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Cook pasta in a large pot of salted, boiling water until al dente. Reserve 1 cup of pasta water. Drain pasta.
Heat oil in a large pan over medium-high heat. Add the chopped onion and sauté for 5 minutes until it starts to soften. Add garlic and sausage. Cook for another 6-8 minutes until the sausage is browned, breaking up the sausage into crumbles while it cooks.
Add crushed tomatoes, basil, oregano, red pepper flakes, salt, and pepper. Bring to a boil then reduce heat to medium-low and simmer for 10-20 minutes to reduce and thicken the sauce.
Stir in heavy cream and 1 cup of the cheese. Simmer until heated through and the cheese has melted.
Add cooked pasta to the sauce and stir to combine. Add as much of the reserved pasta water as you like to get a nice glossy texture. I typically use about ½ cup.
Serve with remaining Parmesan cheese and fresh basil sprinkled on top.