And, when these costs are high, that leaves less money to cover overhead expenses and less to pass into retained earnings for the company, Bierman noted.

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For example, in the most recent quarter, overhead expenses amounted to less than 11% of sales, down from roughly 14% in the year-earlier period.

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By eliminating insurance middlemen and reducing other administrative overhead, Dr. Forrest charges patients less than their out-of-pocket Medicare expenses.

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