Interesting topic. I've been watching some videos where the guy claims to use both stocks and options orderflow. So in one video he was asked the same question - how do you know it's not hedging/legging?
While he did not explain the algo they use(it generates alerts), he said that they can usually tell the difference. My understanding is that they look at aggressiveness of the orders such as orders sweeping multiple exchanges. I believe he mostly trades weeklies, so we are talking short term moves. Also, options on stocks which are liquid, but not to the point where there's so much activity that it's very hard to read orderflow.
Conceptually, I can see how "informed" people can easily front run equity moves with options and it is more difficult to hide options activity than stocks'. So, to me, it sounds like a valid concept, although I haven't tried it yet.