Start by bringing a large pot of salted water to a boil. Add the ziti noodles and cook until al dente (about 7 minutes). Drain the pasta and set aside.

Preheat your oven to 425°F (220°C) and adjust the oven rack to the middle position.

In a large sauté pan, heat the skillet over medium-high heat. Crumble the sausage into the pan and cook until lightly browned (5-6 minutes). Transfer to a plate and drain excess fat.

Add minced garlic to the pan, cook until soft (about 1 minute). Pour in crushed tomatoes, then add salt, sugar, and red pepper flakes. Simmer uncovered for 10 minutes.

In the sauce, add heavy cream, 1/3 cup of pecorino Romano, cooked sausage, and fresh basil. Stir to combine.

Carefully pour the sauce mixture into the pot with the ziti pasta. Gently stir to combine.

Spoon half of the pasta mixture into a baking dish. Add half of the shredded mozzarella and half of the remaining pecorino Romano. Layer the rest of the pasta mixture and top with remaining mozzarella and pecorino Romano.

Bake uncovered until cheese is melted and bubbly (about 15-20 minutes). Sprinkle with additional basil before serving.