Direct-to-consumer telemedicine, including telemedicine performed asynchronously, is a growing field demanded by patients and consumers. When done right, this modality of care can transform the health care system for the better - allowing patients to get the care they need when and where they need it. However, unscrupulous actors, such as call centers or those attempting to defraud public programs like Medicare and Medicaid, tend to claim they are practicing 'telemedicine'. How are the good actors following the law and transforming the system? How can they be distinguished from the bad actors? At the end of the day, consumer demand is going to drive expansion of more convenient and accessible care, so we need to pave the way for its success.