Alfredo Hawit, 64, who has been suspended by Fifa from all football activities, is a former president of the Confederation of North, Central
American and Caribbean Association Football (Concacaf).
He is one of 39 officials and marketing executives accused of soliciting and receiving tens of millions of dollars in bribes and kickbacks in a case that has sparked unprecedented crisis at Fifa.
Hawit entered a plea of not guilty through his lawyer.
He faces 12 counts of racketeering conspiracy, wire fraud, money laundering and conspiracy to obstruct justice and tamper with witnesses.
The defendant, wearing a suit, looked pale and ill, and stood slightly stooped before Magistrate Judge Robert Levy in the federal court in Brooklyn, following the proceedings through a court-appointed interpreter.
His lawyer Justin Weddle told the court that he suffers from pancreatitis and had spent time in intensive care following a severe bout.
He is also diabetic, Weddle said.
Hawit has “serious digestive problems” and requires a no-fat diet, which was not provided in his Swiss prison, where he subsisted on cornflakes and honey bought from the jail commissariat, the lawyer said.
Prosecutors described Hawit as a significant flight risk and demanded that bail be posted at $4 million — guaranteed by either $500,000 in cash or US property.
Weddle asked that Hawit be released to home detention with electronic monitoring at his daughter's house in Miami, Florida, without financial guarantee.
The Hawits, he argued, were of limited means.
Hawit's wife and three sons live in Honduras, where the marital home is in his wife's name.
If released, Hawit would have to surrender his passport and agree not to communicate with any co-defendants or any of the entities mentioned in the indictment.
The Honduran will next appear before Levy on Thursday at 4:30 pm local time, when conditions for bail will be discussed further.