Begin by bringing a large pot of salted water to a rolling boil. Add the ziti pasta and cook for 7-8 minutes until very al dente. Drain and transfer back to the pot.

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

In a large skillet over medium-high heat, add crumbled ground Italian sausage. Sauté for 5-6 minutes until browned and cooked through. Transfer to a plate, leaving the drippings.

Lower the heat and add minced garlic to the remaining fat in the skillet. Sauté for about 1 minute until fragrant. Stir in crushed tomatoes, salt, sugar, and red pepper flakes. Simmer uncovered for 10 minutes.

Reduce heat, mix in heavy cream and one-third cup of Pecorino Romano cheese. Add the cooked sausage and fresh basil, stirring until well combined. Fold this mixture into the cooked ziti.

Spread half of the pasta mixture in a large baking dish. Sprinkle half of the mozzarella and Pecorino Romano cheese on top. Repeat with remaining pasta, mozzarella, and cheese.

Bake uncovered for 15-20 minutes until cheese is melted and golden brown. Let sit for 5 minutes before serving.