Other malware has hidden itself as init, mysqld, php-fpm, etc. This is really nothing new.
$ perl -e '$0="/usr/sbin/httpd";fork or sleep 1000';ps17630 27 S 0:00.00 /usr/sbin/httpd (perl)
which stands out like a sore thumb, IMHO.
ps, top, and htop all show /usr/sbin/httpd on Ubuntu.
It's not completely reliable but most people wouldn't look that deep anyway.
I think I used lsof back then but it’s been a while.
$ readlink /proc/`pgrep /usr/sbin/httpd`/exe
/usr/bin/perl