insurer tactics to avoid paying claims.

Mangione’s fingerprints also matched prints on a water bottle and a protein bar wrapper found near the crime scene, police said.

Mangione comes from a prominent Maryland family. He was the valedictorian of his elite Baltimore prep school and earned undergraduate and graduate degrees in computer science in 2020 from the University of Pennsylvania.

From January to June 2022, Mangione lived at Surfbreak, a “co-living” space at the edge of touristy Waikiki in Honolulu. Josiah Ryan, a spokesperson for owner and founder R.J. Martin, said that Martin learned that Mangione had severe back pain from childhood that interfered with many aspects of his life.

Police have suggested the suspect's motive might have been related to an accident that sent Mangione to an emergency room on July 4, 2023.

Mangione repeatedly posted on social media about how spinal surgery last year had eased his chronic back pain, and he encouraged people with similar conditions to speak up for themselves if they were told they just had to live with it.

In a Reddit post in April, he advised someone with a back problem to seek additional opinions from surgeons and, if necessary, say the pain made it impossible to work.

“We live in a capitalist society,” Mangione wrote. “I’ve found that the medical industry responds to these key words far more urgently than you describing unbearable pain and how it’s impacting your quality of life.”

He was never a UnitedHealthcare client, according to the insurer.

Mangione apparently cut himself off from his family and close friends in recent months.

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Associated Press reporters Michael R. Sisak, Jamie Stengle, Lea Skene and Jake Offenhartz contributed to this report.

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